Pharmacologic Management of Central Fever: A Review of Evidence for Bromocriptine, Propranolol, and Baclofen

Abstract

Objective: The purpose of this review was to evaluate the clinical data supporting bromocriptine, propranolol, and baclofen in the pharmacologic management of central fever. Data Sources: A comprehensive literature review was performed between January 2018 and August 2022 using the following keywords: “central fever” NOT “fever” OR “infection” OR “infectious” AND “neurocritical” OR “neurology” AND “treatment” AND “medication” OR “medicine” OR “drug” OR “pharmaceutical.” Study Selection and Data Extraction: A total of 6 case reports met specified inclusion criteria, with 2 reporting on each of the evaluated medications. Data Synthesis: Significant heterogeneity exists regarding dosing strategies and duration of treatment with these medications for the management of central fever. Although each medication demonstrated the ability to restore normothermia, the variation in underlying cause of the fever and lack of cross-over evaluation between different medications makes a definitive treatment strategy for any of these agents elusive. Conclusions: The development of a central fever has been associated with poor outcomes in patients who have suffered a critical neurologic injury. Although their exact mechanism for this indication has not been fully elucidated, anecdotal evidence seemingly supports the use of bromocriptine, propranolol, and baclofen.