olanzapine and Pulmonary-Embolism

Topics: Antipsychotic Agents; Benzodiazepines; Humans; Olanzapine; Pulmonary Embolism; Risperidone

Treatment with low-potency anti-psychotic agents is an important risk factor in the development of pulmonary embolism (PE). We report a case of 74years old female patient receiving olanzapine for psychotic depression admitted to the emergency service with the complaints of chest pain and shortness of breath. She had tachypnea, hypotension and tachycardia. Arterial blood gas analysis showed hypoxemia-hypocapnia and D-dimer level was high. Computed tomographic pulmonary angiography (CTPA) demonstrated pulmonary embolism in both main pulmonary arteries, through lobar and segmental branches. Tissue plasminogen activator (t-PA) was administered in intensive care unit. As the only possible risk factor for PE was olanzapine, olanzapine treatment was terminated with pyschiatry consultation. During the 12-month follow-up of the patient; malignancy was not observed. Diagnosis and prevention of PE are the important goals to reduce morbidity and mortality in subjects receiving olanzapine.

Topics: Acute Disease; Aged; Anticoagulants; Benzodiazepines; Computed Tomography Angiography; Depression; Female; Humans; Olanzapine; Pulmonary Embolism; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Warfarin

Topics: Benzodiazepines; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Olanzapine; Pulmonary Embolism

Topics: Adult; Aggression; Antipsychotic Agents; Autopsy; Benzodiazepines; Bipolar Disorder; Catatonia; Death, Sudden; Female; Humans; Hypothyroidism; Incidence; Lorazepam; Obesity; Olanzapine; Ovarian Neoplasms; Patient Admission; Patient Transfer; Pulmonary Embolism; Restraint, Physical; Risk; Valproic Acid; Venous Thrombosis

Topics: Adult; Antibodies, Anticardiolipin; Antiphospholipid Syndrome; Antipsychotic Agents; Benzodiazepines; Humans; Male; Olanzapine; Pulmonary Embolism; Schizophrenia

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Fatal Outcome; Female; Haloperidol; Heart Arrest; Heart Failure; Humans; Hypnotics and Sedatives; Lorazepam; Olanzapine; Practice Guidelines as Topic; Pulmonary Artery; Pulmonary Embolism; Restraint, Physical; Schizophrenia, Paranoid; Venous Thromboembolism

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Fatal Outcome; Female; Humans; Hypotension; Male; Middle Aged; Olanzapine; Pulmonary Embolism; Schizophrenia, Paranoid

Pulmonary embolus (PE) is not an uncommon cause of sudden death, and forensic pathologists are not unaccustomed to being the first to diagnose a PE in a patient, since they are often fatal. Forensic pathologists are also familiar with the known risk factors for development of PEs, including advanced age, use of oral contraceptives, smoking, obesity, a sedimentary lifestyle, postsurgery or postinjury, pregnancy, certain malignancies, factor V Leiden and prothrombin mutations, and anticardiolipin antibodies. It has recently been shown in the clinical literature that antipsychotic medications are associated with an increased risk of thromboembolic events. Clozapine, a close relative of olanzapine, has been implicated as an independent risk factor for developing a PE. Four cases have been published within the last 2 years questioning whether olanzapine may also be associated with an increased risk for PE. We report 6 cases from the Bexar County Medical Examiner's Office, occurring between 1998 and 2005 where olanzapine may have been a risk factor in the development of, and death from, PE.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Fatal Outcome; Female; Humans; Male; Middle Aged; Olanzapine; Pulmonary Embolism; Risk Factors; Schizophrenia

Several studies and reports suggest an increased risk of venous thromboembolism (VTE) in patients treated with conventional antipsychotic drugs, as well as with clozapine. We report the case of a 25-year-old man with early-onset schizo-affective disorder, with no identified risk factor for thromboembolism, who developed pulmonary embolism on three occasions, once shortly after initiating treatment with olanzapine and twice with risperidone. This case indicates that VTE can be associated with the use of olanzapine and risperidone, two atypical agents having similar properties and the same 5HT2 receptors antagonism, possibly implicated in this adverse event. As suggested by this observation, patients who have had one episode of VTE with antipsychotics with an affinity for 5HT2 receptors should receive neuroleptics from other classes, such as amisulpride, which does not interact with 5HT2 receptors. They should also be closely monitored to ensure early detection and prompt treatment of VTE.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Humans; Male; Olanzapine; Pulmonary Embolism; Risperidone

