olanzapine and Acute-Kidney-Injury

Serotonin syndrome is a potentially life-threatening complication of serotonergic agents. Although mirtazapine is a relatively safe antidepressant and has a comparatively low incidence of side effects, it still could induce serotonin syndrome.. We described a 34-year-old man with schizophrenic disorder who presented with acute consciousness disturbance, extremely high fever, rigidity, and spontaneous clonus in lower limbs. Two days before entry, oral mirtazapine was added to his regular medication of olanzapine. The serotonin-related symptoms resolved soon after withdrawal of mirtazapine and olanzapine combined with treatment with intravenous benzodiazepine and oral cyproheptadine. However, the clinical course was complicated by rhabdomyolysis, acute renal failure, and acute pulmonary edema. After receiving mechanical ventilation, hemodialysis, and appropriate supportive treatment, his general condition recovered and he was discharged without any neurological sequelae.. With the increasing use of serotonergic agents, awareness of serotonin syndrome is important. Early diagnosis and timely discontinuation of the offending agent(s) are imperative to prevent morbidity and mortality.

Topics: Acute Disease; Acute Kidney Injury; Adult; Benzodiazepines; Humans; Male; Mianserin; Mirtazapine; Olanzapine; Pulmonary Edema; Rhabdomyolysis; Serotonin Syndrome

To investigate the association between acute kidney injury (AKI) and use of second-generation antipsychotics (SGA) in older adults.. In a population-based cohort study using Danish national registries, new users of SGAs (aged ≥ 65) were identified during 2005-2015. Each SGA user was matched to 10 population controls on age, sex, and the SGA initiation date. The outcome was incident AKI within 90 days after the index date. Cox regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting for potential confounders.. In the study, 36,581 new SGA users and 365,810 controls were included. The 90-day incidence rate of AKI was 4.38 and 1.70 per 1000 person-years among SGA users and controls, respectively, corresponding to a crude HR of 2.57 (1.79-3.68). The fully adjusted HR (aHR) was 1.43 (0.89-2.27) for all SGAs. The risk differed among individual drugs with aHRs for olanzapine 3.50 (1.20-10.23), quetiapine 1.62 (0.81-3.26), and risperidone 0.68 (0.28-1.64). In sensitivity analyses, the aHR declined to 1.24 (0.95-1.61) at 1-year follow-up.. Olanzapine use was associated with a significantly increased 90-day AKI risk. For quetiapine, the risk was elevated but not significant, and risperidone had no association. CIs were wide and confounder adjustment largely impacted the estimates. Main limitations included residual confounding and incomplete recording of AKI diagnoses.

Topics: Acute Kidney Injury; Aged; Antipsychotic Agents; Benzodiazepines; Cohort Studies; Denmark; Hospitals; Humans; Incidence; Olanzapine; Quetiapine Fumarate; Risperidone

We present this case to draw attention to the importance of early diagnosis in terms of life-saving, noting that greater awareness is important among healthcare professionals. Our patient developed neuroleptic malignant syndrome (NMS) after his neuroleptic drug dosage was increased. His condition was complicated by acute kidney injury (AKI) which required hemodialysis. The uniqueness of this case is that the causative agent of NMS is an atypical antipsychotic, and atypical antipsychotics are generally considered to be safer than typical antipsychotics.. A 31-year-old Chinese man with underlying schizophrenia presented to our hospital with aggressive behavior. He was admitted to the psychiatric hospital and started on his regular medications, with an increase in the dose of olanzapine tablet from 5 to 10 mg daily. After 5 days in the ward, the patient was noted to have high fever, restlessness, confusion, increased muscle rigidity, tachycardia and tachypnoea. Antipsychotic therapy was stopped in view of suspected NMS. The first laboratory test for serum creatine kinase (CK) showed a markedly high level of this molecule. His renal profile showed raised serum creatinine in comparison to 2 months prior when the baseline serum creatinine was within the normal range. A diagnosis of NMS with AKI was made. Although the patient was given adequate intravenous fluid hydration with close monitoring of urine output, his renal function did not show improvement but continued to show a worsening trend. In view of this, he was started on urgent hemodialysis. The patient was dependent on intermittent hemodialysis before his AKI showed complete recovery. After 2 weeks, his blood test results returned to normal. He was discharged well.. Neuroleptic malignant syndrome is a life-threatening iatrogenic medical emergency in which high index of clinical suspicion is required for diagnosis and prompt treatment.

