Neuroleptic malignant syndrome #
Hyperthermia, rigidity, altered mental status and autonomic instability after dopamine-blocking treatment warrant urgent assessment. Evaluate mimics and complications, including renal injury.
Suspected NMS requires stopping implicated antipsychotic treatment and urgent supportive medical management under the treating team; subsequent rechallenge is a specialist decision.
Serotonin toxicity #
Agitation or confusion with autonomic changes and neuromuscular findings such as hyperreflexia, clonus or tremor can follow serotonergic exposure, especially combinations.
Suspected toxicity requires withdrawal of implicated serotonergic agents and urgent supportive management. Do not delay assessment while waiting for a complete classic presentation.
Lithium toxicity #
New coarse tremor, ataxia, vomiting, confusion or worsening neurological signs need prompt assessment, especially with dehydration, renal change or interacting medicines.
Withhold further lithium when toxicity is suspected and obtain urgent clinical advice, renal/electrolyte assessment and appropriately timed levels. Serum concentration alone does not determine severity.
Clozapine complications #
Chest pain, breathlessness, persistent tachycardia or flu-like illness can signal myocarditis. Fever/infection requires prompt blood-count assessment. Severe constipation, abdominal pain, distension or vomiting may indicate dangerous gastrointestinal hypomotility.
These presentations need urgent assessment; interruption and restarting decisions must follow the applicable clozapine protocol. Do not restart a previous full dose automatically.
Serious drug rash #
Lamotrigine-associated rash, particularly with mucosal lesions, fever, facial swelling or systemic illness, needs prompt medical assessment. The label advises discontinuation at the first rash unless clearly unrelated to the drug.
Review recent initiation, dose escalation and valproate exposure. Restarting after a suspected serious reaction requires specialist evaluation.
References · 5
- Haloperidol oral product information · United States · Supports: Clinical essentials, Neuroleptic malignant syndrome
- Sertraline product information · United States · Supports: Clinical essentials, Serotonin toxicity
- Lithium carbonate capsule product information · United States · Supports: Clinical essentials, Lithium toxicity
- VERSACLOZ product information · United States · Supports: Clozapine complications
- Lamotrigine product information · United States · Supports: Serious drug rash