Malignant syndromes: current advances

Expert Opin Drug Saf. 2021 Sep;20(9):1075-1085. doi: 10.1080/14740338.2021.1919622. Epub 2021 Apr 26.


Introduction: Many drugs are known to induce malignant syndromes. The most common malignant syndromes are induced by the use of antipsychotics and anesthetics and the withdrawal of anti-Parkinson drugs. As the clinical manifestations of antipsychotic malignant syndrome, Parkinson's disease hyperpyrexia syndrome and anesthetic-induced malignant syndrome are very similar, they are easily confused in the clinic.Areas covered: We reviewed articles published between 1960 and April 2021 describing malignant syndromes. This paper provides a detailed literature review of malignant syndromes and important guidance for the diagnosis and treatment of malignant syndromes to clinicians.Expert opinion: Although malignant syndromes are rare conditions with a low incidence, these conditions usually progress rapidly and can endanger patients' lives, meriting attention from clinicians. The typical clinical manifestations of malignant syndromes are hyperpyrexia, muscular rigidity, an altered mental status and increased levels of creatine kinase; however, the pathophysiology, treatment and prognosis of different malignant syndromes are quite different. Prompt diagnosis and treatment may significantly improve the prognosis of patients with malignant syndromes.

Keywords: Malignant syndrome; anesthetic; anti-parkinson drug; antipsychotics; diagnosis; hyperthermia; therapy.

Publication types

  • Review

MeSH terms

  • Anesthetics / administration & dosage
  • Anesthetics / adverse effects
  • Antiparkinson Agents / administration & dosage
  • Antiparkinson Agents / adverse effects
  • Antipsychotic Agents / administration & dosage
  • Antipsychotic Agents / adverse effects
  • Humans
  • Incidence
  • Malignant Hyperthermia / epidemiology
  • Malignant Hyperthermia / etiology*
  • Malignant Hyperthermia / physiopathology
  • Neuroleptic Malignant Syndrome / epidemiology
  • Neuroleptic Malignant Syndrome / etiology*
  • Neuroleptic Malignant Syndrome / physiopathology
  • Parkinson Disease / drug therapy
  • Prognosis


  • Anesthetics
  • Antiparkinson Agents
  • Antipsychotic Agents