What is the treatment of choice for neuroleptic malignant syndrome and malignant hyperthermia?

Dantrolene is the treatment of choice for both neuroleptic malignant syndrome (NMS) and malignant hyperthermia due to its mechanism of action. It works by acting on the ryanodine receptor in skeletal muscle, reducing calcium release from the sarcoplasmic reticulum. This leads to a decrease in muscle contraction and helps lower elevated temperatures in these conditions, which are characterized by hypermetabolism and widespread muscle rigidity.

In neuroleptic malignant syndrome, patients typically present with symptoms such as severe muscle rigidity, altered mental status, autonomic instability, and hyperthermia, often following the administration of antipsychotic medications. Dantrolene's ability to reduce muscle tone and metabolic activity directly addresses these symptoms.

For malignant hyperthermia, which can occur during general anesthesia in predisposed individuals, dantrolene is essential for managing the hypermetabolic state caused by a release of calcium from skeletal muscles in response to certain anesthetic agents. The rapid administration of dantrolene is crucial to prevent complications such as rhabdomyolysis, severe hyperthermia, and potential multi-organ failure.

While other medications like benzodiazepines may be used for supportive care in managing anxiety or sedation, they do