olanzapine and Hypothermia

Hypothermia is unpredictable and life-threatening adverse effect of atypical antipsychotic drug (APD) treatment, which has been little described. The aim of this article is to increase the awareness that hypothermia induced by APD drugs is more common than the current published case reports may suggest, and risk factors increase its development. Moreover, valuable guidelines regarding how to detect the early stages of hypothermia in clinical practice are included. A literature search for reports on APD-induced hypothermia in PubMed, Academic Search Complete, Medline Complete and eHealthMe databases was conducted. The literature search apart from eHealthMe database resulted in 524 articles, which included 34 case reports. Hypothermia was mostly induced by olanzapine (14) and risperidone (10). However, the data from Food and Drug Administration reports revealed several dozen more cases of APD-induced hypothermia (591case reports) compared with the published case reports (e.g. olanzapine-262 and risperidone-161). Hypothermia, mostly mild (61% of cases), has developed mainly in men (71%) having schizophrenia, a few hours after commencement of treatment or in the presence of risk factors. Owing to the increased risk of hypothermia development during APD treatment, doctors should routinely measure body temperature of patients, especially during the first days of the therapy. Early diagnosis of hypothermia and appropriate treatment may prevent death.

Topics: Antipsychotic Agents; Humans; Hypothermia; Mental Disorders; Olanzapine; Risk Factors; Risperidone; Schizophrenia; Sex Factors; Time Factors; United States; United States Food and Drug Administration

Antipsychotic drugs may lead to hypothermia as well as hyperthermia. Although known for decades and clinically highly relevant, the mechanisms by which antipsychotic drugs alter thermoregulatory processes in the human body are still far from being fully understood. In clinical practice, much attention is paid to antipsychotic drug-induced elevation of body core temperature as observed in the neuroleptic malignant syndrome (NMS). But also hypothermia is a clinically highly relevant adverse reaction to antipsychotic drugs.. Here we report a case series of three patients who developed severe hypothermia after administration of olanzapine. A review of the current literature is given with a focus on risk factors for the development of antipsychotic drug-induced hypothermia and its pathophysiologic mechanisms.. A 51-year-old female patient suffering from catatonic schizophrenia, cachectic nutritional condition and hypothyroidism developed severe hypothermia of 30.0°C body core temperature after administration of 30 mg olanzapine per day under comedication with lorazepam and L-thyroxine. A 48-year-old female patient with catatonic schizophrenia showed hypothermia of 31.0°C (rectal measurement) after single-dose administration of olanzapine 10 mg orally and a total of 3 mg lorazepam (1-1-1 mg). The third case report describes a 69-year-old male patient with acute delusional disorder exhibiting hypothermia of 33.0°C (rectal measurement) in combination with a reversible atrioventricular block grade III without any further comedication.. A review of the current literature reveals that thermoregulatory disturbances as sequelae of antipsychotic drug administration depend on individual disposition as well as various independent risk factors such as environmental temperature, somatic comorbidities, endocrinological abnormalities (e.g. hypothyroidism) and structural damage of the brain. A complex interaction of dopaminergic regulatory mechanisms in the ventral hypothalamus and peripheral vaso- and sudomotor adjustments seems to be causative. Hypothermia following antipsychotic drug administration represents a serious adverse drug reaction and a potentially life-threatening event.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Female; Humans; Hypothermia; Male; Middle Aged; Olanzapine; Schizophrenia, Catatonic; Schizophrenia, Paranoid

Hypothermia as an adverse reaction of antipsychotic drug use represents a potentially life-threatening complication. However, the mechanisms by which antipsychotic drugs alter thermoregulatory processes in the human body are far from being fully understood. Here we present a case series of 5 patients developing severe hypothermia after administration of olanzapine and benperidol. Controlled by a network of neural structures, body temperature is physiologically regulated in far more narrow boundaries than are other vital functions, and its homeostasis is critical for survival. The preoptic region in the ventral hypothalamus is assumed to act as a coordinating center that is endowed with thermosensory units that constantly compare actual body temperature with target values and initiate regulatory and compensatory mechanisms in case of mismatch. Hypothermia risk seems to increase in the first days after initiation of antipsychotic drug therapy or increases in the daily dose. Schizophrenic patients bear a higher risk than nonschizophrenic patients treated with antipsychotic drugs (such as patients with dementia or depression). Antipsychotic drugs with strong 5-HT2 antagonism seem to be more frequently associated with hypothermia. These cases demonstrate the clinical relevance of hypothermia as an adverse reaction to antipsychotic treatment and the importance of careful monitoring of body temperature.

