Rhabdomyolysis is not a well-understood adverse effect of antipsychotic use. Proposed mechanisms suggest involvement of serotoninergic and/or dopaminergic blockade. The purpose of this study was to describe the relationship between antipsychotic use and rhabdomyolysis. Patients admitted with rhabdomyolysis and taking an antipsychotic from January 2009 to October 2011 were included. Background demographics, laboratory data, medical and physical history, concomitant medications, and hospital course data were collected. Of the 673 cases admitted with rhabdomyolysis, 71 (10.5%) were on an antipsychotic. This is significantly greater when compared to the general US population, where only 1.3% of individuals take an antipsychotic drug (P < .0001). Cause of rhabdomyolysis was not documented in 38% of cases, and antipsychotic use was suspected in 10% of cases. No significant correlations were found between antipsychotic type and other patient-specific parameters. Seventeen (25%) of these patients were taking 2 or more antipsychotics. The largest percentage was on quetiapine (Seroquel®; AstraZeneca, Wilmington, Delaware), the most commonly prescribed antipsychotic in the United States. Antipsychotic use is a risk factor for rhabdomyolysis and seems to be more common in those taking multiple agents. More research needs to be done to determine which antipsychotics have a higher risk and which receptors are involved. Providers should be aware of rhabdomyolysis associated with antipsychotic use.
StagnittiMN. Trends in Antipsychotic Purchases and Expenses for the US Civilian Noninstitutionalized Population, 1997 and 2007. Statistical Brief #275. MEPS Medical Expenditure Panel Survey. Rockville, MD: AHRQ—Agency for Healthcare Research and Quality; 2010.
5.
ZaidiAN. Rhabdomyolysis after correction of hyponatremia in psychogenic polydipsia possibly complicated by ziprasidone. Ann Pharmacother. 2005;39(10):1726–1731.
6.
ConfortiAChiamuleraCMorettiU. Musculoskeletal adverse drug reactions: a review of literature and data from ADR spontaneous reporting databases. Curr Drug Saf. 2007;2(1):47–63.
7.
BienvenuOJNeufeldKJNeedhamDM. Treatment for four psychiatric emergencies in the intensive care until. Crit Care Med. 2012;40(9):2662–2670.
8.
GabowPAKaehnyWDKelleherSP. The spectrum of rhabdomyolysis. Medicine (Baltimore). 1982;61(3):141–152.
9.
WilhelmKCurtisJBirkettV. The clinical significance of serial creatine phosphokinase estimations in acute ward admissions. Aust N Z J Psychiatry. 1994;28(3):453–457.
10.
ManiamTRahmanMA. All elevated creatine kinase is not neuroleptic malignant syndrome. Med J Malaysia. 1994;49(3):252–254.
11.
CavanaughJJFinlaysonRE. Rhabdomyolysis due to acute dystonic reaction to antipsychotic drugs. J Clin Psychiatry. 1984;45(8):356–357.
12.
MeltzerHYEklumLMolineRA. Serum-enzyme changes in newly-admitted psychiatric patients. Arch Gen Psych. 1969;21(6):731–738.
13.
TsoiWFCandlishJKKuaEH. Creatine phosphokinase and schizophrenia in Singapore. Ann Acad Med. 1985;14(1):84–86.
14.
GeizerMAncillRJ. Does combined neuroleptic-electroconvulsive therapy treatment increase the likelihood of creatine phosphokinase rise?Can J Psychiatry. 1997;42(1):88.
15.
EganMFDarghamAAKirchDG. Serum creatine phosphokinase elevations in patients with tardive dyskinesia. Br J Psychiatry. 1993;162:551–553.
16.
RafoolGJ. Causes of rhabdomyolysis. Mayo Clin Proc. 1995;70(12):1225.
17.
RizzieriDA. Rhabdomyolysis after correction of hyponatremia due to psychogenic polydipsia. Mayo Clin Proc. 1995;70(5):473–476.
18.
AkkayaCSarandolASivriogluEY. A patient using ziprasidone with polydipsia, seizure, hyponatremia, and rhabdomyolysis. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30(8):1535–1538.
