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Delayed-Onset olanzapine-induced rhabdomyolysis
  1. Jun Hua Bowen Lim,
  2. Billy Robinson and
  3. Judith Savige
  1. General Medicine, The Northern Hospital, Epping, Victoria, Australia
  1. Correspondence to Dr Jun Hua Bowen Lim; Bowenlimjh{at}


Olanzapine is a commonly used and effective second-generation antipsychotic agent used for the control of paranoia and agitation in schizophrenia and bipolar disorder as well as in the behavioural and psychological symptoms of dementia. Serious side effects of treatment are uncommon but spontaneous rhabdomyolysis represents a rare complication. We describe here a patient treated with a stable dose of olanzapine for more than 8 years who developed acute severe rhabdomyolysis without an identifiable trigger and without features suggestive of neuroleptic malignant syndrome. The rhabdomyolysis was atypical in its delayed onset and severity with a creatine kinase level of 345 125 U/L, the highest level reported in the available literature. We also describe the clinical manifestations of delayed-onset olanzapine-induced rhabdomyolysis and its differentiation from neuroleptic malignancy syndrome, and we highlight key aspects of management to prevent or minimise further complications such as acute kidney injury.

  • Drugs and medicines
  • Renal system
  • Unwanted effects / adverse reactions
  • Psychiatry
  • Dialysis

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  • Contributors JHBL, BR and JS were directly involved in the care of the patient who kindly allowed the opportunity to publish his case. JHBL and JS were involved in the process of consenting the patient for this case report. JHBL, BR and JS were involved in the decision to publish the case report. JHBL gathered the data and drafted the report. BR and JS helped with revisions to the case report. JS gave final approval of the manuscript for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.