Alcohol-Clozapine Synergism Triggering Rhabdomyolysis at Subtoxic Levels: a case report and literature review

Wenzhen Zhou^1,2Yuxin Sun¹Mingcheng Dai¹Senlin Ma¹Qiuxin Lu¹Junwei Qian¹Zhaoming Shang¹Kangshuai Zhou¹Mingquan Chen^1,3*Xiaofei Jiang^4*

• ¹Department of Emergency, Huashan Hospital, Fudan University, Shanghai, China
• ²Shanghai Institute of Infectious Disease and Biosecurity, 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 one day after consuming 500g liquor followed by ingestion of 8 clozapine tablets (200mg 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.