Clozapine/haloperidol

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Neuroleptic malignant syndrome: case report A 57-year-old woman developed neuroleptic malignant syndrome following treatment with clozapine for schizoaffective disorder bipolar type and haloperidol for agitation. The woman, who had history of schizoaffective disorder bipolar type and unspecified anxiety disorder, presented with poverty of thought content, cognitive blunting, inability to respond to questions meaningfully and looseness of associations. Additionally, she also had medical symptoms including acute rhabdomyolysis with creatinine kinase of 36 600, rigidity and elevated liver function tests. She was admitted for treatment. After review of her history, it was found that she had prior episodes of atypical neuroleptic malignant syndrome with trials of multiple antipsychotics at therapeutic doses and with appropriate titration schedules. The trials included clozapine. She was stabilised during the admission. However, she deteriorated, required additional admission in the following months. Following review of her medications, it was presumed that her neuroleptic malignant syndrome symptoms were due to IM haloperidol [dose not stated], which was administered for her agitation. However, it was found that she had neuroleptic malignant syndrome symptoms even without the addition of haloperidol. After ruling out other causes, her symptoms were suspected to be due to clozapine. At that time, clozapine was started at a dose within starting range and titrated up at an appropriate clinical rate. During the admission, the woman restarted clozapine at very low dose of 12.5 mg/day and with a slower titration rate of 4.7 mg/day over a 14 day trial. Consequently, her psychotic symptoms were improved and she did not have any further episodes of neuroleptic malignant syndrome on the steady dose. It was reported that she developed neuroleptic malignant syndrome with a smaller clozapine dose of 50mg, and titration rate of 25 mg/day. It was concluded that haloperidol had also attributed for the neuroleptic malignant syndrome. Nahmias R, et al. Slow your role: How slowing clozapine titration can prevent recurrent NMS. Schizophrenia Research 218: 332-333, Apr 2020. Available from: URL: http:// 803499948 doi.org/10.1016/j.schres.2019.11.028

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Reactions 5 Sep 2020 No. 1820

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