![]() ![]() Once symptoms develop, they last on average 7-10 days after discontinuation of oral triggering drugs, with peak intensity within the first 72 hours. Other signs may include profuse diaphoresis, tachycardia, tachypnea, labile blood pressure, acidosis, incontinence, and elevated serum creatine kinase (CK) and transaminases from rhabdomyolysis with risk of subsequent renal failure. Manifestations include hyperthermia, muscular rigidity and tremor, mental status alteration and autonomic dysfunction. In about 16% of patients, the syndrome occurs within 24 hours after the initiation of the antipsychotic treatment, 66% within the first week, and less commonly within or after 30 days on stable medication regimens. The incidence may be lower with newer less potent antipsychotics and with reduced severity of symptoms, particularly for clozapine. Neuroleptic malignant syndrome (NMS) occurs in 1/5,000 to 10,000 patients treated with antipsychotics or other central dopamine (D2) receptor antagonists (all age groups male:female ratio 2:1 in some studies higher incidence rates have been reported in the past).
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