Topics: Adult; Aged; Antipsychotic Agents; Benperidol; Benzodiazepines; Body Temperature Regulation; Dose-Response Relationship, Drug; Female; Humans; Hypothermia; Male; Middle Aged; Olanzapine; Risk Factors; Schizophrenia; Serotonin 5-HT2 Receptor Antagonists; Severity of Illness Index

We describe a case of olanzapine-induced hypothermia and hand oedema in an older adult with behavioural and psychological symptoms of dementia (BPSD).. An 82-year-old woman with hypothyroidism and dementia was reviewed by the geriatric team at a nursing home in view of lethargy and an unrecordable oral temperature. She was noted to have a bilateral hand oedema and right basal crackles. Investigations revealed high white cell count and inflammatory markers. She was treated as per hypothermia and communityacquired pneumonia protocols. The patient did not have the expected response to treatment. Olanzapine was tailed down and stopped with good effect as it was suspected to be a contributory cause to both the hypothermia and oedema.. Potentially inappropriate polypharmacy can be specifically targeted with effective deprescribing. Treatment review should be encouraged on a regular basis, especially in frail older adults with polypharmacy.

Topics: Aged; Aged, 80 and over; Dementia; Deprescriptions; Edema; Female; Humans; Hypothermia; Hypothermia, Induced; Olanzapine; Polypharmacy

Hypothermia is a rare but serious condition that has been associated with various psychiatric medications. We present a 76-year-old woman with refractory mania who developed multiple episodes of severe hypothermia associated with several psychiatric medications including olanzapine, quetiapine, valproic acid and oxcarbazepine. These episodes resolved following discontinuation of the agents. The patient had never experienced hypothermia before, despite having been on these or similar agents for many years. With traditional treatments for mania not feasible, other medications were used to treat her including lithium, clonazepam, gabapentin and the novel protein kinase c inhibitor tamoxifen. The regimen resulted in some success and importantly, without triggering hypothermia. This case alerts clinicians to the rare side effect of hypothermia in response to various psychiatric medications, the fact that patients can suddenly develop this intolerance and suggests possible medications that may be used safely without triggering hypothermia.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Carbamazepine; Drug Therapy, Combination; Female; Humans; Hypothermia; Olanzapine; Oxcarbazepine; Quetiapine Fumarate; Recurrence; Valproic Acid

Topics: Antipsychotic Agents; Benzodiazepines; Female; Humans; Hypothermia; Middle Aged; Olanzapine; Schizophrenia

Olanzapine is an a-typical antipsychotic drug antagonizing predominantly 5-HT and dopamine, but also histamine, muscarin, and α-adrenergic receptors. In humans, Olanzapine induces weight gain and increases the risk of type 2 diabetes. The underlying mechanisms of Olanzapine-induced weight gain are unclear. To study this we administered Olanzapine (5mg/kg) in female Wistar rats on a medium fat diet for 14 days via a permanent gastric catheter twice a day, just prior to the onset and at the middle of dark phase. Food and water intake, locomotor activity and body temperature were measured. Olanzapine acutely induced hypothermia, markedly decreased locomotor activity and increased body weight during 14 days of treatment. Olanzapine treatment did not result in an alteration of 24h food intake, but diurnal patterns of feeding behavior and body temperature were dramatically changed. We conclude that in female Wistar rats Olanzapine has an acute hypothermic effect, that the effect of Olanzapine on feeding behavior is secondary to the effect on activity, and that Olanzapine-induced weight gain is primarily the result of reduction in locomotor activity.

Topics: Animals; Benzodiazepines; Drug Administration Schedule; Feeding Behavior; Female; Hypothermia; Motor Activity; Olanzapine; Rats; Rats, Wistar; Sucrose; Weight Gain

Topics: Benzodiazepines; Humans; Hypothermia; Kidney Failure, Chronic; Male; Middle Aged; Olanzapine; Pirenzepine; Renal Dialysis

Olanzapine, an atypical antipsychotic, is often regarded as a safe choice for psychosis management. We hereby report an aged case that presented with conscious depression, bradycardia, hypotension, miosis and hypothermia. Olanzapine was thought to be the offending agent. His condition improved with supportive therapy.

