olanzapine and Rhabdomyolysis

Serotonin syndrome is a potentially life-threatening complication of serotonergic agents. Although mirtazapine is a relatively safe antidepressant and has a comparatively low incidence of side effects, it still could induce serotonin syndrome.. We described a 34-year-old man with schizophrenic disorder who presented with acute consciousness disturbance, extremely high fever, rigidity, and spontaneous clonus in lower limbs. Two days before entry, oral mirtazapine was added to his regular medication of olanzapine. The serotonin-related symptoms resolved soon after withdrawal of mirtazapine and olanzapine combined with treatment with intravenous benzodiazepine and oral cyproheptadine. However, the clinical course was complicated by rhabdomyolysis, acute renal failure, and acute pulmonary edema. After receiving mechanical ventilation, hemodialysis, and appropriate supportive treatment, his general condition recovered and he was discharged without any neurological sequelae.. With the increasing use of serotonergic agents, awareness of serotonin syndrome is important. Early diagnosis and timely discontinuation of the offending agent(s) are imperative to prevent morbidity and mortality.

Topics: Acute Disease; Acute Kidney Injury; Adult; Benzodiazepines; Humans; Male; Mianserin; Mirtazapine; Olanzapine; Pulmonary Edema; Rhabdomyolysis; Serotonin Syndrome

Topics: Antipsychotic Agents; Benzodiazepines; Cardiomyopathies; Catatonia; Clozapine; Heart Failure; Humans; Olanzapine; Rhabdomyolysis

Olanzapine is a commonly used and effective second-generation antipsychotic agent used for the control of paranoia and agitation in schizophrenia and bipolar disorder as well as in the behavioural and psychological symptoms of dementia. Serious side effects of treatment are uncommon but spontaneous rhabdomyolysis represents a rare complication. We describe here a patient treated with a stable dose of olanzapine for more than 8 years who developed acute severe rhabdomyolysis without an identifiable trigger and without features suggestive of neuroleptic malignant syndrome. The rhabdomyolysis was atypical in its delayed onset and severity with a creatine kinase level of 345 125 U/L, the highest level reported in the available literature. We also describe the clinical manifestations of delayed-onset olanzapine-induced rhabdomyolysis and its differentiation from neuroleptic malignancy syndrome, and we highlight key aspects of management to prevent or minimise further complications such as acute kidney injury.

Topics: Antipsychotic Agents; Benzodiazepines; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Rhabdomyolysis; Schizophrenia

Rhabdomyolysis is a rare serious side effect of antipsychotic medication use. There are cases of rhabdomyolysis due to the use of clozapine, risperidone, olanzapine, and haloperidol in the literature. In this report, we describe a rhabdomyolysis case developed on the 13th day of using 2.5 mg /day aripiprazole in a 17-year-old male patient with a diagnosis of somatic symptom disorder. This case is one of the youngest in the literature to develop rhabdomyolysis after the use of aripiprazole. Moreover, this case is distinguished from the others with its low-dose, short-term and single antipsychotic use. In the child and adolescent age group, routine blood tests should be done before starting medication. Symptoms that appear to be nonspecific and that may be overlooked or may be thought to be caused by an existing psychiatric complaint should be carefully and thoroughly considered during follow-up.

Topics: Adolescent; Antipsychotic Agents; Aripiprazole; Child; Humans; Male; Olanzapine; Rhabdomyolysis; Risperidone

Topics: Antipsychotic Agents; Humans; Myocarditis; Olanzapine; Rhabdomyolysis

Olanzapine is a widely adopted atypical antipsychotic medication used to manage schizophrenia. Reports show that the incidence rate of adverse reactions to olanzapine is significantly lower than those of other classic antipsychotic medications. However, olanzapine overdose may be associated with severe consequences. Herein, we report a 21-year-old female patient who had taken nearly 700 mg (70 tablets) of olanzapine; she was found after 30 hours. As her condition progressed, she presented with rhabdomyolysis, swelling in the thighs and hips, paralytic ileus, digestive tract hemorrhage, and elevated serum amylase and lipase levels; notably, she recovered after treatment. This intractable case is of great clinical significance and suggests that early-phase hemoperfusion plays a critical role in olanzapine poisoning-related rhabdomyolysis.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Humans; Muscles; Olanzapine; Rhabdomyolysis; Young Adult

We present the case of a middle-aged man with a chronic history of schizoaffective disorder, depressed type, stable on a second-generation antipsychotic. Psychotic symptoms recurred contingent to medication noncompliance necessitating hospitalization. Treatment was complicated by the development of neuroleptic malignant syndrome (NMS). In addition, subsequent medication rechallenges failed because of recurrent rhabdomyolysis and atypical NMS. Electroconvulsive therapy (ECT) treatment was initiated, affording remission of psychotic symptoms and nonrecurrence of NMS and rhabdomyolysis. Our experience confirmed the efficacy of ECT treatment in providing symptom relief of psychosis complicated by recurrent episodes of NMS and atypical NMS. Likewise, it illustrated the efficacy of ECT treatment for rhabdomyolysis.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Electroconvulsive Therapy; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Patient Compliance; Rhabdomyolysis; Schizophrenia; Treatment Outcome

