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Neuroleptic malignant syndrome variant in a patient receiving donepezil and olanzapine

Nature Clinical Practice Neurology volume 4, pages 170–174 (2008)Cite this article

Abstract

Background A 78-year-old man with a 22-year history of schizoaffective disorder and a 5-year history of dementia presented to the emergency department with a 5-day history of fatigue, progressive weakness, confusion and lethargy, and a 1-day history of severe muscle stiffness. For the past 10 years the patient had been treated with olanzapine for an unspecified psychiatric illness, without adverse effects. One week before presentation the patient was started on donepezil to treat mild dementia.

Investigations Physical examination, serum and urine laboratory evaluation, lumbar puncture, brain CT scan, brain MRI, electroencephalogram, chest X-ray, and electrocardiogram.

Diagnosis A variant of neuroleptic malignant syndrome secondary to drug interaction.

Management Discontinuation of donepezil and olanzapine, aggressive intravenous hydration, intravenous dantrolene, and bromocriptine via a nasogastric tube. The patient was also administered intravenous antibiotics for aspiration pneumonia, and carbidopa–levodopa for residual parkinsonian features.

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Author information

Authors and Affiliations

  1. TC Warwick is Assistant Clinical Professor of Neurology at the University of California San Francisco, Fresno, CA,

    Tanya C Warwick

  2. V Moningi is Clinical Assistant Professor of Medicine, K Lucas is Associate Professor of Pharmacy and Internal Medicine, and S Moningi is an undergraduate student and Research Assistant at West Virginia University, Charleston, WV,,

    Venkata Moningi, Kristy Lucas & Shalini Moningi

  3. P Jami is an Endocrinology Fellow at the University of Louisville, KY,

    Prasuna Jami

  4. O Molokwu is Assistant Clinical Professor at the School of Pharmacy, University of California San Francisco, CA, USA.,

    Ogochukwu Molokwu

Authors
  1. Tanya C Warwick
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  2. Venkata Moningi
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  3. Prasuna Jami
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  4. Kristy Lucas
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  5. Ogochukwu Molokwu
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  6. Shalini Moningi
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Corresponding author

Correspondence to Tanya C Warwick.

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The authors declare no competing financial interests.

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Warwick, T., Moningi, V., Jami, P. et al. Neuroleptic malignant syndrome variant in a patient receiving donepezil and olanzapine. Nat Rev Neurol 4, 170–174 (2008). https://doi.org/10.1038/ncpneuro0728

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