Pediatric Neuroleptic Malignant Syndrome Medication

  • Author: Mary C Mancini, MD, PhD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Nov 21, 2011
 

Skeletal muscle relaxants, nonparalytic

Class Summary

This agent is a direct muscle relaxant to control rigidity.

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Dantrolene sodium (Dantrium)

 

Interferes with release of calcium from sarcoplasmic reticulum, thus directly inhibiting muscle contraction. Also prevents or reduces increase in myoplasmic calcium ion concentration that activates acute catabolic process associated with malignant hyperthermia. Available as sodium salt in 25-mg, 50-mg, and 100-mg caps and in 20-mg vial for IV administration.

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Dopamine agonists

Class Summary

For a dopamine agonist to offer clinical benefit, it must stimulate D2 receptors. D2 receptor blockade might cause neuromalignant malignant syndrome by removing tonic inhibition from the sympathetic nervous system or more directly by neuroleptic agents (eg, phenothiazines).

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Bromocriptine (Parlodel)

 

Is an ergot alkaloid with dopamine receptor agonist action.

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Amantadine (Symmetrel)

 

Has been tried in NMS because it increases synaptic dopamine activity. As an antiviral, actions include inhibition of influenza A virus uncoating, prevention of virus penetration into host, and inhibition of M2 protein in the assembly of progeny virions. Exhibits antiparkinsonian activity by blocking reuptake of dopamine into presynaptic neurons and by causing direct stimulation of postsynaptic receptors.

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Levodopa and carbidopa (Sinemet)

 

Levodopa is a metabolic precursor of dopamine. Few reports of its use in combination with carbidopa (vide infra) in NMS exist because of its dopaminergic action. Crosses the blood-brain barrier and is converted to dopamine by enzyme action, thus restoring dopamine levels in the extrapyramidal centers such as substantia nigra.

Carbidopa, a dopamine decarboxylase inhibitor, does not cross the blood-brain barrier. Diminishes the metabolism of levodopa in the GI tract and peripheral tissues, thus increasing levodopa's availability in the CNS and enhancing its effectiveness.

A variety of dosage ratios are available (ie, 1:10 carbidopa to levodopa, 1:4 carbidopa to levodopa). Also available as IR and SR dosage forms.

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Contributor Information and Disclosures
Author

Mary C Mancini, MD, PhD  Professor and Chief of Cardiothoracic Surgery, Department of Surgery, Louisiana State University School of Medicine in Shreveport

Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Girish G Deshpande, MD, MBBS, FAAP  Associate Professor of Pediatrics, Interim Director and Division Chief of Critical Care Medicine, Department of Pediatrics, University of Illinois College of Medicine at Peoria; Consulting Staff, Division of Critical Care Medicine, Children's Hospital of Illinois at OSF St Francis Medical Center

Girish G Deshpande, MD, MBBS, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

G Patricia Cantwell, MD  FCCM, Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami, Leonard M Miller School of Medicine; Medical Director, Palliative Care Team, Director, Pediatric Critical Care Transport, Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Manager, FEMA, Urban Search and Rescue, South Florida, Task Force 2; Pediatric Medical Director, Tilli Kids – Pediatric Initiative, Division of Hospice Care Southeast Florida, Inc

G Patricia Cantwell, MD is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Barry J Evans, MD  Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

References

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