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Acute Dystonia With Rhabdomyolysis Induced by Paliperidone Palmitate: A Rare Adverse Effect

Antipsychotic medications have been well-established to potentially cause extrapyramidal side effects (EPS) including hyperkinesia, tremor, dyskinesia, dystonia, and parkinsonism. Rhabdomyolysis secondary to extrapyramidal symptoms in patients under antipsychotics is a relatively rare presentation t...

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Autores principales: Allena, Nishant, Doppalapudi, Sai, Khanal, Sneha, Tank, Steven, Nasr, Rabih
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9531761/
https://www.ncbi.nlm.nih.gov/pubmed/36225523
http://dx.doi.org/10.7759/cureus.28771
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author Allena, Nishant
Doppalapudi, Sai
Khanal, Sneha
Tank, Steven
Nasr, Rabih
author_facet Allena, Nishant
Doppalapudi, Sai
Khanal, Sneha
Tank, Steven
Nasr, Rabih
author_sort Allena, Nishant
collection PubMed
description Antipsychotic medications have been well-established to potentially cause extrapyramidal side effects (EPS) including hyperkinesia, tremor, dyskinesia, dystonia, and parkinsonism. Rhabdomyolysis secondary to extrapyramidal symptoms in patients under antipsychotics is a relatively rare presentation to be observed in patients.  In this report, we present a 64-year-old female with rhabdomyolysis following a once-monthly injection of long-acting injectable (LAI) paliperidone palmitate (Invega Sustenna). The patient developed extrapyramidal symptoms one day after the paliperidone injection. She presented with acute dystonia in the form of antecollis, without any evidence of generalized myalgia or kidney involvement. Laboratory investigations demonstrated a creatine kinase (CK) level of 3239 unit/L on admission. The patient’s symptoms were resolved after the administration of benztropine and cyclobenzaprine and CK levels improved after IV hydration. A high index of suspicion in the investigation of rhabdomyolysis for patients presenting with extrapyramidal symptoms being treated with long-acting injectable antipsychotics leads to prompt diagnosis, early treatment, and reduction in renal and cardiac toxicities in the aforementioned population. 
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spelling pubmed-95317612022-10-11 Acute Dystonia With Rhabdomyolysis Induced by Paliperidone Palmitate: A Rare Adverse Effect Allena, Nishant Doppalapudi, Sai Khanal, Sneha Tank, Steven Nasr, Rabih Cureus Internal Medicine Antipsychotic medications have been well-established to potentially cause extrapyramidal side effects (EPS) including hyperkinesia, tremor, dyskinesia, dystonia, and parkinsonism. Rhabdomyolysis secondary to extrapyramidal symptoms in patients under antipsychotics is a relatively rare presentation to be observed in patients.  In this report, we present a 64-year-old female with rhabdomyolysis following a once-monthly injection of long-acting injectable (LAI) paliperidone palmitate (Invega Sustenna). The patient developed extrapyramidal symptoms one day after the paliperidone injection. She presented with acute dystonia in the form of antecollis, without any evidence of generalized myalgia or kidney involvement. Laboratory investigations demonstrated a creatine kinase (CK) level of 3239 unit/L on admission. The patient’s symptoms were resolved after the administration of benztropine and cyclobenzaprine and CK levels improved after IV hydration. A high index of suspicion in the investigation of rhabdomyolysis for patients presenting with extrapyramidal symptoms being treated with long-acting injectable antipsychotics leads to prompt diagnosis, early treatment, and reduction in renal and cardiac toxicities in the aforementioned population.  Cureus 2022-09-04 /pmc/articles/PMC9531761/ /pubmed/36225523 http://dx.doi.org/10.7759/cureus.28771 Text en Copyright © 2022, Allena et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Allena, Nishant
Doppalapudi, Sai
Khanal, Sneha
Tank, Steven
Nasr, Rabih
Acute Dystonia With Rhabdomyolysis Induced by Paliperidone Palmitate: A Rare Adverse Effect
title Acute Dystonia With Rhabdomyolysis Induced by Paliperidone Palmitate: A Rare Adverse Effect
title_full Acute Dystonia With Rhabdomyolysis Induced by Paliperidone Palmitate: A Rare Adverse Effect
title_fullStr Acute Dystonia With Rhabdomyolysis Induced by Paliperidone Palmitate: A Rare Adverse Effect
title_full_unstemmed Acute Dystonia With Rhabdomyolysis Induced by Paliperidone Palmitate: A Rare Adverse Effect
title_short Acute Dystonia With Rhabdomyolysis Induced by Paliperidone Palmitate: A Rare Adverse Effect
title_sort acute dystonia with rhabdomyolysis induced by paliperidone palmitate: a rare adverse effect
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9531761/
https://www.ncbi.nlm.nih.gov/pubmed/36225523
http://dx.doi.org/10.7759/cureus.28771
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