Topics: Acute Kidney Injury; Adult; Antipsychotic Agents; Creatine Kinase; Creatinine; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Renal Dialysis; Tablets

A recently published analysis of population-based claims data from Ontario, Canada reported higher risks of acute kidney injury (AKI) and related outcomes among older adults who were new users of atypical antipsychotics (AAPs) compared with unexposed patients. In light of these findings, the objective of the current study was to further investigate the risks of AKI and related outcomes among older adults receiving AAPs.. A replication of the previously published analysis was performed using the US Truven MarketScan Medicare Supplemental database (MDCR) among patients aged 65 years and older. Compared with non-users of AAPs, the study compared the risk of AKI and related outcomes with users of AAPs (quetiapine, risperidone, olanzapine, aripiprazole, or paliperidone) using a 1-to-1 propensity score matched analysis. In addition, we performed adapted analyses that: (1) included all covariates used to fit propensity score models in outcome models; and (2) required patients to have a diagnosis of schizophrenia, bipolar disorder, or major depression and a healthcare visit within 90 days prior to the index date.. AKI effect estimates [as odds ratios (ORs) with 95% confidence intervals (CIs)] were significantly elevated in our MDCR replication analyses (OR 1.45, 95% CI 1.32-1.60); however, in adapted analyses, associations were not significant (OR 0.91, 95% CI 0.78-1.07)). In analyses of AKI and related outcomes, results were mostly consistent between the previously published and the MDCR replication analyses. The primary change that attenuated associations in adapted analyses was the requirement for patients to have a mental health condition and a healthcare visit prior to the index date.. The MDCR analysis yielded similar results when the methodology of the previously published analysis was replicated, but, in adapted analyses, we did not find significantly higher risks of AKI and related outcomes. The contrast of results between our replication and adapted analyses may be due to the analytic approach used to compare patients (and potential confounding by indication). Further research is warranted to evaluate these associations, while also examining methods to account for differences in older adults who do and do not use these medications.

Topics: Acute Kidney Injury; Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Depressive Disorder, Major; Female; Humans; Male; Olanzapine; Quetiapine Fumarate; Risperidone; Schizophrenia

Several adverse outcomes attributed to atypical antipsychotic drugs, specifically quetiapine, risperidone, and olanzapine, are known to cause acute kidney injury (AKI). Such outcomes include hypotension, acute urinary retention, and the neuroleptic malignant syndrome or rhabdomyolysis.. To investigate the risk for AKI and other adverse outcomes associated with use of atypical antipsychotic drugs versus nonuse.. Population-based cohort study.. Ontario, Canada, from 2003 to 2012.. Adults aged 65 years or older who received a new outpatient prescription for an oral atypical antipsychotic drug (n=97,777) matched 1:1 with those who did not receive such a prescription.. The primary outcome was hospitalization with AKI (assessed by using a hospital diagnosis code and, in a subpopulation, serum creatinine levels) within 90 days of prescription for atypical antipsychotic drugs.. Atypical antipsychotic drug use versus nonuse was associated with a higher risk for hospitalization with AKI (relative risk [RR], 1.73 [95% CI, 1.55 to 1.92]). This association was consistent when AKI was assessed in a subpopulation for which information on serum creatinine levels was available (5.46% vs. 3.34%; RR, 1.70 [CI, 1.22 to 2.38]; absolute risk increase, 2.12% [CI, 0.80% to 3.43%]). Drug use was also associated with hypotension (RR, 1.91 [CI, 1.60 to 2.28]), acute urinary retention (RR, 1.98 [CI, 1.63 to 2.40]), and all-cause mortality (RR, 2.39 [CI, 2.28 to 2.50]).. Only older adults were included in the study.. Atypical antipsychotic drug use is associated with an increased risk for AKI and other adverse outcomes that may explain the observed association with AKI. The findings support current safety concerns about the use of these drugs in older adults.. Academic Medical Organization of Southwestern Ontario.