19.
TenyiTVorosV. Successful switch to olanzapine after rhabdomyolysis caused by water intoxication and clozapine use. Pharmacopsychiatry. 2006;39(4):157–158.
20.
WickiJRutschmannOTBurriH. Rhabdomyolysis after correction of hyponatremia due to psychogenic polydipsia possibly complicated by clozapine. Ann Pharmacol. 1008;32(9):892–895.
21.
MeltzerHYColaPAParsaM. Marked elevations of serum creatine kinase activity associated with antipsychotic drug treatment. Neuropsychopharmacol. 1996;15(4):395–405.
22.
DevarajanSDursunSM. Antipsychotic drugs, serum creatine kinase (CPK) and possible mechanisms. Psychopharmacol. 2000;152(1):122.
23.
BisharaDTaylorD. Upcoming agents for the treatment of schizophrenia: mechanism of action, efficacy, and tolerability. Drugs. 2008;68(16):2269–2292.
24.
MillerKMHollidayKL. Schizophrenia and other psychoses. In: RichardsonMChantCChessmanKHFinskSWHemstreetBAHumeAL, eds. Pharmacotherapy Self-Assessment Program, 7th ed. Neurology and Psychiatry. Lenexa, KS: American College of Clinical Pharmacy; 2012:45–64.
25.
MelkerssonK. Serum creatine kinase levels in chronic psychosis patients—a comparison between atypical and conventional antipsychotics. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30(7):1277–1282.
26.
LeonhauserM. Antipsychotics: multiple indications help drive growth. Pharma Marketers360; 2012:22–24.
27.
AlexanderGCGallagherSAMascolaA. Increasing off-label use of antipsychotic medications in the United States, 1995-2008. Pharmacoepidemiol Drug Saf. 2011;20(2):177–184.
28.
YoshikawaHWatanabeTAbeT. Haloperidol-induced rhabdomyolysis without neuroleptic malignant syndrome in a handicapped child. Brain Develop. 2000;22(4):256–258.
29.
MarshSJDolsonGM. Rhabdomyolysis and acute renal failure during high-dose haloperidol therapy. Ren Fail. 1995;17(4):475–478.
30.
MarinellaMA. Rhabdomyolysis associated with haloperidol without evidence of NMS. Ann Pharmacother. 1997;31(7-8):927–928.
31.
KarrePRGujralJRodriguezE. Rhabdomyolysis with erratic serum creatine phosphokinase levels: intramuscular injection of haloperidol decanoate. BMJ Case Rep. 2009;2009.
32.
NankivellBJBhandariPKKollerLJ. Rhabdomyolysis induced by thioridazine. BMJ. 1994;309(6951):378.
CaruanaRJDilworthLRWillifordPM. Acute rhabdomyolysis associated with overdose of lorazepam, perphenazine and amitriptyline. N C Med J. 1983;44(1):18–19.
36.
ChangKYWuYF. Aripiprazole-associated rhabdomyolysis in a patient with schizophrenia. J Neuropsychiatry Clin Neurosci. 2011;22(3):E51.
37.
MarzettiEBocchinoLTeramoS. Rhabdomyolysis in a patient on aripiprazole with traumatic hip prosthesis luxation. J Neuropsychiatry Clin Neurosci. 2012;24(4):E40–E41.
38.
KorenWKorenENacaschN. Rhabdomyolysis associated with clozapine treatment in a patients with decreased calcium-potassium permeability of cell membranes. Clin Neuropharmacol. 1998;21(4):262–264.
39.
TsengKCHwangTJ. Rhabdomyolysis following dose increase of clozapine and combination therapy with lithium. J Clin Psychopharmacol. 2009;29(4):398–399.
ShusterJ. Olanzapine and rhabdomyolysis. Nursing. 2000;30(9):87.
42.
RosebraughCJFlockhartDAYasudaSU. Olanzapine-induced rhabdomyolysis. Ann Pharmacother. 2001;35(9):1020–1023.
43.
