Neuroleptic Malignant Syndrome (NMS) is a severe and potentially life-threatening reaction to neuroleptic medications. Understanding the patterns of neuroleptic use and associated risk factors is crucial for early diagnosis and prevention of extrapyramidal complicationsTo describe the neuroleptic and antiparkinsonian drugs prescribed to patients evaluated for suspected NMS and identify the causative factors associated with different neuroleptic agents.This was a retrospective, observational, XX-center study conducted in the ED of XXX over a five year period from January 2020 to october 2025.Data were collected on neuroleptic and antiparkinsonian drug prescriptions, including specific molecules, co-prescriptions, and identified causes of adverse reactions.The most frequently prescribed agents were butyrophenones ( 41.5%), followed by fluphenazine ( 22.3%) and risperidone (19.1%). Other neuroleptics were less commonly used: phenothiazines (9.6%), olanzapine (3.2%), amisulpride (2.1%), and aripiprazole (1.1%).Regarding antiparkinsonian medications, 46.5% of patients received such treatment. Biperiden accounted for 45.5% of prescriptions, while trihexyphenidyl  was administered to only 3 patients (3%). Analysis by molecule showed that butyrophenones were almost always given without antiparkinsonian agents (rate near 1%), increasing the risk of extrapyramidal symptoms. Fluphenazine was combined with Biperiden in 66% of cases but rarely with Trihexyphenidyl (near 2%), whereas risperidone was paired with antiparkinsonian drugs in only 15% of cases, with no use of Trihexyphenidyl.The identified causes of adverse events varied by neuroleptic agent.Butyrophenones were linked to overdose, rapid dose escalation, or accidental cumulative intake. Fluphenazine was involved in several overdoses of Fluphenazine  (75 to 200 mg), withdrawal of Biperiden, and various therapeutic errors. Risperidone was associated with overdose, abrupt therapeutic changes, or isolated adverse reactions. Amisulpride was related to accidental overdose; olanzapine with concomitant Chlorpromazine overdose; and other molecules were implicated sporadically.Among confirmed NMS cases, butyrophenones were the most frequently implicated neuroleptics, followed by fluphenazine and risperidone often in the context of absent antiparkinsonian co-treatment, overdose, or dosage changes. The limited use of trihexyphenidyl and inadequate administration of Biperiden in several high-risk patients constitute major aggravating factors.These findings underscore the importance of strict therapeutic monitoring, appropriate use of antiparkinsonian agents, and heightened vigilance during dose adjustments.