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Clozapine-induced myotoxicity in patients with chronic psychotic disorders

From the Departments of Neurology (Drs. Scelsa, Simpson, and Reichler) and Psychiatry (Drs. McQuistion and Fineman, and K. Ault), the Mount Sinai Medical Center, New York; and Project Renewal, Inc. (Dr. McQuistion); and the Department of Neurology, Montefiore Medical Center, New York (Dr. Scelsa).
Presented in part at the 47th annual meeting of the American Academy of Neurology, Seattle, WA, May 6-13, 1995.
Received February 23, 1996. Accepted in final form May 8, 1996.
Address correspondence and reprint requests to Dr. Stephen N. Scelsa, Clinical EMG Laboratory, Department of Neurology, Montefiore Medical Center, 111 E. 210th Street, Bronx, NY 10467.

Muscle dysfunction related to clozapine treatment is largely unrecognized.We evaluated weekly creatine kinase (CK) levels in 37 consecutive clozapine-treated outpatients with chronic psychotic disorders. Those with CK elevations underwent clinical neurologic evaluation, electromyography (EMG), and nerve conduction studies. Patients with probable myopathy had a quadriceps muscle biopsy. Twenty control patients had a single CK level determination. Twenty-nine of 37 clozapine-treated patients had CK elevations. Three patients had extreme CK elevations (>20,000 IU/L), without myoglobinuria. Mean CK levels were significantly greater in clozapine patients (194 IU/L) than in control patients (142.3, p = 0.033). Of 18 clozapine-treated patients evaluated clinically, 6 had mild proximal weakness. EMG in 13 patients was myopathic in 5, normal in 5, and neurogenic in 3. Muscle biopsy in 5 patients showed rare regenerating myofibers and mild acute denervation (1), mild type II fiber atrophy (1), minimal acute denervation (1), and normal muscle (2). In conclusion, clozapine therapy may be associated with CK elevations and, rarely, mild myopathy.

NEUROLOGY 1996;47: 1518-1523

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