Children with autism often display difficult behaviors including tantrums, extreme irritability, and physical aggression. There is emerging evidence that olanzapine is useful in decreasing these disruptive behaviors. The most common adverse effects are weight gain and short-term sedation. On the other hand, olanzapine rarely causes rhabdomyolysis. We report a case with rhabdomyolysis in an autistic child just after 2 doses of olanzapine treatment. Initial creatine kinase value was 30,690 IU/L (range, 5-130 U/L), and rhabdomyolysis resolved with hydration and alkalinization over 7 days. Monitoring serum creatine kinase levels may be useful in pediatric cases after initiation of olanzapine treatment.

Topics: Adolescent; Autistic Disorder; Benzodiazepines; Creatine Kinase; Fluid Therapy; Follow-Up Studies; Humans; Male; Olanzapine; Rhabdomyolysis; Selective Serotonin Reuptake Inhibitors

"Atypical" antipsychotics tend to replace traditional antipsychotics as first line therapy for psychotic disorders, due to their better side-effect profile with fewer extrapyramidal manifestations, allowing a better observance. Nevertheless, second-generation antipsychotics may also lead to adverse events such as metabolic disorders, agranulocytosis or muscle damage. Cases of rhabdomyolysis (aside neuroleptic malignant syndrome) have been reported in patients receiving olanzapine (Zyprexa).. We reviewed the cases of olanzapine induced rhabdomyolysis reported to the French national database of drug adverse events and retrieved additional cases published in the medical literature.. We collected 13 cases from the French pharmacovigilance database and eight additional cases from the literature. Seventeen patients needed hospitalization. Creatine kinase (CK) rate ranged between 413 and 34,500 UI/L. Outcome was favorable in 85% of the cases (17 out of 20 cases) after discontinuation of olanzapine.. Although rhabdomyolysis is a rare side effect (< 1%) of olanzapine, this adverse event should be evoked when a patient with olanzapine presents with muscle pain, unexplained fatigue or weakness. Prompt dosage of CK should be performed. However, it remains uncertain whether a mild and asymptomatic muscle enzyme increase without any metabolic disorder requires the discontinuation of olanzapine therapy.

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Creatine Kinase; Female; Humans; Male; Middle Aged; Olanzapine; Rhabdomyolysis

Topics: Adolescent; Anticonvulsants; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Drug Therapy, Combination; Female; Fever; Fructose; Humans; Olanzapine; Rhabdomyolysis; Topiramate

We report on a case of rhabdomyolysis induced by the correction of hyponatremia after psychogenic polydipsia and clozapine use, where the switch to a high dose of olanzapine resulted in the non-recurrence of rhabdomyolysis. The 46-year-old patient with the diagnosis of schizophrenia paranoid type, who had been on clozapine treatment for the previous 4 years, was admitted with the symptoms of generalized seizure and vomiting, and as severe hyponatremia was proved, its correction with the parallel use of clozapine treatment was done. CK concentrations increased to 48 120 U/L without any symptom of neuroleptic malignant syndrome. To prevent acute renal insufficiency, high-volume alkaline diuresis was initiated and clozapine was tapered and stopped. On the day 12 of treatment, olanzapine was started and was elevated to 30 mg/day. CK concentration began to fall returning to the normal concentration on day 20. Six months after the switch to olanzapine no recurrence of rhabdomyolysis was detected; clinical and laboratory findings were normal. We suggest that after a benzodiazepine-type antipychotic-induced rhabdomyolysis, a switch to another atypical antipsychotic can be a cautious clinical strategy.

Topics: Antipsychotic Agents; Benzodiazepines; Clozapine; Creatine Kinase; Humans; Male; Middle Aged; Olanzapine; Rhabdomyolysis; Schizophrenia; Water Intoxication

Olanzapine is an atypical antipsychotic that is reported to cause myopathy and raised creatine kinase (CK) levels. The prevalence and severity of acute myopathy after deliberate olanzapine ingestion are unclear. Therefore, we reviewed case notes from 64 consecutive patients admitted to our institution after olanzapine overdose. Overall, serum CK was higher than five times the upper limit of normal in 17% of patients. The prevalence of raised CK values was positively correlated with the stated quantity of olanzapine ingested, suggesting a dose-dependent relationship for acute muscle toxicity. There was an apparent delay of 12 hours or more between olanzapine ingestion and the occurrence of maximum CK. Despite the high prevalence of acute muscle toxicity after olanzapine ingestion, none of the patients developed renal failure.

