Olanzapine overdose is associated with acute muscle toxicity

Abstract

Olanzapine is an atypical antipsychotic that is reported to cause myopathy and raised creatine kinase (CK) levels. The prevalence and severity of acute myopathy after deliberate olanzapine ingestion are unclear. Therefore, we reviewed casenotes from 64 consecutive patients admitted to our institution after olanzapine overdose. Overall, serum CK was higher than five times the upper limit of normal in 17% of patients. The prevalence of raised CK values was positively correlated with the stated quantity of olanzapine ingested, suggesting a dose-dependent relationship for acute muscle toxicity. There was an apparent delay of 12 hours or more between olanzapine ingestion and the occurrence of maximum CK. Despite the high prevalence of acute muscle toxicity after olanzapine ingestion, none of the patients developed renal failure.

Keywords

creatine kinase myositis olanzapine rhabdomyolysis serotonin syndrome

References

Fulton B , Goa KL . Olanzapine. A review of its pharmacological properties and therapeutic efficacy in the management of schizophrenia and related psychoses . Drugs 1997; 53: 281–298 .

Beasley CM Jr , Tollefson G , Tran P , Satterlee W , Sanger T , Hamilton S . Olanzapine versus placebo and haloperidol: acute phase results of the North American double-blind olanzapine trial . Neuropsychopharmacology 1996; 14: 111–123 .

Callaghan JT , Bergstrom RF , Ptak LR , Beasley CM . Olanzapine. Pharmacokinetic and pharmacodynamic profile . Clin Pharmacokinet 1999; 37: 177–193 .

Beasley CM Jr , Tollefson GD , Tran PV . Safety of olanzapine . J Clin Psychiatry 1997; 58: 13–17 .

Palenzona S , Meier PJ , Kupferschmidt H , Rauber-Luethy C . The clinical picture of olanzapine poisoning with special reference to fluctuating mental status . J Toxicol Clin Toxicol 2004; 42: 27–32 .

Bhanji NH , Chouinard G , Hoffman L , Margolese HC . Seizures, coma, and coagulopathy following olanzapine overdose . Can J Psychiatry 2005; 50: 126–127 .

Biswasl PN , Wilton LV , Pearcel GL , Freemantle S , Shakir SA . The pharmacovigilance of olanzapine: results of a post-marketing surveillance study on 8858 patients in England . J Psychopharmacol 2001; 15: 265–271 .

Rosebraugh CJ , Flockhart DA , Yasuda SU , Woosley RL . Olanzapine-induced rhabdomyolysis . Ann Pharmacother 2001; 35: 1020–1023 .

Baumgart U , Schmid R , Spiessl H . Olanzapine-induced acute rhabdomyolysis-a case report . Pharmacopsychiatry 2005; 38: 36–37 .

10.

Marcus EL , Vass A , Zislin J . Marked elevation of serum creatine kinase associated with olanzapine therapy . Ann Pharmacother 1999; 33: 697–700 .

11.

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 .

12.

Meltzer HY , Cola PA , Parsa M . Marked elevations of serum creatine kinase activity associated with antipsychotic drug treatment . Neuropsychopharmacology 1996; 15: 395–405 .

13.

Ballesteros S , Martínez MA , Ballesteros MA , Sánchez de la Torre C , Rodríguez Borregán JC . A severe case of olanzapine overdose with whole blood concentrations . J Toxicol Clin Toxicol 2006; 44: 500–501 .

14.

Balicka-Slusarczyk B , Szczeklik J , Szpak D , Groszek B . Clinical course of acute poisoning with olanzapine . Przegla Lekarski 2005; 62: 489–491 .

15.

Filice GA , McDougall BC , Ercan-Fang N , Billington CJ . Neuroleptic malignant syndrome associated with olanzapine . Ann Pharmacother 1998; 32: 1158–1159 .

16.

Nyfort-Hansen K , Alderman CP . Possible neuroleptic malignant syndrome associated with olanzapine . Ann Pharmacother 2000; 34: 667-667 .

17.

Kogoj A , Velikonja I . Olanzapine induced neuroleptic malignant syndrome: a case review . Hum Psychopharmacol 2003; 18: 301–309 .

18.

Hanft A , Eggleston CF , Bourgeois JA . Neuroleptic malignant syndrome in an adolescent after brief exposure to olanzapine . J Child Adolesc Psychopharmacol 2004; 14: 481–487 .

19.

Haslett CD , Kumar S . Can olanzapine be implicated in causing serotonin syndrome? Psychiatry Clin Neurosci 2002; 56: 533–535 .

