olanzapine and Respiratory-Insufficiency

Although the atypical antipsychotic olanzapine is increasingly being used in child and adolescent psychiatry, reports of olanzapine overdose in this young population are scarce. We report on two cases of adolescents who attempted suicide with an overdose of olanzapine: (1) A 14-year-old female ingested 275 mg olanzapine, which produced the highest reported nonlethal serum level (1503 ng/mL) and caused somnolence, agitation (acutely), and extrapyramidal symptoms (EPS; after 54 hours) but no major clinical complications. The serum olanzapine level dropped to 129 ng/mL within 48 hours; and (2) a 17-year-old male ingested 400 mg olanzapine, the highest reported nonlethal dose of olanzapine in adolescents, which produced respiratory suppression requiring intubation and mechanical ventilation; he recovered after 3 days. Based on clinical monitoring and postmortem data, the 2 patients survived the ingestion of high doses of olanzapine. We also provide a review of the literature, encompassing all reported cases of olanzapine overdose in children and adolescents and discuss symptoms, diagnosis, and treatment options, based on pharmacokinetic and pharmacodynamic considerations.

Topics: Adolescent; Antipsychotic Agents; Benzodiazepines; Child; Dose-Response Relationship, Drug; Drug Overdose; Female; Follow-Up Studies; Humans; Male; Metabolic Clearance Rate; Olanzapine; Respiratory Insufficiency; Suicide, Attempted

Atypical antipsychotics are used in cardiac intensive care units (CICU) to treat delirium despite limited data on safety in patients with acute cardiovascular conditions. Patients treated with these agents may be at higher risk for adverse events such as QTc prolongation and arrhythmias. We performed a retrospective cohort study of 144 adult patients who were not receiving antipsychotics before admission and received olanzapine (n = 50) or quetiapine (n = 94) in the Michigan Medicine CICU. Data on baseline characteristics, antipsychotic dose and duration, length of stay, and adverse events were collected. Adverse events included ventricular tachycardia (sustained ventricular tachycardia attributed to the medication), hypotension (systolic blood pressure <90 mm Hg attributed to the medication), and QTc prolongation (QTc increase by ≥60 ms or to an interval ≥500 ms). Twenty-six patients (18%) experienced an adverse event. Of those adverse events, 20 patients (14%) experienced QTc prolongation, 3 patients (2%) had ventricular tachycardia, and 3 patients (2%) had hypotension. Patients who received quetiapine had a higher rate of adverse events (25% vs 6%, p = 0.01) including QTc prolongation (18% vs 6%, p = 0.046). Intensive care unit length of stay was shorter in patients who received olanzapine (6.5 vs 9.5 days, p = 0.047). Eighteen patients (13%) had their antipsychotic continued at discharge from the hospital. In conclusion, QTc prolongation was more common in patients treated with quetiapine versus olanzapine although the number of events was relatively low with both agents in a CICU cohort.

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Arrhythmias, Cardiac; Coronary Care Units; Delirium; Endocarditis; Female; Heart Arrest; Heart Failure; Humans; Hypotension; Length of Stay; Long QT Syndrome; Male; Middle Aged; Olanzapine; Quetiapine Fumarate; Respiratory Insufficiency; Retrospective Studies; Shock, Cardiogenic; ST Elevation Myocardial Infarction; Tachycardia, Ventricular

Parenteral olanzapine is an emerging therapy for a variety of conditions in the emergency department (ED). Intramuscular administration is standard; however, intravenous administration has been proposed as a safe alternative route. We investigate the safety and efficacy of both intramuscular and intravenous olanzapine in the ED when used for a variety of indications.. This was a prospective observational study of patients presenting to an urban Level I trauma center ED. Trained research associates screened the ED for patients receiving parenteral olanzapine. The primary outcome of the study was incidence of respiratory depression measured with standard markers. Secondary outcomes included use of additional doses or sedatives, corrected QT interval (QTc) data, time to nadir sedation, adverse events, and physician assessment of efficacy.. There were 784 patients included in the final analysis. Intravenous olanzapine was administered to 295 patients; 489 received intramuscular olanzapine. Respiratory depression occurred in 11 of 295 patients (3.7%; 95% confidence interval [CI] 1.6% to 5.9%) receiving intravenous olanzapine and 10 of 489 (2.0%; 95% CI 0.8% to 3.3%) receiving intramuscular olanzapine. Seven patients required intubation, 2 in the intravenous group and 5 in the intramuscular group. Nonrespiratory complications occurred in 8 patients, 6 of 295 (2.0%; 95% CI 0.4% to 3.6%) in the intravenous group and 2 of 489 (0.4%; 95% CI 0% to 0.96%) in the intramuscular group. Dysrhythmias were isolated to 2 episodes of bradycardia requiring only supportive care.. These data suggest that, with proper monitoring, administration of olanzapine, both intramuscular and intravenous, is safe for several indications in the ED.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Conscious Sedation; Emergency Service, Hospital; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Olanzapine; Prospective Studies; Psychomotor Agitation; Respiratory Insufficiency; Young Adult

Topics: Adult; Antiparkinson Agents; Antipsychotic Agents; Benzodiazepines; Chlorpromazine; Drug Therapy, Combination; Dystonia; Fatal Outcome; Haloperidol; Humans; Larynx; Male; Olanzapine; Respiratory Distress Syndrome; Respiratory Insufficiency; Risperidone; Schizophrenia

We describe a full-term infant with failed respiratory effort and decerebrate posturing following in utero exposure to paroxetine. All signs and symptoms associated with the paroxetine exposure were resolved by the second day of life. Upon discharge, the infant revealed a normal neurodevelopmental examination.

Topics: Antidepressive Agents, Second-Generation; Benzodiazepines; Clonazepam; Humans; Infant, Newborn; Male; Neonatal Abstinence Syndrome; Olanzapine; Paroxetine; Respiratory Insufficiency; Serotonin Syndrome

Hypersensitivity syndrome is defined as a drug-induced complex of symptoms consisting of fever, rash, and internal organ involvement. The hypersensitivity syndrome is well recognized as being caused by anticonvulsants. Olanzapine is an atypical antipsychotic agent whose side effects include sedation, weight gain, and increased creatinine kinase and transaminase levels. To date, there have been no reports of hypersensitivity syndrome related to this drug. A 34-year-old man developed a severe generalized pruritic skin eruption, fever, eosinophilia, and toxic hepatitis 60 days after ingestion of olanzapine. After termination of olanzapine treatment, the fever resolved, the skin rash was reduced, eosinophil count was reduced to normal, and the transaminase levels were markedly reduced. Clinical features and the results of skin and liver biopsies indicated that the patient developed hypersensitivity syndrome caused by olanzapine.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Chemical and Drug Induced Liver Injury; Diagnostic Errors; Drug Eruptions; Drug Hypersensitivity; Dyspnea; Eosinophilia; Fever; Humans; Male; Olanzapine; Pirenzepine; Pruritus; Respiratory Hypersensitivity; Respiratory Insufficiency; Schizophrenia, Paranoid; Syndrome

Olanzapine is considered a safe drug. However, somnolence appears in up to 39% of the patients treated with 15 mg./day of this drug. The authors describe an elderly patient with chronic lung disease who developed CO2 narcosis and respiratory failure after treatment with olanzapine. The sedative effect of this drug was probably the cause of this life-threatening complication. The authors suggest that elderly patients with chronic lung disease who are treated with olanzapine should be carefully observed, especially during the first weeks of treatment.

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Female; Humans; Olanzapine; Pirenzepine; Respiratory Insufficiency; Schizophrenia, Paranoid