Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Neuroleptic malignant syndrome variant in a patient receiving donepezil and olanzapine


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.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout


  1. Pelonero A et al. (1998) Neuroleptic malignant syndrome: a review. Psychiatr Serv 49: 1163–1172

    Article  CAS  Google Scholar 

  2. Bottoni TN (2002) Neuroleptic malignant syndrome: a brief review. Hosp Physician 38: 58–63

    Google Scholar 

  3. Rozzini L et al. (2004) Severe worsening of parkinsonism in Lewy body dementia due to donepezil. Neurology 63: 1543–1544

    Article  Google Scholar 

  4. Bourke D and Druckenbrod RW (1998) Possible association between donepezil and worsening Parkinson's disease. Ann Pharmacother 32: 610–611

    Article  CAS  Google Scholar 

  5. Morita S et al. (2004) A patient with probable dementia with Lewy bodies, who showed catatonia induced by donepezil: a case report [Japanese]. No To Shinkei 56: 881–884

    PubMed  Google Scholar 

  6. Lee JW (2007) Catatonic variants, hyperthermic extrapyramidal reactions, and subtypes of neuroleptic malignant syndrome. Ann Clin Psychiatry 19: 9–16

    Article  Google Scholar 

  7. Hu S and Frucht S (2007) Emergency treatment of movement disorders. Curr Treat Options Neurol 9: 103–114

    Article  Google Scholar 

  8. Trollor JN and Sachdev PS (1999) Electroconvulsive treatment of neuroleptic malignant syndrome: a review and report of cases. Aust N Z J Psychiatry 33: 650–659

    Article  CAS  Google Scholar 

  9. Sato Y et al. (2004) Efficacy of methylprednisolone pulse therapy on neuroleptic malignant syndrome in Parkinson's disease. J Neurol Neurosurg Psychiatry 75: 510–515

    PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Tanya C Warwick.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing