Amisulpride and Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome (NMS) is a rare but lethal complication of neuroleptics. Its incidence ranges between 0.02% and 3%. Amisulpride, a second generation neuroleptic, was associated with rhabdomyolysis in one report and NMS in 2 reports. Althoughthe precise pathogenesis is still unclear, dopamine receptor blockade is theorized to play acentral role. Conventional presentations include hyperthermia, muscle rigidity, and elevatedcreatine kinase concentrations. However, similar to other second generation neuroleptics,amisulpride induces an atypical form of NMS, which presents with lower degrees of hyperthermia and elevation of creatine kinase than the typical form. This phenomenon makes itdifficult to identify early signs of NMS. This study describes the first case of amisulprideinduced NMS in Taiwan, together with a review of the current knowledge on NMS. In thiscase, the correlation between NMS and amisulpride was categorized as “probable” on theNaranjo adverse drug reaction probability scale