Topics: Acute Disease; Adult; Antipsychotic Agents; Benzodiazepines; Creatine Kinase, MM Form; Dose-Response Relationship, Drug; Drug Overdose; Female; Humans; Male; Middle Aged; Muscle, Skeletal; Muscular Diseases; Olanzapine; Retrospective Studies; Rhabdomyolysis; Scotland

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Creatine Kinase; Humans; L-Lactate Dehydrogenase; Male; Olanzapine; Rhabdomyolysis; Schizophrenia, Paranoid

Topics: Adverse Drug Reaction Reporting Systems; Aged; Anemia, Hemolytic, Autoimmune; Anti-Infective Agents; Anticoagulants; Benzodiazepines; Caffeine; Canada; Ceftriaxone; Central Nervous System Stimulants; Child; Drug Interactions; Female; Humans; Ketolides; Middle Aged; Olanzapine; Peripheral Nervous System Diseases; Phytotherapy; Pulmonary Embolism; Rhabdomyolysis; Selective Serotonin Reuptake Inhibitors; Warfarin; Weight Loss

Rhabdomyolysis is a disorder characterized by skeletal muscle injury and fatal complications at times. The causes of rhabdomyolysis are usually traumatic and non-traumatic, such as neuroleptic malignant syndrome and rhabdomyolysis associated to septicemia. The cases of 2 schizophrenic patients with rhabdomyolisis during pneumonia infection and neuroleptic therapy are reported. At admission, both patients had important respiratory distress and hyperthermia; the clinical conditions required endotracheal intubation. Blood and urine cultures were always negative, while the bronchial sputum culture was positive. The diagnosis of rhabdomyolysis was confirmed by myoglobinemia dosage and ortholuidine test. Pneumonia infection was treated with antibiotic specific therapy whereas renal failure was treated with adequate hydratation and strained diuresis. The absence of muscle rigidity, the improvement of X-r images and the reduction of corporeal temperature, during antibiotic treatment, excluded neuroleptic malignant syndrome. The impro-vement allowed extubation and discharge of the patients from intensive care unit. In both cases neuroleptic malignant syndrome was excluded, therefore rhabdomyolysis was the consequence of pneumonia infection or of a combination of factors capable to cause an important damage of skeletal muscles.

Topics: Acute Kidney Injury; Adult; Antipsychotic Agents; Benzodiazepines; Diagnosis, Differential; Fever; Humans; Male; Middle Aged; Muscle Rigidity; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Pneumonia, Bacterial; Rhabdomyolysis; Risperidone; Schizophrenia

To report a possible case of olanzapine-induced rhabdomyolysis with concomitant lithium-induced pseudo-infarction electrocardiogram changes.. A 13-year-old white boy was admitted to the hospital with profound weakness and electrocardiogram (EGG) changes suggestive of myocardial damage after starting olanzapine and lithium. An adverse medication effect was not considered at the time of the patient's admission. The time course of onset of weakness was coincident with administration of olanzapine. ECG abnormalities are a known manifestation of lithium therapy. This is a case description of olanzapine-induced rhabdomyolysis. Although other antipsychotic agents have been reported to cause rhabdomyolysis, an adverse drug reaction was not initially part of this patient's differential diagnosis. The patient had begun reporting rnyalgias six days after starting olanzapine. Fourteen days later, these symptoms forced him to bed rest; lithium was added for behavior misinterpreted as disobedience and oppositional disorder. Only when medications were considered as cause of the weakness and EGG changes, was the true nature of the patient's illness discovered.. Olanzapine, like other neuroleptic agents, can cause rhabdomyolysis. Lithium can cause multiple EGG changes that can be misinterpreted as myocardial damage. Medication effects and adverse effects must always be considered in any disease complex.

Topics: Adolescent; Antipsychotic Agents; Benzodiazepines; Diagnosis, Differential; Electrocardiography; Humans; Lithium; Male; Olanzapine; Pirenzepine; Rhabdomyolysis

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Creatine Kinase; Drug Monitoring; Humans; Male; Olanzapine; Pirenzepine; Rhabdomyolysis

To report a case of marked elevation of serum creatine kinase (CK) associated with olanzapine therapy.. A 39-year-old white Jewish schizophrenic man treated with olanzapine developed an elevated serum CK concentration with a peak concentration of 4000 IU/L (normal < 230). No other diagnostic criteria for neuroleptic malignant syndrome (NMS) were present. On discontinuation of the drug, serum CK concentrations returned to normal within eight days.. Olanzapine, like other atypical antipsychotic drugs, may cause muscle injury with concomitant elevations of serum CK of muscle origin. We suggest that in patients treated with olanzapine, CK concentrations should be checked on initiation of therapy, within the first 48 hours, and weekly thereafter for at least one month. In addition, patients with clinical signs suggestive of NMS should be monitored more carefully. For those patients with a history of NMS, or even of isolated serum CK elevation during antipsychotic therapy, follow-up should be stricter.. Marked elevation of serum CK may be a possible complication of olanzapine therapy.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Chronic Disease; Creatine Kinase; Humans; Male; Olanzapine; Pirenzepine; Rhabdomyolysis; Schizophrenia