20.

Duggal HS , Fetchko J . Serotonin syndrome and atypical antipsychotics . Am J Psychiatry 2002; 159: 672–673 .

21.

Broyd C , McGuinness A . Pontine haemorrhage mimicked by an olanzapine overdose . Emerg Med J 2006; 23: e29-e29 .

22.

Theisen FM , Grabarkiewicz J , Fegbeutel C , Hubner A , Mehler-Wex C , Remschmidt H . Olanzapine overdose in children and adolescents: two case reports and a review of the literature . J Child Adolesc Psychopharmacol 2005; 15: 986–995 .

23.

Yip L , Dart RC , Graham K . Olanzapine toxicity in a toddler . Pediatrics 1998; 102: 1494-1494 .

24.

Guis S , Mattei JP , Cozzone PJ , Bendahan D . Pathophysiology and clinical presentations of rhabdomyolysis . Joint Bone Spine 2005; 72: 382–389 .

25.

Sulowicz W , Walatek B , Sydor A , Ochmanski W , Milkowski A , Szymczakiewicz-Multanowska , Szumilak D , Krasniak A , Lonak H . Acute renal failure in patients with rhabdomyolysis . Med Sci Monit 2002; 8: CR24–7 .

26.

David WS . Myoglobinuria . Neurol Clin 2000; 18: 215–243 .

27.

Pasternak RC , Smith SC Jr , Bairey-Merz CN , Grundy SM , Cleeman JI , Lenfant C . American College of Cardiology; American Heart Association; National Heart, Lung and Blood Institute (ACC/AHA/NHLBI) clinical advisory on the use and safety of statins . Stroke 2002; 33: 2337–2341 .

28.

Staffa JA , Chang J , Green L . Cerivastatin and reports of fatal rhabdomyolysis . New Engl J Med 2002; 346: 539–540 .

29.

Walubo A , Seger D . Fatal multi-organ failure after suicidal overdose with MDMA, ‘ecstasy’: case report and review of the literature . Hum Exp Toxicol 1999; 18: 119–125 .

30.

Laurence AS , Wight J , Forrest AR . Fatal theophylline poisoning with rhabdomyolysis . Anaesthesia 1992; 47: 82-82 .

31.

Bywaters EG . 50 years on: the crush syndrome . Br Med J 1990; 301: 1412–1415 .

32.

Brown CV , Rhee P , Chan L , Evans K , Demetriades D , Velmahos GC . Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference? J Trauma 2004; 56: 1191–1196 .

33.

Black HR , Quallich H , Gareleck CB . Racial differences in serum creatine kinase levels . Am J Med 1986; 81: 479–487 .

34.

Lott JA , Abbott LB . Creatine kinase isoenzymes . Clin Lab Med 1986; 6: 547–576 .

35.

Terao T , Matsuda S , Kojima H , Okuno K , Hori H , Kaku A , Veda N , Etoh A . Incidence and risk factors of benign creatine phosphokinase elevations in chronic psychiatric patients . Neuropsychobiology 1999; 39: 173–180 .

36.

Oliver JJ , Kelly C , Jarvie D , Denieul S , Bateman DN . Venlafaxine poisoning complicated by a late rise in creatine kinase: two case reports . Hum Exp Toxicol 2002; 21: 463–466 .

37.

Clarkson PM , Kearns AK , Rouzier P , Rubin R , Thompson PD . Serum creatine kinase levels and renal function measures in exertional muscle damage . Med Sci Sports Exerc 2006; 38: 623–627 .

38.

Meltzer HY , Matsubara S , Lee JC . Classification of typical and atypical antipsychotic drugs on the basis of dopamine D-1, D-2 and serotonin2 pKi values . J Pharmacol Exp Therapeut 1989; 251: 238–246 .

39.

Hajduch E , Rencurel F , Balendran A , Batty IH , Downes CP , Hundal HS . Serotonin (5-hydroxytryptamine), a novel regulator of glucose transport in rat skeletal muscle . J Biol Chem 1999; 274: 13563–13568 .

40.

Meltzer HY . Massive serum creatine kinase increases with atypical antipsychotic drugs: what is the mechanism and the message? Psychopharmacology 2000; 150: 349–350 .

41.

Elian AA . Fatal overdose of olanzepine . Forens Sci Int 1998; 91: 231–235 .

42.

Anderson RJ , Barry DW . Clinical and laboratory diagnosis of acute renal failure . Best Pract Res: Clin Anaesthesiol 2004; 18: 1–20 .