Causative Agents
The significance of a pyrexia has to be considered in the context of each case (including clinical environment e.g. resuscitation area following anaesthetic induction) and after a history and especially drug history has been taken. In addition to a prescribed drug history, it is important to take a history of recreational drug use and assess risk of any overdose. In addition, non-drug causes for hyperthermia should always be considered including sepsis.
Below are listed the causative drugs for each hyperthermic syndrome:
Malignant hyperthermia
- Anaesthetic gases eg halothane, isoflurane, cyclopropane
- Depolarising neuromuscular relaxants e.g. suxamethonium
Neuroleptic malignant syndrome
- Typical antipsychotics e.g. chlorpromazine, haloperidol, prochlorperazine
- Atypical antipschotics e.g. olanzapine, clozapine, quetiapine
- Tricyclic antidepressants e.g. amitriptyline, clomipramine, imipramine
- Monoamine oxidase inhibitors e.g. phenelzine, moclobemide
- Anticonvulsants
- Withdrawal or dose reduction of antiparkinsonian medications such as Levodopa or other dopamine agonists
Anticholinergic poisoning
- Antihistamines e.g. chlorphenamine, cyproheptadine, hydroxyzine, promethiazine
- Neuroleptics e.g. chlorpromazine, olanzapine, quetiapine
- Antiparkinsonian drugs e.g. trihexyphenidyl, benztropine
- Antispasmodics e.g. hyoscyamine, oxybutynin, propantheline
- Tricyclic antidepressants e.g. amitriptyline, clomipramine, imipramine
- Atropine
- Cyclopentolate
Sympathomimetic poisoning
- Cocaine
- Ecstasy (MDMA)
- Metamphetamines
- Amphetamines
Serotonin syndrome
- Amphetamines
- Cocaine
- Ecstasy(MDMA)
- Tramadol
- Levodopa
- Lithium
- SSRIs e.g. citalopram, fluoxetine, sertraline
- SNRIs e.g. venlafaxine
- Serotonin modulators e.g. trazadone
- Tricyclic antidepressants e.g. amitriptyline, clomipramine, imipramine
- Metoclopramide
- Ondansetron
- Dextrometorphan
- Monoamine oxidase inhibitors e.g. phenelzine, moclobemide
- LSD
Other drugs causing hyperthermia
- Salicylate
- Strychnine