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Neuroleptic malignant-like syndrome due to donepezil and maprotiline

Neuroleptic malignant syndrome (NMS) is an uncommon and potentially fatal complication of neuroleptic treatment.1 It is characterized by hyperthermia, muscle rigidity, autonomic instability, delirium, and elevated creatinine kinase (CK) activity.1 Although antipsychotics, such as chlorpromazine and haloperidol, are the main drugs responsible, there have been several reports among antidepressants2 and antiparkinson drug withdrawal.3 We report the development of a NM-like syndrome in a patient receiving the cholinesterase inhibitor donepezil and a low-dose antidepressant.

A 73-year-old man was diagnosed with probable AD by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition and National Institute of Neurological and Communicative Disorders and Stroke–AD and Related Disorders Association criteria. He had a 2-month history of memory loss and confusion at night. A daily 20-mg dose of the antidepressant, maprotiline, was started at a psychiatrist’s clinic in …