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Clozapine and myopathic dysfunction: is creatinine kinase an important parameter to measure?

Published online by Cambridge University Press:  01 September 2022

P. Barbosa ,
M. Remelhe ,
Â. Venâncio  and
L. Ribeiro
P. Barbosa*
Affiliation:
Centro Hospitalar de Vila Nova de Gaia/Espinho, Psychiatry, Vila Nova de Gaia, Portugal
M. Remelhe
Affiliation:
Centro Hospitalar de Vila Nova de Gaia, Psychiatry, Vila Nova de Gaia, Portugal
Â. Venâncio
Affiliation:
Vila Nova de Gaia Hospital Center, Psychiatry And Mental Health Service, Vila Nova de Gaia, Portugal
L. Ribeiro
Affiliation:
Vila Nova de Gaia Hospital Center, Psychiatry And Mental Health Service, Vila Nova de Gaia, Portugal
*
*Corresponding author.

Abstract

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Introduction

There have been reports of myopathic dysfunction with creatinine kinase (CK) elevation associated with neuroleptics, particularly, in clozapine-treated patients. The patients in these reports did not have any other clinical symptoms or signs indicative of neuropleptic malignant syndrome. Myopathic dysfunction was supported by the presence of CK elevations and either proximal limb weakness or fatigue, characteristic electrophysiologic abnormalities, or both. It has also been reported that CK elevation is neither dose nor treatment-duration dependent. The underlying mechanism is still unknown although it has been postulated that it is associated with cytochrome P450 interactions and/or calmodulin antagonism.

Objectives

To report a case of elevation of CK during treatment with clozapine.

Methods

The authors report a case of elevation of CK during treatment with clozapine. A non-systematic review was conducted by searching the PubMed database, using the terms “clozapine”, “myotoxicity”.

Results

A 36-year-old man was admitted after abandoning treatment with clozapine. During the titration of the medication, he developed complaints of muscle fatigue in conjunction with an elevation of CK. CK levels normalized after intravenous hydration and with dose reduction. Furthermore, CK levels would increase with clozapine re-titration.

Conclusions

Clozapine has numerous side effects. Myopathic dysfunction with CK elevation is a possible side effect which could have serious consequences such as renal impairment. In such cases, appropriate treatment should be implemented. Therefore, clinicians should be aware of this potential side effect.

Disclosure

No significant relationships.

Keywords

Myopathic DysfunctionclozapineCK elevation
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S883
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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