Fatal neuroleptic malignant syndrome in a previously long-term user of clozapine following its reintroduction in combination with paroxetine.
A 77-year-old patient with initial behavioral and psychological symptoms of dementia was treated with clozapine (50 mg/daily). Since no clinical benefit was apparent, clozapine was discontinued after six weeks and the patient started on paroxetine (20 mg/daily). After three weeks on paroxetine, he was given another trial of clozapine at a starting dosage of 25 mg/daily. While clozapine had previously been well tolerated, this time he rapidly developed fever, mental confusion, lethargy, muscle spasms and rigidity. The diagnosis of neuroleptic malignant syndrome was delayed, because there was no leukocytosis and serum creatine phosphokinase was initially not elevated. Subcutaneous apomorphine was then given but, after an initial improvement, the patient developed a multiple organ failure syndrome and died.
Gambassi
Giovanni
G
Dipartimento di Scienze Gerontologiche, Centro di Medicina dell'Invecchiamento, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy. giovanni_gambassi@rm.unicatt.it
Capurso
Sabrina
S
Tarsitani
Patrizia
P
Liperoti
Rosa
R
Bernabei
Roberto
R
D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003024:Clozapine / Q000008:administration & dosage / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009459:Neuroleptic Malignant Syndrome / Q000209:etiology*; D017374:Paroxetine / Q000009:adverse effects*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
D014150:Antipsychotic Agents; D003024:Clozapine; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors