olanzapine and Myocardial-Infarction

The authors compared 1-year mortality rates associated with ziprasidone and olanzapine in real-world use.. The Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC) was an open-label, randomized, postmarketing large simple trial that enrolled patients with schizophrenia (N=18,154) in naturalistic practice in 18 countries. The primary outcome measure was nonsuicide mortality in the year after initiation of assigned treatment. Patients were randomly assigned to receive treatment with either ziprasidone or olanzapine and followed for 1 year by unblinded investigators providing usual care. A physician-administered questionnaire was used to collect baseline demographic information, medical and psychiatric history, and concomitant medication use. Follow-up information on hospitalizations and emergency department visits, patients' vital status, and current antipsychotic drug status was collected and reported by treating psychiatrists. Post hoc analyses of sudden death, a secondary endpoint, were also conducted.. The incidence of nonsuicide mortality within 1 year of initiating pharmacotherapy was 0.91 for ziprasidone (N=9,077) and 0.90 for olanzapine (N=9,077). The relative risk was 1.02 (95% CI=0.76-1.39). This finding was confirmed in numerous secondary and sensitivity analyses.. Despite the known risk of QTc prolongation with ziprasidone treatment, the findings of this study failed to show that ziprasidone is associated with an elevated risk of nonsuicidal mortality relative to olanzapine in real-world use; the study excludes a relative risk larger than 1.39 with a high probability. However, the study was neither powered nor designed to examine the risk of rare events like torsade de pointes.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Cause of Death; Cross-Sectional Studies; Death, Sudden, Cardiac; Diabetic Ketoacidosis; Female; Hospitalization; Humans; Incidence; Kaplan-Meier Estimate; Long QT Syndrome; Male; Middle Aged; Myocardial Infarction; Olanzapine; Piperazines; Product Surveillance, Postmarketing; Prospective Studies; Risk; Schizophrenia; Suicide; Thiazoles

Delusional parasitosis (DP) is a rare delusional disorder in which patients believe that they are infected with parasites, worms, insects, or bacteria. Antipsychotics are the preferred treatment in these patients.. Case series in which we summarize six patients with DP treated with atypical antipsychotic medications including amisulpride, olanzapine, and risperidone.. One patient had a myocardial infarction after being given amisulpride, and several patients did not adjust well. Parenterally administered antipsychotics, particularly risperidone, were the most effective treatment in this series of patients with DP.. Patients with DP can be difficult to treat; however, parenterally administered antipsychotics appear to produce better results in these patients.

Topics: Adolescent; Adult; Aged; Amisulpride; Antipsychotic Agents; Benzodiazepines; Female; Follow-Up Studies; Humans; Injections; Male; Middle Aged; Myocardial Infarction; Olanzapine; Parasitic Diseases; Paresthesia; Patient Compliance; Risperidone; Schizophrenia, Paranoid; Somatoform Disorders; Sulpiride; Treatment Outcome

Delirium is a transient global disorder of cognition. Almost any medical illness or medication can cause delirium. Here, we report a 71-year-old male who presented to the emergency department with a sudden change in mental status, which later resolved. An electrocardiogram was consistent with acute myocardial infarction. The patient later developed symptoms of delirium, and haloperidol was administered. The symptoms did not resolve, and risperidone was initiated instead. The patient subsequently became hypotensive, and treatment was again changed to olanzapine. He returned to full consciousness with olanzapine treatment. When the potential hypotensive effects of haloperidol and risperidone are taken into consideration, in patients with high cardiac risk, olanzapine may provide a better option for the treatment of delirium.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Delirium; Humans; Hypotension; Male; Myocardial Infarction; Olanzapine; Risperidone