Clozapine Rechallenge Following Neuroleptic Malignant Syndrome: A Systematic Review.

  title={Clozapine Rechallenge Following Neuroleptic Malignant Syndrome: A Systematic Review.},
  author={John Lally and Cathal McCaffrey and Conall OʼMurchu and Amir Krivoy and Allys Guerandel and James Hunter MacCabe and Fiona Gaughran},
  journal={Journal of Clinical Psychopharmacology},
PURPOSE/BACKGROUND Neuroleptic malignant syndrome (NMS) has been described with most antipsychotics, most commonly first generation. Clozapine has also been associated with NMS. METHODS/PROCEDURES We conducted a systematic review to identify all studies investigating or describing (a) clozapine rechallenge following suspected NMS associated with clozapine, (b) clozapine use after suspected NMS associated with another antipsychotic, and (c) rechallenge with nonclozapine antipsychotics after… 
Clozapine in the treatment of refractory schizophrenia: a practical guide for healthcare professionals
There is a need for better management of serious clozapine-related adverse events in addition to agranulocytosis, and better education of patients and carers, general practitioners, A&E and ITU staff and others of the problems posed in using clozAPine safely.
Neuroleptic malignant syndrome: a guide for psychiatrists
The clinical presentation of the syndrome, its differential diagnosis and use of supportive care, medication and electroconvulsive therapy in its treatment are discussed, and prevention of NMS and reinstatement of treatment after an episode are explored.
Risk Factors, Incidence, and Outcomes of Neuroleptic Malignant Syndrome on Long-Acting Injectable vs Oral Antipsychotics in a Nationwide Schizophrenia Cohort.
NMS remains a potentially life-threatening risk, yet these results should further contribute to mitigate concerns about LAI safety regarding NMS onset or outcomes, including mortality.
Clozapine Combination and Augmentation Strategies in Patients With Schizophrenia -Recommendations From an International Expert Survey Among the Treatment Response and Resistance in Psychosis (TRRIP) Working Group.
Given the limited evidence from randomized trials of treatment strategies for clozapine-resistant schizophrenia (CRS), this consensus-based series of recommendations provides a framework for decision making to manage this challenging clinical situation.


Neuroleptic Rechallenge after Neuroleptic Malignant Syndrome: Case Report and Literature Review
The results of the review suggest that neuroleptic rechallenge following NMS is associated with an acceptable risk of recurrence in most patients, however, close monitoring for NMS and careful selection of patients for antipsychotic rechallenges is mandatory.
Neuroleptic malignant syndrome and atypical antipsychotic drugs.
The fact that 21 cases of NMS with clozapine were found indicates that low occurrence of extrapyramidal symptoms (EPS) and low EPS-inducing potential do not prevent the occurrence of neuroleptic malignant syndrome and D(2) dopamine receptor blocking potential does not have direct correlation with the occurrenceof NMS.
Neuroleptic Malignant Syndrome Associated with Atypical Antipsychotic Drugs
It is suggested that, in general, NMS associated with atypical antipsychotic drugs manifests in a typical manner, and one notable exception is clozapine-induced NMS, which appears less likely to manifest with extra-pyramidal features, including rigidity and tremor.
Neuroleptic Malignant Syndrome
NMS is a rare adverse drug reaction, with a complex pathophysiology and presentation, and timely diagnosis and discontinuation of antipsychotic therapy is the first-line treatment, followed by supportive care and pharmacotherapy.
Neuroleptic malignant syndrome and clozapine.
  • S. Reddig, A. Minnema, R. Tandon
  • Psychology, Medicine
    Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists
  • 1993
NMS should be included in the differential diagnosis of a febrile patient with a history of any neuroleptic treatment, including clozapine, as a single agent that developed in a patient with no prior history of NMS.
Clozapine-induced neuroleptic malignant syndrome: review and report of new cases.
It is suggested that typical NMS does occur with clozapine and that its incidence may be as common as with the classic neuroleptics and with fewer extrapyramidal side effects and a lower rise in creatine kinase levels.
Neuroleptic malignant syndrome induced by atypical antipsychotics
  • D. Farver
  • Psychology, Medicine
    Expert opinion on drug safety
  • 2003
By evaluating the case reports of atypical antipsychotic-induced NMS, valuable information may be obtained concerning similarities or differences from that induced by the traditional antipsychotics.
Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis
Systematic analysis of case reports suggests that even the most recently marketed antipsychotics are not free from the risk of inducing NMS, and primary studies suggest that SGA-NMS is characterized by lower incidence, lower clinical severity, and less frequent lethal outcome.
[Neuroleptic malignant syndrome after 30 years treatment with clozapine: a rarely seen differential diagnosis on intensive care units].
The differential diagnosis of NMS is not always trivial and is therefore discussed and the therapy with clozapine was stopped definitively and benzodiazepines were administered assuming a relapse of an alleviated, probably reconvening NMS.
Apparent neuroleptic malignant syndrome with clozapine and lithium.
When clozapine was administered (in conjunction with lithium) to a patient with a past history of NMS with fluphenazine, the syndrome reappeared after about 3 weeks of treatment, the first report of apparent neuroleptic malignant syndrome with clozAPine.