0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letters   |    
Aripiprazole-Associated Rhabdomyolysis in a Patient With Schizophrenia
Kuo-Yung Chang, M.D., M.P.H.; Yung-Fu Wu, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2011;23:E51-E51.
View Author and Article Information

Dept. of Psychiatry, Beitou Armed Forces Hospital, Taipei, Taiwan

Correspondence: Kuo-Yung Chang, M.D. e-mail: psy6699@yahoo.com.tw

To the Editor: Rhabdomyolysis is a potentially lethal syndrome owing to the lysis of muscle fibers, with release of potentially toxic cellular materials into the systemic circulation.1 Aripiprazole is a recently developed sga with lower incidence of extrapyramidal side effects than placebo in controlled trials.2 Here, we report a patient developing rhabdomyolysis 30 days after the start of aripiprazole therapy, 15 mg/day.

A 31-year-old Taiwanese man with a history of schizophrenia had received risperidone and quetiapine during past outpatient records without adverse extrapyramidal reactions. Recently, he had received quetiapine 400 mg daily for 2 weeks, which was discontinued because of excessive somnolence; he was then switched to aripiprazole 15 mg daily. Within 1 month after initiating aripiprazole, he was found lying on the floor with fluctuating consciousness and muscle weakness. The patient was afebrile (36°c), with blood pressure of 113/68 mmHg, pulse of 120 bpm, and respiratory rate of 18 rpm. Neurological examination revealed intermittent disorientation, slurred and incoherent speech, fluctuating consciousness, and weakness of bilateral lower extremities. Laboratory findings included an elevated CK, peaking at 19,660 IU, and an elevated serum glutamate oxaloacetate transaminase, peaking at 238 IU/liter. His WBC count was 16,620mm3, and a routine urine specimen showed presence of myoglobin. His toxicology screen was negative. NMS was not considered because of the lack of autonomic instability and fever. During the hospitalization, supportive therapies were instituted, with close monitoring and treatment. He was treated with high-volume intravenous solution replacement daily, which improved his consciousness. After 3 days, the serum CK level fell to 6,348 IU and continued to normalize through regular follow-up after discharge.

Aripiprazoile exhibited a novel mechanism of action, combining partial agonist activity at dopamine-2 (D2), dopamine-3 (D3), and serotonin-1A (5-HT1A) receptors, with antagonist activity at serotonin 2A (5-HT2A) receptors.3 The possible mechanism of rhabdomyolysis related to aripiprazole use was the effect of antagonist activity at 5-HT2A receptors4 that exist in adult skeletal muscle. The stimulation of the 5-HT2A receptor caused a rapid stimulation of glucose uptake. It is possible that decreases in the density or blockade of this receptor, which would compromise the uptake of glucose, might lead to changes in the sarcolemma, which increases its permeability to CK. The drugs that produce this type of increase in serum CK activity share relatively more potent 5-HT2A than dopamine D2 receptor antagonism. The patient's rhabdomyolysis was finally resolved after discontinuation of aripiprazole. Because we could only find one case of rhabdomyolysis from aripiprazole treatment in monotherapy in the literature, we could only recommend being aware of the possibility of an individual susceptibility for rhabdomyolysis in every patient taking antipsychotic medication. However, further study should be continued to reinforce this finding.

Luck  RP;  Verbin  S:  Rhabdomyolysis: a review of clinical presentation, etiology, diagnosis, and management.  Pediatr Emerg Care 2008; 24:262–268
[PubMed]
[CrossRef]
 
Marder  SR;  McQuade  RD;  Stock  E  et al:  Aripiprazole in the treatment of schizophrenia: safety and tolerability in short-term, placebo-controlled trials.  Schizophr Res 2003; 61:123–136
[PubMed]
[CrossRef]
 
Naber  D;  Lambert  M:  Aripiprazole: a new atypical antipsychotic with a different pharmacological mechanism.  Prog Neuropsychopharmacol Biol Psychiatry 2004; 28:1213–1219
[PubMed]
[CrossRef]
 
Meltzer  HY:  Massive serum creatine kinase increases with atypical antipsychotic drugs: what is the mechanism and the message? Psychopharmacology (Berlin) 2000; 150:349–350
[CrossRef]
 
References Container
+

References

Luck  RP;  Verbin  S:  Rhabdomyolysis: a review of clinical presentation, etiology, diagnosis, and management.  Pediatr Emerg Care 2008; 24:262–268
[PubMed]
[CrossRef]
 
Marder  SR;  McQuade  RD;  Stock  E  et al:  Aripiprazole in the treatment of schizophrenia: safety and tolerability in short-term, placebo-controlled trials.  Schizophr Res 2003; 61:123–136
[PubMed]
[CrossRef]
 
Naber  D;  Lambert  M:  Aripiprazole: a new atypical antipsychotic with a different pharmacological mechanism.  Prog Neuropsychopharmacol Biol Psychiatry 2004; 28:1213–1219
[PubMed]
[CrossRef]
 
Meltzer  HY:  Massive serum creatine kinase increases with atypical antipsychotic drugs: what is the mechanism and the message? Psychopharmacology (Berlin) 2000; 150:349–350
[CrossRef]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 1

Related Content
Books
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 62.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 62.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 1.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 26.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 26.  >
Topic Collections
Psychiatric News
Read more at Psychiatric News >>
APA Guidelines
PubMed Articles