In the management of Neuroleptic Malignant Syndrome, what is the immediate first step?

• A. Discontinue the offending antipsychotic
• B. Administer dantrolene
• C. Start haloperidol
• D. Administer benzodiazepines

Answer: (A)

In Neuroleptic Malignant Syndrome, the immediate priority is to remove the trigger by stopping the offending antipsychotic. Ongoing dopamine blockade drives the dangerous combination of fever, extreme muscle rigidity, and autonomic instability, so halting the drug is the single most important first action to prevent further deterioration. After stopping the agent, you begin aggressive supportive care—cooling, IV fluids, careful monitoring, and electrolyte management—and consider specific pharmacologic treatments (like dantrolene or bromocriptine) if needed to control symptoms. Using benzodiazepines can help with agitation, but they don’t address the root cause, and continuing or starting another antipsychotic would worsen the condition.