HungCFHuangTYLinPY. Hypothermia and rhabdomyolysis following olanzapine injection in an adolescent with schizophreniform disorder. Gen Hosp Psychiatry. 2009;31(4):376–378.
44.
KarakayaPYisUKurulSH. Rhabdomyolysis associated with olanzapine treatment in a child with autism. Ped Emerg Care. 2010;26(1):41–42.
45.
StrawnJRAdlerCMStrakowskiSM. Hyperthermia and rhabdomyolysis in an adolescent treated with topiramate and olanzapine. J Child Adolesc Psychopharmacol. 2008;18(1):116–118.
46.
StephaniCTrenkwalderC. Rhabdomyolysis after low dose quetiapine in a patient with Parkinson’s disease with drug-induced psychosis: a case report. Mov Disord. 2010;25(6):790–791.
47.
HimmerichHEhrlingerMHackenbergM. Possible case of quetiapine-induced rhabdomyolysis in a patient with depression treated with fluoxetine. J Clin Psychopharmacol. 2006;26(6):676–677.
CeriMUnverdiS. Comment on: low dose quetiapine-induced severe rhabdomyolysis. Ren Fail. 2011;33(4):463–464.
50.
DickmannJRMDickmannLM. An uncommonly recognized cause of rhabdomyolysis after quetiapine intoxication. Am J Emerg Med. 2010;28(9):1060–1061.
51.
SmithRPPuckettBNCrawfordJ. Quetiapine overdose and sever rhabdomyolysis. J Clin Psychopharmacol2004;24(3):343.
52.
LioliosASentissiO. Rhabdomyolysis following acute extended-release quetiapine poisoning: as case report. Case Rep Psychiatry. 2012;2012:347421.
53.
WebberMAMahmudWLightfootJD. Rhabdomyolysis and compartment syndrome with coadministration of risperidone and simvastatin. J Psychopharmacol. 2004;18(3):432–434.
54.
GinerVMunozRRedonJ. Risperidone and severe cerivastatin induced rhabdomyolysis. J Int Med. 2002;251(2):177–178.
55.
VivesSBatlleMMontaneE. Rhabdomyolysis and renal failure secondary to interaction between simvastatin, ciclosporin A and risperidone in an allogenic stem cell transplantation patient. Med Clin Barc. 2008;131(17):676.
56.
PatierJLFerrereFMoreno CoboMA. Rhabdomyolysis caused by the association of simvastatin and risperidone. Med Clin Barc. 2007;129(11):439.
57.
ZinkMKnopfUArgiriouS. A case of pulmonary thromboembolism and rhabdomyolysis during therapy with mirtazapine and risperidone. J Clin Psychiatry. 2006;67(5):835.
58.
YangSHMcNeelyMJ. Rhabdomyolysis, pancreatitis, and hyperglycemia with ziprasidone. Am J Psychiatry. 2002;159(8):1435.
59.
StarKIessaNAlmandilNB. Rhabdomyolysis reported for children and adolescents treated with antipsychotic medicines: a case series analysis. J Child Adoles Psychopharmacol. 2012;22(6):440–451.
60.
LinaresLAGolombBAJaojocoJA. Modern spectrum of rhabdomyolysis: drug toxicity revealed by creatine kinase screening. Curr Drug Saf. 2009;4(3):181–187.
61.
GallegoJABonettiJZhangJ. Prevalence and correlates of antipsychotic polypharmacy: a systematic review and meta-regression of global and regional trends from the 1970s to 2009. Schizophrenia Res. 2012;138(1):18–28.
62.
PadurangiAKVernonJT. Antipsychotic polypharmacy in the USA. In: Ritsner, ed. Polypharmacy in Psychiatry Practice. Vol II. Netherlands: M.S. Springer Science + Business Medial; 2013:11–29.
63.
GorenJLMeterkoMWilliamsS. Antipsychotic prescribing pathways, polypharmacy, and clozapine use in treatment of schizophrenia. Psychiatr Serv. 2013;64(6):527–533.
64.
WaringWSWrateJBatemanDN. Olanzapine overdose is associated with acute muscle toxicity. Hum Exp Toxicol. 2006;25(12):735–740.
