Massive Creatine Kinase Elevations with Quetiapine: Report of Two Cases

Massive elevations of serum creatine kinase (CK) can occur in a significant number of patients treated with neuroleptics in the absence of neuroleptic malignant syndrome (NMS). We report two cases of CK-elevations associated with quetiapine treatment, which disappeared after drug discontinuation. To our knowledge, case number one is the first case of quetiapine-induced CK elevation in a neuroleptic-naïve patient. We thus suggest CK assessment when myalgia occurs with neuroleptic treatment.

References

• 1 Adnet P, Lestavel P, Krivosic-Horber R. Neuroleptic malignant syndrome.  Br J Anaesth. 2000;  85 129-135
• 2 Boot E, de Haan L. Massive increase in serum creatine kinase during olanzapine and quetiapine treatment, not during treatment with clozapine.  Psychopharmacology. 2000;  150 347-348
• 3 Devarajan S, Dursum S M. Antipsychotic drugs, serum creatine kinase (CPK) and possible mechanisms.  Psychopharmacology. 2000;  152 122
• 4 Holtmann M, Meyer A E, Pitzer M, Schmidt M H. Risperidone-induced marked elevation of serum creatine kinase in adolescence. A case report.  Pharmacopsychiatry. 2003;  36 317-318
• 5 Keshavan M S, Stecker J, Kambhampati R K. Creatine kinase elevations with clozapine.  Br J Psychiatry. 1994;  164 118-120
• 6 Kirson J L, McQuistion H L, Pierce D W. Severe elevations in serum creatine kinase associated with clozapine.  J Clin Psychopharmacol. 1995;  15 287-288
• 7 Marcus E L, Vass A, Zislin J. Marked elevation of creatine kinase associated with olanzapine therapy.  Ann Pharmacother. 1999;  33 697-700
• 8 Meltzer H Y. Massive serum creatine kinase increases with atypical antipsychotic drugs: what is the mechanism and the message?.  Psychopharmacology. 2000;  150 349-350
• 9 Meltzer H Y, Cola P A, Parsa M. Marked elevations of serum creatine kinase activity associated with antipsychotic drug treatment.  Neuropsychopharmacology. 1996;  15 395-405
• 10 Reznik I, Volchek L, Mester R, Kotler M, Sarova-Pinhas I, Spivak B, Weizman A. Myotoxicity and neurotoxicity during clozapine treatment.  Clin Neuropharmacology. 2000;  23 276-280
• 11 Rosebraugh C J, Flockhart D A, Yasuda S U, Woosley R L. Olanzapine-induced rhabdomyolysis.  Ann Pharmacother. 2001;  35 020-1023
• 12 Roth D, Alarcon F J, Fernandez J A, Preston R A, Bourgoignie J J. Acute rhabdomyolysis associated with cocaine intoxication.  N Engl J Med. 1988;  319 673-677
• 13 Sass H, Houben I. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. [dt.] Göttingen; Hogrefe 1996: p 832
• 14 Scelsa S N, Simpson D M, McQuistion H L, Fineman A, Ault K, Reichler B. Clozapine-induced myotoxicity in patients with chronic psychotic disorders.  Neurology. 1996;  47 1518-1523
• 15 Sieb J P, Gillessen T. Iatrogenic and toxic myopathies.  Muscle Nerve. 2002;  27 142-156