olanzapine and Pancreatitis

Topics: Adolescent; Amylases; Antipsychotic Agents; Benzodiazepines; Biomarkers; Female; Humans; Lipase; Olanzapine; Pancreatitis; Schizophrenia, Paranoid; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Humans; Male; Olanzapine; Pancreatitis; Schizophrenia

A case of acute pancreatitis associated with lisinopril and olanzapine is described.. A 69-year-old woman came to the emergency department after four days of experiencing epigastric pressurelike pain that radiated to the left lower quadrant and worsened with ingestion of food. She had started lisinopril three months prior for treatment of hypertension and had been taking olanzapine regularly for bipolar disorder. Upon admission, she was afebrile and hemodynamically stable and exhibited tenderness of the epigastric region. Elevated pancreatic enzymes and abdominal computed tomography (CT) imaging findings confirmed the diagnosis of pancreatitis. Common causes of pancreatitis were ruled out, and it was determined that the recent combination of lisinopril and olanzapine was the likely cause. Food and liquids were withheld, and all oral medications were stopped at hospital admission. Her pain resolved completely after two days. She was discharged on hospital day 4, and all of her medications except lisinopril and olanzapine were resumed. During a follow-up visit with her primary care physician, she reported to be doing well and had no systemic complaints. Olanzapine was reinitiated at that time but was discontinued a month later by her psychiatrist, who was concerned about the development of recurrent symptoms of pancreatitis. Valsartan was prescribed to achieve optimal blood pressure control three weeks after discharge. A follow-up CT scan of the abdomen a month later found no residual pancreatic abnormalities.. The additive effect of two known pancreatitis-causing medications resulted in increased risk and subsequent acute pancreatitis in this patient.

Topics: Acute Disease; Aged; Angiotensin-Converting Enzyme Inhibitors; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Drug Interactions; Drug Therapy, Combination; Female; Humans; Hypertension; Lisinopril; Olanzapine; Pancreatitis

Topics: Acute Disease; Adult; Antipsychotic Agents; Benzodiazepines; Humans; Male; Olanzapine; Pancreatitis

To report a case of fatal hyponatremia, marked hyperglycemia, and acute pancreatitis following simultaneous administration of paroxetine, fluphenazine, haloperidol and olanzapine.. A 44-year-old non-diabetic male was admitted unconsciously, with severe hyponatremia, hyperglycemia and bradypnea. The patient had a history of long-term treatment with paroxetine, fluphenazine, haloperidol and olanzapine. Upon arrival, the plasma sodium level was 104 mmol/l, and blood glucose was 940 mg/dl. The therapy consisted of ventilatory support and intensive correction of hyponatremia and hyperglycemia. 2 hours later, hypotension and refractory cardiac arrest occurred. The autopsy disclosed severe cerebral edema as cause of death, and a modest hemorrhagic pancreatitis.. Paroxetine is a selective serotonin reuptake inhibitor which stimulates antidiuretic hormone (ADH) release and may cause the syndrome of inappropriate ADH secretion with consecutive hyponatremia. Fluphenazine and haloperidol may contribute to this syndrome. Fluphenazine, and particularly olanzapine are associated with an increased incidence ofdiabetes. Olanzapine has been reported as a risk factor for acute pancreatitis. The Naranjo probability scale was not applicable because of almost immediate lethal outcome.. Polypharmacy increases the risk of various adverse reactions. Adverse effects of paroxetine and many anti-psychotic drugs, such as hyponatremia and hyperglycemia, should be monitored periodically to prevent complications. The role of olanzapine in the etiology of acute pancreatitis remains to be evaluated.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Brain Edema; Fatal Outcome; Fluphenazine; Haloperidol; Heart Arrest; Humans; Hyperglycemia; Hyponatremia; Inappropriate ADH Syndrome; Male; Mental Disorders; Olanzapine; Pancreatitis; Paroxetine; Polypharmacy; Selective Serotonin Reuptake Inhibitors

Topics: Acute Disease; Adult; Antipsychotic Agents; Benzodiazepines; Chylomicrons; Humans; Male; Olanzapine; Pancreatitis; 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

The antipsychotic agent clozapine has been linked to several cases of pancreatitis. The newer, but related, olanzapine was believed to have fewer side effects.. A 42-year-old man in good physical condition gradually developed hypertriglyceridemia, hypercholesterolemia, elevated alanine aminotransferase, diabetes and, ultimately, acute pancreatitis after 19 months of olanzapine monotherapy. Due to multiorgan failure, he was in the intensive care unit and surgical ward for 29 days. He made a full recovery. The olanzapine was discontinued. Glucose, triglyceride and cholesterol levels normalized as did pancreas and liver function.. We report olanzapine as the probable cause of acute pancreatitis in a patient without any known predisposing factors. Olanzapine-treated patients should be monitored with glucose, lipid, pancreatic function and liver function tests, and the olanzapine should be discontinued if the results of these tests worsen.

