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We describe here a patient treated with a stable dose of olanzapine for more than 8\u2009years who developed acute severe rhabdomyolysis without an identifiable trigger and without features suggestive of neuroleptic malignant syndrome. The rhabdomyolysis was atypical in its delayed onset and severity with a creatine kinase level of 345\u2009125\u2009U\/L, the highest level reported in the available literature. We also describe the clinical manifestations of delayed-onset olanzapine-induced rhabdomyolysis and its differentiation from neuroleptic malignancy syndrome, and we highlight key aspects of management to prevent or minimise further complications such as acute kidney injury.<\/jats:p>","DOI":"10.1136\/bcr-2022-254377","type":"journal-article","created":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T07:55:14Z","timestamp":1678434914000},"page":"e254377","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Delayed-Onset olanzapine-induced rhabdomyolysis"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8813-2881","authenticated-orcid":false,"given":"Jun Hua Bowen","family":"Lim","sequence":"first","affiliation":[{"name":"General Medicine, The Northern Hospital, Epping, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Billy","family":"Robinson","sequence":"additional","affiliation":[{"name":"General Medicine, The Northern Hospital, Epping, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Savige","sequence":"additional","affiliation":[{"name":"General Medicine, The Northern Hospital, Epping, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,3,10]]},"reference":[{"key":"2025082704002899000_16.3.e254377.1","doi-asserted-by":"crossref","first-page":"2559","DOI":"10.2147\/NDT.S209284","article-title":"A commentary on the efficacy of olanzapine for the treatment of schizophrenia: the past, present, and future","volume":"15","author":"Citrome","year":"2019","journal-title":"Neuropsychiatr Dis Treat"},{"key":"2025082704002899000_16.3.e254377.2","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2021.730769","article-title":"Worth the weight? olanzapine prescribing in schizophrenia. 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Olanzapine-induced rhabdomyolysis and hepatotoxicity: relevance for the rheumatologist. 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