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Neuroleptic Poisoning

Neuroleptic Poisoning is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Neuroleptics (antipsychotics) used for management of:
    • Psychotic disorders
    • Agitation
    • Dementia in the elderly
    • Autism and behavioral problems in children
    • Eating disorders
    • Antiemetic
    • Migraine headaches
  • Acute overdose:
    • Symptoms usually mild to moderate
    • CNS and cardiovascular symptoms predominate
    • CNS depression, seizure, and coma possible
  • Dystonic reactions (dystonia):
    • Most common adverse effect
    • Can occur at any time, often within 48 hr of starting medication
  • Akathisia:
    • Patient has motor restlessness and feels a need to pace or move constantly
    • Occurs within hours to weeks of starting medication
  • Neuroleptic malignant syndrome (NMS):
    • Idiosyncratic, life-threatening event
    • Can occur at any time but most commonly in overdose, dose increase, and during the 1st wk of usage
  • Tardive dyskinesia:
    • Movement disorder usually affecting patients after years of taking neuroleptics
    • Treated by decreasing, discontinuing, or changing the drug

Etiology

  • Typical neuroleptics (phenothiazines, butyrophenones) strongly antagonize dopaminergic receptors, these include:
    • Haloperidol (Haldol)
    • Chlorpromazine (Thorazine)
    • Prochlorperazine (Compazine)
    • Thioridazine (Mellaril)
    • Fluphenazine (Prolixin)
    • Promethazine (Phenergan)
    • Droperidol (Inapsine)
    • Hydroxyzine (Atarax)
  • Typical neuroleptics also have varying degrees of antagonism for histamine, muscarinic, and α-adrenergic receptors.
  • Atypical neuroleptics have weaker dopaminergic antagonism and moderate serotonergic antagonism, these include:
    • Asenapine (Saphris)
    • Aripiprazole (Abilify)
    • Clozapine (Clozaril)
    • Paliperidone (Invega)
    • Risperidone (Risperdal)
    • Olanzapine (Zyprexa)
    • Quetiapine (Seroquel)
    • Ziprasidone (Geodon)

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Citation

Rosen, Peter, et al., editors. "Neuroleptic Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307516/all/Neuroleptic_Poisoning.
Neuroleptic Poisoning. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307516/all/Neuroleptic_Poisoning. Accessed April 23, 2019.
Neuroleptic Poisoning. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307516/all/Neuroleptic_Poisoning
Neuroleptic Poisoning [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307516/all/Neuroleptic_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Neuroleptic Poisoning ID - 307516 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307516/all/Neuroleptic_Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -