Miyazaki Kensuke, Otaka Masabumi, Yasui-Furukori Norio
Department of Pediatrics, Aomori Rosai Hospital, Hachinohe, Japan.
Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki.
Clin Neuropharmacol. 2018 Nov/Dec;41(6):216-217. doi: 10.1097/WNF.0000000000000303.
Rhabdomyolysis involves the release of intracellular contents secondary to muscle cell injury; it generally presents with muscle pain and weakness. Although several psychotropic agents have been documented as causes of rhabdomyolysis, there are no reports of tandospirone-induced rhabdomyolysis.
We present the case of a 15-year-old Japanese girl who had posttraumatic stress disorder after the Great East Japan Earthquake. She received a dose of 60 mg of tandospirone while taking 10 mg of tandospirone and 400 mg of valproic acid every day. She developed appetite loss, muscle weakness, muscle soreness, and general malaise on day 2, and laboratory data revealed a serum creatine phosphokinase level of 17,770 IU/L that reached a peak of 35,530 IU/L on day 4. Lactate dehydrogenase, aspartate aminotransferase, and alanine transaminase levels were also abnormal. After a fluid infusion was initiated and tandospirone was discontinued, most of her symptoms and abnormal laboratory data resolved within 10 days.
This case suggests that careless high dosing of partial 5-HT1A receptor agonists is harmful to at-risk patients, such as adolescent patients with poor mental condition.
横纹肌溶解症是指继发于肌肉细胞损伤后细胞内物质的释放；通常表现为肌肉疼痛和无力。虽然已有多种精神药物被记录为横纹肌溶解症的病因，但尚无坦度螺酮诱发横纹肌溶解症的报道。
我们报告一例15岁日本女孩的病例，该女孩在东日本大地震后患有创伤后应激障碍。她在每天服用10mg坦度螺酮和400mg丙戊酸的同时，接受了一剂60mg坦度螺酮。第2天，她出现食欲减退、肌肉无力、肌肉酸痛和全身不适，实验室检查数据显示血清肌酸磷酸激酶水平为17770IU/L，第4天达到峰值35530IU/L。乳酸脱氢酶、天冬氨酸氨基转移酶和丙氨酸氨基转移酶水平也异常。在开始补液并停用坦度螺酮后，她的大多数症状和异常实验室检查数据在10天内得到缓解。
该病例表明，对部分5-HT1A受体激动剂不慎进行高剂量给药对高危患者有害，如精神状态不佳的青少年患者。
