Trimipramine Neuroleptic malignant syndrome: 00 case report

A 47-year-old woman with a 7 -year history of obsessive compulsive disorders and major depression had been previously treated with amitriptyline, thiothixene, haloperidol , amoxapine and clomipramine wi thout success. Concurren t medications were warfar in , for mitral valve replacement surgery 4 years previously, estrogen/ progesterone combination since a hysterectomy 9 years previously, and alprazolam 3 mg/day for anxiety . Following ECT therapy for a psychotic depressive episode whilst on clomipramine, treatment with trimipramine was initiated and within 2 weeks a dose of 250 mg/ day had been reached .

After 1 month of treatment it was noted that the patient had increased her fluid intake and was urinating more frequently . Muscular hypertonicity, polyu ria and diarrhoea had developed a day after the last dose increase . She was admitted with extreme lead-pipe rigidity without cog -wheeling and was mute and unresponsive but awake with open eyes. She had grossly elevated levels of creatinine phosphokinase and white blood cells and a low sodium level. IV fluids were administered to compensate for the high urine output , and over 3 days electrolyte and renal function values normalised . About 24 hours after admission she developed bilateral aspiration pneumonia which was treated with IV antibacterials. Urine sample analysis showed only tricyclic metabolites and no neuroleptics. IV dantrolene 50 mg/6 hours and oral bromocriptine 2.5 mg/6 hours were administered for 3 days over a general improvement in muscular rig idity, alertness and fever seen within the following 2 weeks. Clomipramine and lithium treatment were initiated after recovery from pneumonia and substantial improvement was seen over the next 4 months.

Langlow JR. Alarcon RD T"mlpramlne-Induced neuroleptic malignant syndrome after transient psychogenic polydipsia In one patient Journal of Clinical Psychiatry 50 144·145, Apr 1989 ....