Which combination represents the two medications commonly given for neuroleptic malignant syndrome?

• A. Bromocriptine (Parlodel) and Dantrolene
• B. Bromocriptine alone
• C. Dantrolene alone
• D. Cyproheptadine and Lithium

Answer: (A)

Neuroleptic malignant syndrome is driven by abrupt dopamine receptor blockade, which causes severe muscle rigidity, hyperthermia, autonomic instability, and elevated CK. Treating it focuses on reversing the dopaminergic blockade and reducing the much of the muscle hyperactivity.

Bromocriptine is a dopamine agonist that helps restore dopaminergic activity in the CNS, counteracting the blockade and easing the rigidity and fever. Dantrolene acts directly on skeletal muscle by inhibiting calcium release from the sarcoplasmic reticulum, which decreases muscle contraction and lowers heat production. Using both targets the problem from two angles: improving central dopaminergic signaling and reducing peripheral muscle hyperactivity. That combination is commonly employed in managing NMS.

Other options don’t fit as well. Dantrolene alone can help with muscle symptoms but doesn’t address the underlying dopamine deficiency; bromocriptine alone tackles dopaminergic blockade but may not sufficiently reduce severe rigidity and hyperthermia without the muscle-relaxing effect. Cyproheptadine is used for serotonin syndrome, not NMS, and lithium isn’t a treatment for this condition.