Topics: Age Factors; Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Bradycardia; Cardiovascular Diseases; Delusions; Dementia; Humans; Hypotension; Hypothermia; Male; Olanzapine

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Female; Haloperidol; Humans; Hypothermia; Methotrimeprazine; Olanzapine; Pirenzepine; Thioridazine

The study objectives were to examine the effects of the atypical antipsychotic drugs olanzapine, risperidone, and quetiapine on core temperature in the rat in relation to such effects produced by clozapine and to compare possible in vivo intrinsic efficacy of olanzapine, risperidone, and quetiapine at dopamine (DA) D(1) receptors with such effects previously shown for clozapine. Core temperature measurements were made in adult male Wistar rats maintained under standard laboratory conditions using a reversed 12-h daylight cycle. Clozapine (0-32 micromol/kg s.c.), olanzapine (0-32 micromol/kg s.c.), and risperidone (0-4 micromol/kg s.c.) all produced a dose-dependent hypothermia. Except for slight nondose-dependent hyperthermia, there were no effects of quetiapine (0-16 micromol/kg s.c. or i.p.) on the core temperature. The hypothermia produced by clozapine, but not that produced by equipotent doses of olanzapine or risperidone, was fully antagonized by pretreatment with the DA D(1) receptor antagonist SCH-23,390 (0.1 micromol/kg s.c.). On the other hand, quinpirole-induced hypothermia (4 micromol/kg s.c.) was partially antagonized by olanzapine (2 micromol/kg s.c.), risperidone (4 micromol/kg s.c.), and quetiapine (16 micromol/kg s.c.) but not by clozapine (1 micromol/kg s.c.). Clozapine preferentially stimulates DA D(1) receptors in comparison with olanzapine and risperidone, whereas olanzapine, risperidone, and quetiapine preferentially block DA D(2) receptors compared with clozapine. It is suggested that stimulation of DA D(1) receptors, presumably in the prefrontal cortex, is a distinguishing feature of clozapine responsible for its favorable profile on cognitive functioning in schizophrenia.

Topics: Animals; Antipsychotic Agents; Benzazepines; Benzodiazepines; Clozapine; Dibenzothiazepines; Dopamine Agonists; Dose-Response Relationship, Drug; Drug Interactions; Fever; Hypothermia; Male; Olanzapine; Pirenzepine; Quetiapine Fumarate; Quinpirole; Rats; Rats, Wistar; Receptors, Dopamine; Risperidone; Time Factors

We report the case of a 43-year-old schizophrenic who sustained, after 12 days of treatment including olanzapine (20 mg.day-1), carbamazepine, levomepromazine and alprazolan, a severe shock with bradycardia (HR: 40 b.min-1), circulatory collapse (SAP: 60 mmHg), hypothermia (T: 27 degrees C), coma and disseminated intravascular coagulation. A significant improvement was obtained with high doses of intravenous glucagon, whereas the normalization of central temperature, atropine, adrenaline and volume loading had been inefficient. Olanzapine, alone of associated with other psychotropics, could cause severe circulatory collapse with hypothermia and coma responding to a treatment including glucagon.

Topics: Adult; Alprazolam; Antipsychotic Agents; Benzodiazepines; Bradycardia; Carbamazepine; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Gastrointestinal Agents; Glucagon; Humans; Hypothermia; Infusions, Intravenous; Male; Methotrimeprazine; Olanzapine; Pirenzepine; Schizophrenia; Shock

The atypical antipsychotic olanzapine (2.5-20 mg/kg) produced hypothermia in rats. The decrease in rectal temperature caused by olanzapine (2.5-20 mg/kg) was blocked by the selective dopamine D2 receptor antagonist pimozide (0.5 and 1 mg/kg) but not by the dopamine D1 receptor antagonist SCH 23390 (0.5 and 1 mg/kg). The dopamine D1/D2 receptor agonist apomorphine (3 mg/kg) and the selective dopamine D2 receptor agonist talipexole (0.5 mg/kg) produced hypothermia in rats. Olanzapine (10 and 20 mg/kg) significantly blocked hypothermia produced by both apomorphine and talipexole while the lower doses (2.5 and 5 mg/kg) of olanzapine failed to block it. The present results demonstrate that olanzapine behaves as a partial agonist at brain DA D2 receptor populations involved in thermoregulation in the rat.

Topics: Animals; Antipsychotic Agents; Apomorphine; Azepines; Benzazepines; Benzodiazepines; Body Temperature; Dopamine Agonists; Dopamine Antagonists; Hypothermia; Male; Olanzapine; Pimozide; Pirenzepine; Rats; Rats, Wistar

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Female; Humans; Hypothermia; Olanzapine; Pirenzepine; Prader-Willi Syndrome; Psychotic Disorders; Risperidone