Rhabdomyolysis has been reported as a rare adverse effect of psychotropic use. This paper presents a case of rhabdomyolysis in a 39-year-old man with depression and substance use disorder. He had been started on quetiapine two months before and mirtazapine two weeks before developing symptoms of pain and weakness. His creatine kinase (CK) was elevated to 5870 U/L, with no other contributing factors elicited. He improved with symptomatic treatment along with cessation of psychotropics. A literature review on rhabdomyolysis associated with quetiapine and/or mirtazapine therapy found 12 cases with quetiapine, one case with mirtazapine, and three cases with quetiapine and mirtazapine combination treatment. The majority were men, aged 19 to 70 years old. There was no clear correlation between dose and maximum CK levels, and the time to onset of symptoms varied from two days to eight months. The proposed mechanism is a serotoninergic or dopaminergic blockade. Rhabdomyolysis associated with quetiapine or mirtazapine can occur even at therapeutic doses and clinicians should be aware of this potentially life-threatening adverse effect.
Keywords: adverse drug reaction; antidepressant; antipsychotic; creatine kinase; mirtazapine; quetiapine; rhabdomyolysis.
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