Key result
The introduction of mirtazapine and increase of quetiapine induced severe rhabdomyolysis in a 40-year-old military soldier, likely due to 5-HT2A receptor inhibition combined with muscle training.
Case Report (n=1)
No
The combination of mirtazapine and quetiapine, along with muscle training, may induce severe rhabdomyolysis, highlighting the need for caution when adjusting psychotropic medications in athletic populations.
Suggests possible rhabdomyolysis risk with mirtazapine-quetiapine during intense training; leaves open 5-HT2A inhibition as mechanism.
Rhabdomyolysis is a potential complication of psychotropic drugs use and may potentially lead to life-threatening complications, such as an acute renal failure. We describe the case of a 40-year-old military soldier suffering from post-traumatic stress disorder was admitted for an adaptation of his treatment. Mirtazapine was introduced and quetiapine increased. Two days later, the patient presented with severe rhabdomyolysis syndrome. Mirtazapine administration was paused and intravenous hydration commenced. Shortly after the creatine kinase levels decreased enabling mirtazapine to be reintroduced without complication. It is our opinion that 5-hydroxytryptamine 2a serotonergic receptors inhibition (related to mirtazapine and quetiapine) associated with muscle training was responsible for inducing rhabdomyolysis. This must be kept in mind when psychotropic medications are adjusted, especially in an athletic population such as military.
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Saguin et al. (2018) conducted a case report in Post-traumatic stress disorder (n=1). Mirtazapine and quetiapine was evaluated on Severe rhabdomyolysis syndrome. The introduction of mirtazapine and increase of quetiapine induced severe rhabdomyolysis in a 40-year-old military soldier, likely due to 5-HT2A receptor inhibition combined with muscle training.
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