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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by tina on July 18, 2000, at 17:46:30
Hey Cam: Just wondering if you have a second to tell me about AD's and elevated CPK levels in the liver. It seems my doc tells me that mine are way too high and that I might have to go off meds altogether. Won't know for sure until doc appt tomorrow but a bit of info would be nice. Thank you hun.
Hugs
Tina
Posted by Cam W. on July 18, 2000, at 22:17:28
In reply to CPK level increase--CamW?????, posted by tina on July 18, 2000, at 17:46:30
Sorry Tina - That's a hospital pharmacy question. I think CPK stands for creatinin phospokinase. I think it is the enzyme that breaks down creatinin (&/or creatine?). The protein creatine is used in the movement of muscles (I think). I really do not know the implications of high CPK levels though.
Sorry - Cam
Posted by Sunnely on July 19, 2000, at 0:22:25
In reply to CPK level increase--CamW?????, posted by tina on July 18, 2000, at 17:46:30
> Hey Cam: Just wondering if you have a second to tell me about AD's and elevated CPK levels in the liver. It seems my doc tells me that mine are way too high and that I might have to go off meds altogether. Won't know for sure until doc appt tomorrow but a bit of info would be nice. Thank you hun.
> Hugs
> TinaTina,
May I?
CPK stands for creatinine phosphokinase. It is an enzyme. It is a sensitive marker of muscle injury. The CPK level considered normal is under 200. Significant elevations in CPK levels usually indicate muscle damage. There are 3 types of CPK: skeletal muscle, myocardium (heart), and brain.
Muscle CPK levels can rise significantly in the following conditions: 1] muscle trauma, 2] exercise, 3] cocaine intoxication, 4] alcoholism, 5] intramuscular injections, 6] psychotic agitation, 7] acute dystonic reactions (muscle stiffness) due to antipsychotics, 8] malignant hyperthermia (occurs during anesthesia), 9] hypothermia, 10] coma, 11] infections involving muscles, 12] convulstions, 13] hypothyroidism (underactive thyroid), 14] cardiac catheterization, 15] surgery, 16] stroke, 17] prolonged immobilization, 18] neuroleptic malignant syndrome (NMS), and 19] CPK can also rise for no apparent reason.
I highly doubt you have the following. Merely citing the importance of muscle CPK elevations in one specific condition. Significant elevations of CPK, along with symptoms of muscle rigidity, confusion, and catatonic-like behavior, in a patient receiving an antipsychotic drug, may indicate impending NMS. This is a serious adverse reaction of antipsychotic drug. Early recognition and discontinuation of the offending drug is of paramount importance to avoid the deveopment of a full-blown syndrome which sometimes could be fatal.
Some of the newer antidepressants have the potential to cause elevation of muscle CPK since they are capable of inducing dystonic reactions such as neck stiffness (torticollis) and back/trunk stiffness. The potential for drug-drug interactions between serotonin-boosting antidepressants and other serotonin drugs may lead to serotonin syndrome which may also cause some elevations in muscle CPK but usually not as high as NMS.
Are you an avid runner or engaging in strenuous exercise which could lead to significant elevations of muscle CPK? Are you experiencing any muscle aches or pains? Are you taking other meds? For example, some of the cholesterol-lowering drugs may cause muscle aches/pains and if not caught early may lead to a more serious muscle destruction (rhabdomyolysis) which could in turn lead to acute kidney failure.
Posted by tina on July 19, 2000, at 7:12:28
In reply to Re: CPK level increase--CamW?????, posted by Sunnely on July 19, 2000, at 0:22:25
I'm pretty sure it's the exercise. I just started lifting weights again but my doc doesn't know that and was concerned about the cpk level on my last blood test. I think that's all it is but thank you very much for all the useful info. What an asset you are to this board. I hope you have a very nice day wherever you are.
Be well and peaceful
Tina
> > Hey Cam: Just wondering if you have a second to tell me about AD's and elevated CPK levels in the liver. It seems my doc tells me that mine are way too high and that I might have to go off meds altogether. Won't know for sure until doc appt tomorrow but a bit of info would be nice. Thank you hun.
> > Hugs
> > Tina
>
> Tina,
>
> May I?
>
> CPK stands for creatinine phosphokinase. It is an enzyme. It is a sensitive marker of muscle injury. The CPK level considered normal is under 200. Significant elevations in CPK levels usually indicate muscle damage. There are 3 types of CPK: skeletal muscle, myocardium (heart), and brain.