Topics: Acute Kidney Injury; Age Factors; Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Cause of Death; Creatinine; Dibenzothiazepines; Female; Hospitalization; Humans; Hypotension; Male; Olanzapine; Ontario; Quetiapine Fumarate; Retrospective Studies; Risk Factors; Risperidone; Urinary Retention

Topics: Acute Kidney Injury; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Fever; Humans; Hydrotherapy; Male; Neuroleptic Malignant Syndrome; Olanzapine; Ramipril

Although the relationship between antipsychotic medication, particularly second-generation antipsychotics (SGAs), and metabolic disturbance is increasingly accepted, there is an important, but little recognised, potential interaction between this and the other important serious adverse effect of neuroleptic malignant syndrome (NMS). We report a case of a 35-year old female who developed new onset type II diabetes mellitus with hyperosmolar hyperglycaemic coma and acute renal failure following treatment with a SGA for a first manic episode. The history is strongly suggestive of concurrent NMS. This case raises important questions about non-ketotic, hyperosmolar diabetic coma with antipsychotics, the possible association between hyperglycaemia and hyperthermia, and the direction of causality in this, the recognition of either syndrome when they co-exist and management issues in such patients. These questions are considered in the context of currently available literature.

Topics: Acute Kidney Injury; Adult; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Diabetes Mellitus, Type 2; Female; Humans; Hyperglycemic Hyperosmolar Nonketotic Coma; Neuroleptic Malignant Syndrome; Olanzapine

Topics: Acute Kidney Injury; Antipsychotic Agents; Benzodiazepines; Electroencephalography; Female; Fluphenazine; Humans; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Psychotic Disorders

Topics: Acute Disease; Acute Kidney Injury; Adult; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Cocaine-Related Disorders; Diabetic Ketoacidosis; Humans; Male; Olanzapine; Pancreatitis; Piperazines; Quinolones; Schizophrenia

Atypical antipsychotics are commonly used to treat behavioral disturbances in elderly demented patients. However, recent data have brought the tolerability of these drugs into question, as the majority of them have been associated with an increased risk for cerebrovascular events and death in this population. Specifically, increased risk has been found with olanzapine, aripiprazole, risperidone, and quetiapine. The other 2 atypical anti- psychotics, clozapine and ziprasidone, have not been studied in elderly populations. Although these medications are all classified as atypical antipsychotics, they exert varying degrees of blockade at dopamine, muscarinic, histaminic, and adrenergic receptors. Among these drugs, olanzapine has the greatest affinity for muscarinic receptors and, hence, may be associated with a greater risk for anticholinergic effects, including urinary retention.. The aim of this report was to discuss the possibility that administration of olanzapine may provoke acute urinary retention (AUR) in some patients.. We describe the development of AUR leading to acute renal failure subsequent to olanzapine administration in 2 geriatric patients with benign prostatic hypertrophy (BPH).. Given the cases presented, we recommend that clinicians measure electrolytes, blood urea nitrogen, and creatinine every 2 or 3 days for 1 or 2 weeks after initiating olanzapine treatment and after each dose increase. This is especially important for cognitively impaired elderly patients with BPH, as they may not be able to provide clear feedback regarding adverse effects of the medication.

Topics: Acute Disease; Acute Kidney Injury; Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Blood Urea Nitrogen; Creatinine; Drug Monitoring; Electrolytes; Humans; Male; Olanzapine; Prostatic Hyperplasia; Receptors, Muscarinic; Urinary Retention

Rhabdomyolysis is a disorder characterized by skeletal muscle injury and fatal complications at times. The causes of rhabdomyolysis are usually traumatic and non-traumatic, such as neuroleptic malignant syndrome and rhabdomyolysis associated to septicemia. The cases of 2 schizophrenic patients with rhabdomyolisis during pneumonia infection and neuroleptic therapy are reported. At admission, both patients had important respiratory distress and hyperthermia; the clinical conditions required endotracheal intubation. Blood and urine cultures were always negative, while the bronchial sputum culture was positive. The diagnosis of rhabdomyolysis was confirmed by myoglobinemia dosage and ortholuidine test. Pneumonia infection was treated with antibiotic specific therapy whereas renal failure was treated with adequate hydratation and strained diuresis. The absence of muscle rigidity, the improvement of X-r images and the reduction of corporeal temperature, during antibiotic treatment, excluded neuroleptic malignant syndrome. The impro-vement allowed extubation and discharge of the patients from intensive care unit. In both cases neuroleptic malignant syndrome was excluded, therefore rhabdomyolysis was the consequence of pneumonia infection or of a combination of factors capable to cause an important damage of skeletal muscles.

Topics: Acute Kidney Injury; Adult; Antipsychotic Agents; Benzodiazepines; Diagnosis, Differential; Fever; Humans; Male; Middle Aged; Muscle Rigidity; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Pneumonia, Bacterial; Rhabdomyolysis; Risperidone; Schizophrenia