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Heparin; Humans; Male; Olanzapine; Pulmonary Embolism; Treatment Outcome

Topics: Anticoagulants; Antipsychotic Agents; Benzodiazepines; Female; Humans; Middle Aged; Olanzapine; Pulmonary Embolism; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adult; Antiphospholipid Syndrome; Antipsychotic Agents; Benzodiazepines; Coma; Drug Overdose; Epilepsy, Complex Partial; Humans; Male; Olanzapine; Pulmonary Embolism; Schizophrenia, Paranoid; Thrombophilia; Venous Thrombosis

Topics: Adverse Drug Reaction Reporting Systems; Aged; Anemia, Hemolytic, Autoimmune; Anti-Infective Agents; Anticoagulants; Benzodiazepines; Caffeine; Canada; Ceftriaxone; Central Nervous System Stimulants; Child; Drug Interactions; Female; Humans; Ketolides; Middle Aged; Olanzapine; Peripheral Nervous System Diseases; Phytotherapy; Pulmonary Embolism; Rhabdomyolysis; Selective Serotonin Reuptake Inhibitors; Warfarin; Weight Loss

Elderly patients are particularly vulnerable to adverse drug reactions as a result of polypharmacy and metabolic changes associated with aging. We present a case of leukocytoclastic vasculitis induced by olanzapine, a medication commonly used in elderly patients.. An 82-year-old woman was admitted to the extended-care center for short-term rehabilitation after prolonged hospitalization for a pulmonary embolism requiring mechanical ventilation. The pulmonary problem resolved, but her hospitalization and subsequent rehabilitation were complicated by agitated delirium, which was treated with olanzapine and modification of contributory factors. At the time of admission to the rehabilitation facility, the patient had been receiving warfarin for 2 weeks and olanzapine for 6 days. On the eighth day after initiation of olanzapine, erythematous skin lesions developed on dependent areas. The international normalized ratio for warfarin was within the acceptable range; however, because warfarin has been associated with subcutaneous bleeding presenting as petechiae and ecchymosis, subcutaneous enoxaparin was substituted for warfarin. The skin lesions continued to worsen over the next week and developed into palpable lesions. Biopsy of the rash revealed leukocytoclastic vasculitis. In the absence of another cause, olanzapine was discontinued and the rash improved significantly. When the agitation recurred, risperidone was initiated, but the patient experienced dizziness with this agent. Olanzapine was resumed and the skin lesions recurred. Olanzapine was then changed to quetiapine, and the skin lesions improved over the next few weeks.. Olanzapine is commonly used in elderly patients to control behavioral disturbances associated with dementia, delirium, and other psychiatric disorders. Leukocytoclastic vasculitis is an infrequently reported adverse drug reaction with olanzapine. Its exact pathogenic mechanism is unknown, but both cell-mediated and humoral immunity appear to play important roles. Because drug-induced vasculitis has an identical clinical presentation and identical serologic/pathologic parameters to idiopathic forms of vasculitis, a high index of suspicion is necessary for its accurate diagnosis.. Because adverse drug reactions are common in elderly patients taking multiple medications, physicians should be vigilant when starting new medications and should attempt to eliminate unnecessary medications. Clinicians should be aware of the potential for leukocytoclastic vasculitis in association with olanzapine.

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Delirium; Drug Eruptions; Female; Humans; Olanzapine; Pulmonary Embolism; Respiration, Artificial; Skin; Vasculitis, Leukocytoclastic, Cutaneous

Clozapine has recently been associated with venous thromboembolism. The aim of this study was to describe three elderly patients in whom olanzapine therapy was associated with venous thromboembolism. During a 4-month period at the same psychogeriatric clinic, three elderly patients (an 89-year-old male, a 78-year-old male and an 83-year-old female) developed deep venous thrombosis shortly after treatment with olanzapine was initiated. Two of the patients also had symptoms consistent with a diagnosis of pulmonary embolism. None had previously been diagnosed with venous thromboembolism. These cases indicate that venous thromboembolism might be associated with the use of olanzapine, at least in geriatric patients. Subjects treated with olanzapine should be monitored clinically for venous thromboembolism to ensure early detection and prompt intervention, and a possible discontinuation of treatment with olanzapine should be considered after a diagnosis of venous thromboembolism.

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Female; Humans; Male; Olanzapine; Pirenzepine; Pulmonary Embolism; Thromboembolism; Venous Thrombosis

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Humans; Male; Olanzapine; Pirenzepine; Psychotic Disorders; Pulmonary Embolism