14th February 2025

Management of NMS

The most important step is to stop the psychotropic drug trigger or, in cases triggered by cessation of dopamine agonists, to restart the dopamine agonist.

Supportive care includes IV or oral rehydration, NGT insertion if dysphagia is limiting food, fluid and medication intake, and cooling. Physical cooling measures must be used as antipyretics are ineffective. Invasive measures might be required in severe hyperthermia, such as cold fluid gastric lavage or intravascular cooling.

Rhabdomyolysis should be treated if present.

Pharmacological treatment may include:

• Sedation: with agitation, severe hyperthermia or poor toleration of therapy consider a benzodiazepine
• Dopamine agonist (bromocriptine or amantadine) or dantrolene (postsynaptic muscle relaxant)

Escalation to ICU (intensive care unit) is required with severe hyperthermia >38.5℃, ineffective ventilation due to muscle rigidity, AKI or coma.

After recovery from the acute illness psychotropic drugs should not be started for 2 weeks, and the causative agent should be avoided.