Topics: Adult; Benzodiazepines; Humans; Male; Olanzapine; Pancreatitis

To evaluate hepatic enzyme elevations during treatment with olanzapine, divalproex, and their combination.. Fifty-two children, aged 4 to 18 years, with hepatic enzyme levels measured during treatment with olanzapine (n = 17), divalproex (n = 23), or their combination (n = 12), were identified in the computerized records at a pediatric medical center. Clinical characteristics as well as serial alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase levels were collected.. Mean and peak hepatic enzyme levels were significantly higher for the combined treatment group compared to the olanzapine or divalproex groups. All 12 patients who received combined treatment had at least one peak enzyme elevation during the treatment. For 42% of these patients, at least one enzyme level remained elevated during the time for which values were available (mean 8 +/- 6 months). For those treated with divalproex either alone or in combination, the findings were not explained by variations in divalproex plasma levels. Two patients receiving combined treatment had the combination treatment discontinued because of medical complications (pancreatitis in one and steatohepatitis in the other).. Combined treatment with olanzapine and divalproex was associated with more elevations of hepatic enzymes than treatment with either agent alone. The long-term significance of this is unknown but warrants study.

Topics: Adolescent; Alanine Transaminase; Antimanic Agents; Antipsychotic Agents; Aspartate Aminotransferases; Benzodiazepines; Child; Child, Preschool; Drug Interactions; Female; Humans; L-Lactate Dehydrogenase; Liver; Male; Olanzapine; Pancreatitis; Pirenzepine; Retrospective Studies; Valproic Acid

To report the case of a patient taking olanzapine who developed diabetic ketoacidosis (DKA).. A 46-year-old African American woman with no previous history of diabetes mellitus was admitted to the hospital and subsequently diagnosed with DKA and acute pancreatitis. The patient had been taking olanzapine, valproic acid, carbamazepine, hydrochlorothiazide/triamterene, and conjugated estrogens prior to admission. Olanzapine was the last medication added to the regimen. In addition to clinicians treating the DKA with appropriate interventions, olanzapine (due to possible association with hyperglycemia and DKA) as well as valproic acid (due to possible association with pancreatitis) were discontinued from the medication regimen. The patient was discharged home and her most recent glycosylated hemoglobin and fasting glucose concentrations have been within the normal range.. Atypical antipsychotics, such as olanzapine, have been associated with hyperglycemia and possibly DKA. We believe that this occurred in our patient who had no previous history of diabetes mellitus. Possible mechanisms of action and potential confounding variables are discussed.. Clinicians should monitor blood glucose concentrations periodically in patients taking olanzapine, especially in those patients with risk factors for diabetes mellitus.

Topics: Antipsychotic Agents; Benzodiazepines; Diabetic Ketoacidosis; Female; Humans; Middle Aged; Olanzapine; Pancreatitis; Pirenzepine

To report the first published case of olanzapine-induced acute pancreatitis.. A 72-year-old white woman was admitted to the intensive care unit (ICU) with acute hemorrhagic pancreatitis and unintentional verapamil overdose. The patient did not consume alcohol and had undergone a cholecystectomy in the past; other medical causes of pancreatitis had been ruled out. She was taking several medications chronically, but olanzapine was started six days prior to the onset of acute abdominal symptoms. According to the Naranjo probability scale, olanzapine was considered the probable cause of acute pancreatitis in this patient. Following a 12-day stay in the ICU, the patient was transferred to the ward where she died a few days later of unrelenting peritonitis secondary to acute pancreatitis.. A literature search (1966-July 2000) and contact with the manufacturer failed to detect any published reports of acute pancreatitis associated with olanzapine. The contribution of concomitant medications taken prior to ICU admission in initiating or worsening the pancreatitis was deemed unlikely. More common causes of acute pancreatitis, such as ethanol consumption and gallstones, were also ruled out in this patient. Therefore, olanzapine was rated as a probable cause for acute pancreatitis in our patient. The mechanism of this adverse reaction is unknown.. This is believed to be the first published report suspecting olanzapine, an atypical antipsychotic agent, to have caused acute hemorrhagic pancreatitis in a patient, leading to admission to the ICU and, eventually, death secondary to unrelenting peritonitis.

Topics: Acute Disease; Aged; Antipsychotic Agents; Benzodiazepines; Fatal Outcome; Female; Hemorrhage; Humans; Olanzapine; Pancreatitis; Pirenzepine

Topics: Adult; Alcohol Drinking; Antipsychotic Agents; Benzodiazepines; Chronic Disease; Humans; Male; Olanzapine; Pancreatitis; Pirenzepine; Schizophrenia