>
> Muscle CPK levels can rise significantly in the following conditions: 1] muscle trauma, 2] exercise, 3] cocaine intoxication, 4] alcoholism, 5] intramuscular injections, 6] psychotic agitation, 7] acute dystonic reactions (muscle stiffness) due to antipsychotics, 8] malignant hyperthermia (occurs during anesthesia), 9] hypothermia, 10] coma, 11] infections involving muscles, 12] convulstions, 13] hypothyroidism (underactive thyroid), 14] cardiac catheterization, 15] surgery, 16] stroke, 17] prolonged immobilization, 18] neuroleptic malignant syndrome (NMS), and 19] CPK can also rise for no apparent reason.
>
> I highly doubt you have the following. Merely citing the importance of muscle CPK elevations in one specific condition. Significant elevations of CPK, along with symptoms of muscle rigidity, confusion, and catatonic-like behavior, in a patient receiving an antipsychotic drug, may indicate impending NMS. This is a serious adverse reaction of antipsychotic drug. Early recognition and discontinuation of the offending drug is of paramount importance to avoid the deveopment of a full-blown syndrome which sometimes could be fatal.
>
> Some of the newer antidepressants have the potential to cause elevation of muscle CPK since they are capable of inducing dystonic reactions such as neck stiffness (torticollis) and back/trunk stiffness. The potential for drug-drug interactions between serotonin-boosting antidepressants and other serotonin drugs may lead to serotonin syndrome which may also cause some elevations in muscle CPK but usually not as high as NMS.
>
> Are you an avid runner or engaging in strenuous exercise which could lead to significant elevations of muscle CPK? Are you experiencing any muscle aches or pains? Are you taking other meds? For example, some of the cholesterol-lowering drugs may cause muscle aches/pains and if not caught early may lead to a more serious muscle destruction (rhabdomyolysis) which could in turn lead to acute kidney failure.
Posted by noa on July 19, 2000, at 7:28:07
In reply to Re: CPK level increase--CamW?????---Sunnely, posted by tina on July 19, 2000, at 7:12:28
Also, in Dr. Bob's tips there is a discussion of elevated cpk with clozapine.
Posted by SLS on July 21, 2000, at 9:31:40
In reply to Re: CPK level increase--CamW?????, posted by Sunnely on July 19, 2000, at 0:22:25
Hi Sunnely.
> Some of the newer antidepressants have the potential to cause elevation of muscle CPK since they are capable of inducing dystonic reactions such as neck stiffness (torticollis) and back/trunk stiffness. The potential for drug-drug interactions between serotonin-boosting antidepressants and other serotonin drugs may lead to serotonin syndrome which may also cause some elevations in muscle CPK but usually not as high as NMS.
Which of the "newer" antidepressants are capable of causing dystonic reactions? What mechanisms might be responsible for this?
Also, out of curiousity, are there different types of CPK depending upon the type of muscle it originates from?
It is so tempting to ask you a trillion questions. I apologize.
Thanks.
- Scott
Posted by Sunnely on July 21, 2000, at 22:41:30
In reply to Re: CPK level increase - antidepressant dystonia ? » Sunnely, posted by SLS on July 21, 2000, at 9:31:40
> Which of the "newer" antidepressants are capable of causing dystonic reactions? What mechanisms might be responsible for this?
Virtually all of the SSRIs have been reported to cause dystonic reaction (muscle stiffness).[1,2] The exact mechanism is unclear. One hypothesis is that, SSRIs do this by an inhibition of dopamine release from the nigrostriatal pathway (one of the 4 major dopamine pathways) arising from the inhibitory serotonergic input from the raphe.[3] Another hypothesis proposed is that, at least some SSRIs can cause extrapyramidal movement disorders (such as neck stiffness) by acting on the sigma 2 receptors located in the red nucleus.[3]
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> Also, out of curiousity, are there different types of CPK depending upon the type of muscle it originates from?CPK is found in relatively high concentrations in 3 tissues: the heart, skeletal muscles, and the brain. The skeletal muscle CPK is called CPK-MM; heart is CPK-MB; brain is CPK-BB.
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> It is so tempting to ask you a trillion questions. I apologize.Fogettaboutit. Ciao! :)
Sources:
1] Fluoxetine, Sertraline, and Extrapyramidal Reactions. In: International Drug Therapy Newsletter, November 1998.
2] Paroxetine, Fluvoxamine, Citalopram and Extrapyramidal Reactions - Part II. In: International Drug Therapy Newsletter, December 1998.
3] Leonard BE, Faherty C: SSIs and movement disorders: Is serotonin the culprit? Human Psychopharmacology 1996;11:S75-S82.
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