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Olanzapine Long-Acting Injections After Neuroleptic Malignant Syndrome : Two Case Reports

Neuroleptic malignant syndrome (NMS) is a rare, unpredictable, but potentially life-threatening condition associated with antipsychotic use. It is characterized by rigidity, tremor, fever, alterations of mental status, leukocytosis, and creatine kinase (CK) elevation.1 Although more than half of all reported NMS cases are associated with haloperidol, it is associated with virtually all antipsychotics.2 Patients with schizophrenia need to be treated after recovery from NMS, but they are at an elevated risk of developing NMS after future exposure to antipsychotics. The data regarding antipsychotic treatment after NMS are sparse. Low-potency antipsychotics are recommended, including clozapine 3 and quetiapine.1, 3 Both drugs are available only in oral formulations. Long-acting injectable (LAI) antipsychotics are recommended for nonadherent patients with schizophrenia, and they showed superiority compared with oral antipsychotics in preventing hospitalizations.4 There are no data of treatment with LAI antipsychotics after the resolution of NMS, and sustained high level of dopamine D2 receptor occupancy might induce the recurrence of NMS. Olanzapine LAI was associated with D2 receptor occupancy of approximately 60%.5 Other LAI antipsychotics including haloperidol decanoate and risperidone LAI 6, 7 occupy a higher percentage of dopamine D2 receptors. There are currently no data for paliperidone and aripiprazole LAIs.

Neuroleptic malignant syndrome, olanzapine long-acting injectiong, treatment after neuroleptic malignant syndrome, schizophrenia

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