title: Neuroleptic malignant syndrome associated with olanzapine therapy: a case report.
abstract: We present the case of a 42-year-old male with a history of schizophrenia who developed signs and symptoms consistent with Neuroleptic Malignant Syndrome (NMS) after 3 weeks of treatment with Olanzapine. The patient presented with hyperpyrexia, tremors, labile blood pressure, and mental status changes that had progressed over the preceding 24 h. Laboratory data revealed a metabolic acidosis and an escalating creatinine phosphokinase. Olanzapine is a relatively new atypical anti-psychotic agent first introduced in November of 1996 under the trade name of zyprexa. Olanzapine differs from typical anti-psychotic agents in that it has a lower affinity for dopaminergic receptors and binds antagonistically to serotonin receptors in the nigrostriatal pathway. These unique properties result in relatively fewer extra-pyramidal symptoms when compared to traditional anti-psychotics. Because of olanzapine's favorable side-effect profile, it has quickly gained popularity in the psychiatric community. Although NMS is a recognized complication of anti-psychotic use, there has been only one case of olanzapine induced NMS reported in the literature. The POISON-INDEX system, used by toxicologists throughout the United States, does not list NMS as a potential reaction to olanzapine. The pharmacists at our institution were also unaware that NMS was a possible complication of olanzapine. We present this case to make clinicians aware of the potential for Olanzapine induced NMS.
authors.affiliation: Department of Emergency Medicine, Lexington Medical Center, Lexington, South Carolina, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Stanfield
authors.forename: T
authors.initials: T
authors.lastname: Privette
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001569:Benzodiazepines; D001971:Bromocriptine / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017679:Cryotherapy; D003620:Dantrolene / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000627:therapeutic use; D004638:Emergency Treatment / Q000379:methods; D006429:Hemiplegia / Q000139:chemically induced; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009459:Neuroleptic Malignant Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000077152:Olanzapine; D010890:Pirenzepine / Q000009:adverse effects* / Q000031:analogs & derivatives*; D012559:Schizophrenia / Q000188:drug therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D001971:Bromocriptine; D003620:Dantrolene; D018491:Dopamine Agonists; D009125:Muscle Relaxants, Central; D000077152:Olanzapine; D010890:Pirenzepine; D017367:Selective Serotonin Reuptake Inhibitors