title: Rhabdomyolysis in Clozapine Overdose.
abstract: BACKGROUND
  Clozapine is used for decennia for the treatment of schizophrenia. Agranulocytosis, diabetic ketoacidosis, gastrointestinal hypomotility, and myocarditis are well-known adverse effects of clozapine, which are sometimes life threatening. Here we report a case of rhabdomyolysis upon an acute overdose of clozapine.
  
  
  METHODS
  A male patient, 36 years, with elevated creatinine kinase levels (9899 U/l), developed rhabdomyolysis afterafter admission to the emergency department. Approximately 2-4 h earlier he had intoxicated himself with his maintenance oral medication clozapine 125 mg, temazepam 20 mg and lorazepam 1.5 mg. Co-medications, and physical and laboratory examinations did not reveal other risk factors for rhabdomyolysis. According to the Naranjo probability scale there was a probable relation between clozapine dose and symptoms, that developed approximately 2-4 h after the auto-intoxication of 125 mg tablets. At day 5 of hospitalization, clozapine and creatinine kinase levels returned to normal and the patient was discharged with no somatic sequelae.
  
  
  CONCLUSIONS
  Elevated creatinine kinase levels in acute clozapine intoxication may be an indicator that rhabdomyolysis may be involved.
authors.affiliation: Department of Clinical Pharmacy, Deventer Hospital, Nico Bolkesteinlaan 75, Deventer, 7416 SE, The Netherlands. f.g.a.jansman@dz.nl.|Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands. f.g.a.jansman@dz.nl.
authors.forename: Frank G A
authors.initials: FG
authors.lastname: Jansman
authors.affiliation: Department of Clinical Pharmacy, Deventer Hospital, Nico Bolkesteinlaan 75, Deventer, 7416 SE, The Netherlands.
authors.forename: Heleen A
authors.initials: HA
authors.lastname: Crommelin
authors.affiliation: Department of Emergency Medicine, Deventer Hospital, Deventer, The Netherlands.
authors.forename: Freek J A H
authors.initials: FJ
authors.lastname: van Hout
authors.affiliation: Department of Intensive Care Center and National Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Meulenbelt