Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by YANG, S. H. Articles by McNEELY, M. J. Search for Related Content PubMed Citation Articles by YANG, S. H. Articles by McNEELY, M. J. Atypical Neuroleptics Schizophrenia Spectrum Disorders

Rhabdomyolysis, Pancreatitis, and Hyperglycemia With Ziprasidone

To the Editor: Atypical antipsychotics have been associated with neuroleptic malignant syndrome, rhabdomyolysis, pancreatitis, and type 2 diabetes mellitus (1–3). We describe what we believe to be the first report of these complications attributed to the newer atypical antipsychotic agent ziprasidone. This case was reported to the Food and Drug Administration’s MedWatch.

Ms. A, a middle-aged woman with schizoaffective disorder, had been treated for many years with clozapine, risperidone, and lithium. She had no history of diabetes mellitus, renal disease, pancreatitis, or substance abuse. Two weeks before admission, her risperidone therapy was discontinued, and ziprasidone treatment, 40 mg/day, was initiated. Ms. A was admitted for an altered mental status with a decreased level of consciousness, agitation, and disorientation. Her body temperature was 38.5°C (her maximum temperature was 41.3°C on hospital day 3), her blood pressure was 160/100 mm Hg, and her pulse was 112 bpm. She had no muscle rigidity at admission or during her hospital course.

Results of a physical examination were otherwise unremarkable. Results of laboratory studies included a negative toxicology screen and alcohol level; a low lithium level; an elevated WBC count (15,000 cells/µl); negative urine, blood, and CSF cultures; an elevated creatinine level (1.8 mg/dl, which peaked at more than 7 mg/dl on hospital day 7); an elevated glucose level (250 mg/dl, which increased to 980 mg/dl a day later); a creatinine kinase level of more than 64,000 U/liter during the first week in the hospital; and a sevenfold increase in pancreatic amylase with pancreatic inflammation found on an abdominal computerized tomography scan.

Ms. A’s ziprasidone and lithium treatments were discontinued. Clozapine was initially discontinued but was later restarted for severe psychosis. Ms. A’s mental status returned to its baseline level, and her pancreatitis resolved. Hemodialysis was required for 1 week, after which renal function gradually returned. Severe hyperglycemia without ketoacidosis was managed with intravenous insulin, initially requiring up to 200 units over 24 hours. Over 3 weeks the hyperglycemia gradually improved until diabetes medication was no longer required.

The patient’s rhabdomyolysis, hypertension, and fever associated with the initiation of ziprasidone treatment suggest neuroleptic malignant syndrome, although the patient never had muscle rigidity. An absence of muscle rigidity with neuroleptic malignant syndrome has been reported (4, 5). This case illustrates the possibility of adverse reactions to ziprasidone, which are similar to those associated with other atypical neuroleptics.

References

1. Wirshing DA: Adverse effects of atypical antipsychotics. J Clin Psychiatry 2001; 62(suppl 21):7-10
2. Doucette DE, Grenier JP, Robertson PS: Olanzapine-induced acute pancreatitis. Ann Pharmacother 2000; 34:1128-1131[Abstract]
3. Hasan S, Buckley P: Novel antipsychotics and the neuroleptic malignant syndrome: a review and critique. Am J Psychiatry 1998; 155:1113-1116[Abstract/Free Full Text]
4. Benazzi F: Neuroleptic malignant syndrome without rigidity (letter). Ital J Neurol Sci 1991; 12:121[Medline]
5. Wong MM: Neuroleptic malignant syndrome: two cases without muscle rigidity. Aust N Z J Psychiatry 1996; 30:415-418[Medline]

This article has been cited by other articles:

				A. N Zaidi Rhabdomyolysis After Correction of Hyponatremia in Psychogenic Polydipsia Possibly Complicated by Ziprasidone Ann. Pharmacother., October 1, 2005; 39(10): 1726 - 1730. [Abstract] [Full Text] [PDF]

				P. Cavazzoni, N. Mukhopadhyay, C. Carlson, A. Breier, and J. Buse Retrospective analysis of risk factors in patients with treatment-emergent diabetes during clinical trials of antipsychotic medications The British Journal of Psychiatry, April 1, 2004; 184(47): s94 - s101. [Abstract] [Full Text] [PDF]

				L. H. Beebe Health Promotion in Persons with Schizophrenia: Atypical Medications Journal of the American Psychiatric Nurses Association, August 1, 2003; 9(4): 115 - 122. [Abstract] [PDF]

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by YANG, S. H. Articles by McNEELY, M. J. Search for Related Content PubMed Citation Articles by YANG, S. H. Articles by McNEELY, M. J. Atypical Neuroleptics Schizophrenia Spectrum Disorders

Get information about faster international access.

Privacy Policy

Copyright © 2002 American Psychiatric Association. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us