Reactions 549 - 6 May 1995

SCisapride/metoclopramide

Neuroleptic malignant syndrome: case reportA 77-year-old man developed neuroleptic malignant

syndrome following treatment with cisapride 7.5mg daily andmetoclopramide 30mg daily for gastroparesis, nausea andpoor appetite.

One week after the start of treatment he experiencedstiffness in his legs. Over the next week he becameincreasingly tremulous and immobile, and experienceddifficulty swallowing and speaking. He also became depressedand developed hypersalivation.

About 1 month after the start of therapy, he was admittedwith fever, leukocytosis, lethargy, muscle rigidity, tachycardiaand alternate hyperventilation and apnoea; intubation wasnecessary.

Neuroleptic malignant syndrome was diagnosed, andcisapride and metoclopramide were stopped. The patienttreated with carbidopa/levodopa, amantadine andbromocriptine. After 8 days he became afebrile, his musclerigidity gradually resolved and his level of consciousnessimproved. The abnormal rhythm of his respirationdisappeared, and he could speak the occasional word afterremoval of the endotracheal tube.

The man died on day 45 of hospitalisation, due tosuffocation after vomiting.

Author comment: In this case cisapride may have enhancedthe symptoms of metoclopramide-induced neurolepticmalignant syndrome. Abnormal respiratory rhythmicity hasbeen reported only rarely with neuroleptic malignantsyndrome.Shintani S, et al. Hyperventilation alternating with apnea in neuroleptic malignantsyndrome associated with metoclopramide and cisapride. Journal of theNeurological Sciences 128: 232-233, Feb 1995 - Japan 807069699

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Reactions 6 May 1995 No. 5490114-9954/10/0549-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved