Editing Neuroleptic malignant syndrome (section)

==Treatment==
NMS is a medical emergency and can lead to death if untreated. The first step is to stop the culprit medication and treat the [[hyperthermia]] aggressively, such as with cooling blankets or ice packs to the axillae and groin. [[Acetaminophen]] is commonly used as an anti-pyretic. Supportive care in an intensive care unit capable of circulatory and ventilatory support is crucial. In those unable to control their secretions, or who have muscle spams of the respiratory muscles, mechanical ventilation may be needed.<ref name="Wijdicks 2024" /> 

The best pharmacological treatment is still unclear.  [[Dantrolene]] has been used when needed to reduce muscle rigidity, and dopamine pathway medications such as [[bromocriptine]] have shown benefit.<ref>{{cite journal | vauthors = Dhib-Jalbut S, Hesselbrock R, Mouradian MM, Means ED | title = Bromocriptine treatment of neuroleptic malignant syndrome | journal = The Journal of Clinical Psychiatry | volume = 48 | issue = 2 | pages = 69–73 | date = February 1987 | pmid = 3804991 }}</ref> Dantrolene may act centrally on thermoregulatory pathways to lower the temperature.<ref name="Wijdicks 2024" /> Dantrolene also inhibits calcium release from the muscle sarcoplasmic reticulum to cause muscle relaxation.<ref name="Wijdicks 2024" />
[[Amantadine]] is another treatment option due to its dopaminergic and anticholinergic effects.
[[Apomorphine]] may be used however its use is supported by little evidence.<ref name=uptodate.com/> [[Benzodiazepine]]s may be used to control [[wikt:agitation|agitation]]. Highly elevated blood [[myoglobin]] levels from muscle breakdown (rhabdomyolysis) can result in [[kidney]] damage, therefore aggressive intravenous hydration with diuresis may be required.  When recognized early NMS can be successfully managed; however, up to 10% of cases can be fatal.<ref name=Str2007/>

Should the affected person subsequently require an antipsychotic, trialing a low dose of a low-potency atypical antipsychotic is recommended.<ref name=Str2007/>

[[Electroconvulsive therapy]] may be used in life threatening cases of NMS that are refractory to first line treatments.<ref name="Wijdicks 2024" />