We report a case of rhabdomyolysis and acute compartment syndrome of the lower extremity in a schizophrenic patient taking risperid one following the addition of simvastatin to treat hyperlipidemia. We suspect that disrupted drug metabolism, resulting from interactions with cytochrome P450 enzymes, rapidly elevated drug plasma levels, which then led to muscle toxicity. Clinicians who pharmacologically treatmedical comorbidities in patients receiving atypical antipsychotics must be proactive in anticipating potential drug–drug interactions.
Bogaerts Y , Lameire N , Ringoir S (1982) The compartmental syndrome: a serious complication of acute rhabdomyolysis . Clin Nephrol17: 206–211
2.
Domon S E , Cargile C S (2002) Quetiapine-associated hyperglycemia and hypertriglyceridemia . J Am Acad Child Adolesc Psychiatry41: 495–496
3.
Fang J , Bourin M , Baker G B (1999) Metabolism of risperidone to 9-hydroxyrisperidone by human cytochromes P450 2D6 and 3A4 . Naunyn-Schmiedeberg’s Arch Pharmacol359: 147–151
4.
Giner V , Munoz R , Redon J (2002) Risperidone and severe cerivastatininduced rhabdomyolysis . J Intern Med251: 177–178
5.
Hargreaves S (2003) NICE guidelines address social aspect of schizophrenia . BMJ326: 679–679
6.
Hiratsuka M , Mizugaki M (2001) Genetic polymorphisms in drug-metabolizing enzymes and drug targets . Mol Genet Metab73: 298–305
7.
Jaanson P , Marandi T , Kiivet R , Vasar V , Vaan S , Svensson J , Dahl M (2002) Maintenance therapy with zuclopenthixol decanoate: associations between plasma concentrations, neurological side effects and CYP 2D6 genotype . Psychopharmacology162: 67–73
8.
Kawanishi C , Furuno T , Onishi H , Sugiyama N , Suzuki K , Matsumura T , Ishigami T , Kosaka K (2000) Lack of association in Japanesepatients between neuroleptic malignant syndrome and a debrisoquine4-hydroxylase genotype with low enzyme activity . Psychiatr Genet10: 145–147
9.
McIntyre R S , McCann S M , Kennedy S H (2001) Antipsychotic metabolic effects: weight gain, diabetes mellitus, and lipid abnormalities . Can J Psychiatry46: 273–281
10.
NICE Guidelines (2003) Royal College of Psychiatrists. Schizophrenia: full national clinical guideline on core interventions in primary and secondary carehttp://www.rcpsych.ac.uk
11.
Omar M A , Wilson J P , Cox T S (2001) Rhabdomyolysis and HMG-CoA reductase inhibitors . Ann Pharmacother35: 1096–1107
12.
Prior T I , Baker G B (2003) Interactions between the cytochrome P450system and the second-generation antipsychotics . J Psychiatry Neurosci28: 99–112
13.
Rubio-Gozalbo M E , van Waardenburg D A , Forget P P , Spaapen L J M , Verrips A , Vroomen P C A J (2001) Neuroleptic malignant syndrome during zuclopenthixol therapy in X-linked cerebral adrenoleukodystrophy . J Inherit Metab Dis24: 605–606
14.
Schneider J M , Roger D J , Uhl R L (1996) Bilateral forearm compartment syndromes resulting from neuroleptic malignant syndrome . J Hand Surg (Am)21A: 287–289
15.
Tiwari A , Haq A I , Myint F , Hamilton G (2002) Acute compartment syndromes . Br J Surg89: 397–412
16.
Williams D , Feely J (2002) Pharmacokinetic-pharmacodynamic drug inter-actions with HMG-CoA reductase inhibitors . Clin Pharmacokinet41: 343–370
