I'm hoping to get your opinions on this case. Case involves a 20 year old man with schizophrenia who was fairly treatment naive. Psychosis started over the last 6 months. He was previously on short trials of Zyprexa, but would stop after a few days of hospital discharge and end up getting rehospitalized. He was switched to Invega during his last hospital stay which was helpful. He transitioned to Sustenna, receiving the initial 234 and 156 loading doses; he stabilized and discharged.
Unfortunately, he developed NMS shortly after, was medically hospitalized, and the anti-psychotic was stopped. Now medically stable, transferred to the psychiatric unit. Creatine Kinase has remained mildly elevated, ranging from 500-2000 over the last 3 weeks. He is now approximately 4 weeks out from the initial NMS presentation and restarting an antipsychotic has not occurred with CK still elevated. He is getting scheduled benzodiazepines for control of anxiety/irritability, and for sedation because he is very psychotic and angry that he is in the hospital.
He is not overexerting himself or engaging in any physical activity that could account for this ongoing CK elevation, I don't think. He does pace the hallway listening to music, but no more than a typical patient. Outside of CK elevation he has no other symptoms of NMS, cbc/cmp normal, no fever, no rigidity, vitals stable/normal.
I'm interested in opinions on this case. Could the Invega Sustenna be causing ongoing low level CK elevation. He is about 6-7 weeks out from the 156 mg loading dose, but Invega Sustenna takes several months to completely clear from the body, and there is likely still some amount of the medication present in very low amounts even 48 weeks out after initial loading doses (this is based on the manufacturers website).
Could the ongoing CK elevation be accounted for with him simply pacing the halls listening to music?
Ideally his CK would fall into the normal range for some time before moving forward with restarting an antipsychotic. How would you proceed in this situation? How long have you seen elevated CK following NMS?
Planning to reengage the hospitalists with this patient to assure no other medical issues might be causing CK elevation.
Unfortunately, he developed NMS shortly after, was medically hospitalized, and the anti-psychotic was stopped. Now medically stable, transferred to the psychiatric unit. Creatine Kinase has remained mildly elevated, ranging from 500-2000 over the last 3 weeks. He is now approximately 4 weeks out from the initial NMS presentation and restarting an antipsychotic has not occurred with CK still elevated. He is getting scheduled benzodiazepines for control of anxiety/irritability, and for sedation because he is very psychotic and angry that he is in the hospital.
He is not overexerting himself or engaging in any physical activity that could account for this ongoing CK elevation, I don't think. He does pace the hallway listening to music, but no more than a typical patient. Outside of CK elevation he has no other symptoms of NMS, cbc/cmp normal, no fever, no rigidity, vitals stable/normal.
I'm interested in opinions on this case. Could the Invega Sustenna be causing ongoing low level CK elevation. He is about 6-7 weeks out from the 156 mg loading dose, but Invega Sustenna takes several months to completely clear from the body, and there is likely still some amount of the medication present in very low amounts even 48 weeks out after initial loading doses (this is based on the manufacturers website).
Could the ongoing CK elevation be accounted for with him simply pacing the halls listening to music?
Ideally his CK would fall into the normal range for some time before moving forward with restarting an antipsychotic. How would you proceed in this situation? How long have you seen elevated CK following NMS?
Planning to reengage the hospitalists with this patient to assure no other medical issues might be causing CK elevation.
