Bromocriptine treatment of neuroleptic malignant syndrome

Five patients with neuroleptic malignant syndrome were treated with bromocriptine mesylate 7.5-45 mg/day in three divided doses for at least 10 days. Response to therapy was assessed by monitoring vital signs and serum creatine kinase (CK) levels. In addition, a disability score was determined using a scale based on variables assessed on neurologic examinations. In all five patients, significant improvement was noted 24-72 hours after initiation of bromocriptine treatment and was accompanied in four patients by a rapid drop in serum CK levels. Resolution of confusion and mutism was noted within 24-48 hours after treatment. Normalization of vital signs occurred within 48 hours to 4 days, and resolution of extrapyramidal rigidity occurred within 1 week. In two patients, early discontinuation of bromocriptine resulted in relapse of neuroleptic malignant syndrome, which responded to reinstitution of the drug. The results suggest a therapeutic role for bromocriptine in the treatment of neuroleptic malignant syndrome.