Heng Gerard, Soh Teck Hwee, Kwok Cecilia
Psychiatry, Singapore General Hospital, Singapore, SGP.
Cureus. 2024 Feb 1;16(2):e53428. doi: 10.7759/cureus.53428. eCollection 2024 Feb.
Rhabdomyolysis has been reported as a rare adverse effect of psychotropic use. This paper presents a case of rhabdomyolysis in a 39-year-old man with depression and substance use disorder. He had been started on quetiapine two months before and mirtazapine two weeks before developing symptoms of pain and weakness. His creatine kinase (CK) was elevated to 5870 U/L, with no other contributing factors elicited. He improved with symptomatic treatment along with cessation of psychotropics. A literature review on rhabdomyolysis associated with quetiapine and/or mirtazapine therapy found 12 cases with quetiapine, one case with mirtazapine, and three cases with quetiapine and mirtazapine combination treatment. The majority were men, aged 19 to 70 years old. There was no clear correlation between dose and maximum CK levels, and the time to onset of symptoms varied from two days to eight months. The proposed mechanism is a serotoninergic or dopaminergic blockade. Rhabdomyolysis associated with quetiapine or mirtazapine can occur even at therapeutic doses and clinicians should be aware of this potentially life-threatening adverse effect.
横纹肌溶解症已被报道为使用精神药物罕见的不良反应。本文介绍了一名39岁患有抑郁症和物质使用障碍的男性发生横纹肌溶解症的病例。在出现疼痛和无力症状前两个月，他开始服用喹硫平，两周前开始服用米氮平。他的肌酸激酶（CK）升高至5870 U/L，未发现其他促成因素。在采取对症治疗并停用精神药物后，他的病情有所改善。一项关于与喹硫平及/或米氮平治疗相关的横纹肌溶解症的文献综述发现，有12例与喹硫平有关，1例与米氮平有关，3例与喹硫平及米氮平联合治疗有关。大多数为男性，年龄在19至70岁之间。剂量与CK最高水平之间没有明显相关性，症状出现时间从两天到八个月不等。推测的机制是5-羟色胺能或多巴胺能阻滞。即使在治疗剂量下，与喹硫平或米氮平相关的横纹肌溶解症也可能发生，临床医生应意识到这种潜在的危及生命的不良反应。
