Alcohol-clozapine synergism triggering rhabdomyolysis at subtoxic levels - a case report and literature review

Sep 28, 2026

Uploaded by Margaret

Alcohol-clozapine synergism causing rhabdomyolysis is documented through a clinical case in which therapeutic-dose clozapine was taken after alcohol intake without reaching toxic clozapine concentrations. A 39-year-old male developed impaired consciousness, and toxicology confirmed subtoxic clozapine levels while laboratory results showed rhabdomyolysis, acute kidney injury, and myocardial damage. Hemopurification and fluid resuscitation improved consciousness, creatine kinase, renal function, and cardiac enzymes, with recovery to normal ranges by 15 days. Findings support dynamic CK and myoglobin monitoring and early blood purification to interrupt the rhabdomyolysis-renal injury cascade.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Background and rationale

Case presentation

Patient presentation and toxicology

Laboratory findings and management

Clinical outcome and follow-up

Conclusion

Monitoring and early intervention recommendations

TYPE Case Report PUBLISHED 17 December 2025 DOI 10.3389/ftox.2025.1692362 OPEN ACCESS EDITED BY Ulises Coffeen, National Institute of Psychiatry Ramon de la Fuente Muñiz (INPRFM), Mexico REVIEWED BY Antonina Argo, University of Palermo, Italy Johanna Catherine Catherine Ruiz Castillo, Cooperative University of Colombia, Colombia Mareli Vazquez, General Hospital of Mexico, Mexico *CORRESPONDENCE Mingquan Chen, [mingquanchen@fudan.edu.cn](mingquanchen@fudan.edu.cn)[ ](mingquanchen@fudan.edu.cn)Xiaofei Jiang, [sule_jiang@126.com](sule_jiang@126.com) †These authors have contributed equally to this work and share first authorship. RECEIVED 25 August 2025 REVISED 05 November 2025 ACCEPTED 11 November 2025 PUBLISHED 17 December 2025 CITATION Zhou W, Sun Y, Dai M, Ma S, Lu Q, Qian J, Shang Z, Zhou K, Chen M and Jiang X (2025) Alcohol-clozapine synergism triggering rhabdomyolysis at subtoxic levels: a case report and literature review. Front. Toxicol. 7:1692362 . doi: 10.3389/ftox.2025.1692362 COPYRIGHT © 2025 Zhou, Sun, Dai, Ma, Lu, Qian, Shang, Zhou, Chen and Jiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Alcohol-clozapine synergism triggering rhabdomyolysis at subtoxic levels: a case report and literature review Wenzhen Zhou 1†, Yuxin Sun 2†, Mingcheng Dai 2†, Senlin Ma 2, Qiuxin Lu 2, Junwei Qian 2, Zhaoming Shang 2, Kangshuai Zhou 2, Mingquan Chen 2,3* and Xiaofei Jiang 4* 1Department of Emergency, Huashan Hospital, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China, 2Department of Emergency, Huashan Hospital, Fudan University, Shanghai, China, 3Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China, 4Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China Background: While excessive oral intake of clozapine is known to cause severe complications, this case report highlights that even conventional doses of clozapine ingested after alcohol consumption–without reaching toxic concentrations–can lead to the rare complication of rhabdomyolysis when synergistic effects occur between the two substances. Case presentation: We report a case of a 39-year-old male patient who presented with impaired consciousness 1 day after consuming 500 g liquor followed by ingestion of 8 clozapine tablets (200 mg total) . Toxicology screening upon admission indicated subtoxic levels of clozapine. Laboratory findings confirmed rhabdomyolysis, acute kidney injury, and myocardial damage. During hospitalization, the patient underwent hemopurification and fluid resuscitation. His consciousness improved significantly, accompanied by marked improvement in creatine kinase (CK) levels, renal function, and cardiac enzymes. At 15-day follow-up, renal function, CK levels, and cardiac enzymes had returned to within normal limits. Conclusion: In patients consuming clozapine after alcohol intake, dynamic monitoring of CK and myoglobin should be implemented regardless of whether toxicology results are within normal limits. Early implementation of blood purification can effectively disrupt the rhabdomyolysis-renal injury cascade, thereby securing a critical therapeutic window for clinical intervention. KEYWORDS clozapine, rhabdomyolysis, drug synergism, ethanol, adverse drug reaction 1 Introduction Clozapine, a second-generation antipsychotic drug classified as a dibenzodiazepin

FAQs

What clinical scenario is described in the case report?

The report describes a 39-year-old male who consumed alcohol (liquor) and then ingested clozapine at a total dose of 200 mg, followed by impaired consciousness 1 day later.

What did the toxicology and laboratory tests show?

Toxicology screening showed subtoxic clozapine levels. Laboratory findings confirmed rhabdomyolysis, acute kidney injury, and myocardial damage.

What treatment was used and what was the outcome?

The patient received hemopurification and fluid resuscitation. Consciousness improved, creatine kinase, renal function, and cardiac enzymes markedly improved, and at 15-day follow-up results returned to within normal limits.

Sep 28, 2026

Uploaded by Margaret