olanzapine and Urinary-Retention

Topics: Aged; Antipsychotic Agents; Bethanechol; Dementia; Humans; Male; Muscarinic Agonists; Olanzapine; Problem Behavior; Urinary Retention

Several adverse outcomes attributed to atypical antipsychotic drugs, specifically quetiapine, risperidone, and olanzapine, are known to cause acute kidney injury (AKI). Such outcomes include hypotension, acute urinary retention, and the neuroleptic malignant syndrome or rhabdomyolysis.. To investigate the risk for AKI and other adverse outcomes associated with use of atypical antipsychotic drugs versus nonuse.. Population-based cohort study.. Ontario, Canada, from 2003 to 2012.. Adults aged 65 years or older who received a new outpatient prescription for an oral atypical antipsychotic drug (n=97,777) matched 1:1 with those who did not receive such a prescription.. The primary outcome was hospitalization with AKI (assessed by using a hospital diagnosis code and, in a subpopulation, serum creatinine levels) within 90 days of prescription for atypical antipsychotic drugs.. Atypical antipsychotic drug use versus nonuse was associated with a higher risk for hospitalization with AKI (relative risk [RR], 1.73 [95% CI, 1.55 to 1.92]). This association was consistent when AKI was assessed in a subpopulation for which information on serum creatinine levels was available (5.46% vs. 3.34%; RR, 1.70 [CI, 1.22 to 2.38]; absolute risk increase, 2.12% [CI, 0.80% to 3.43%]). Drug use was also associated with hypotension (RR, 1.91 [CI, 1.60 to 2.28]), acute urinary retention (RR, 1.98 [CI, 1.63 to 2.40]), and all-cause mortality (RR, 2.39 [CI, 2.28 to 2.50]).. Only older adults were included in the study.. Atypical antipsychotic drug use is associated with an increased risk for AKI and other adverse outcomes that may explain the observed association with AKI. The findings support current safety concerns about the use of these drugs in older adults.. Academic Medical Organization of Southwestern Ontario.

Topics: Acute Kidney Injury; Age Factors; Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Cause of Death; Creatinine; Dibenzothiazepines; Female; Hospitalization; Humans; Hypotension; Male; Olanzapine; Ontario; Quetiapine Fumarate; Retrospective Studies; Risk Factors; Risperidone; Urinary Retention

Atypical antipsychotics are commonly used to treat behavioral disturbances in elderly demented patients. However, recent data have brought the tolerability of these drugs into question, as the majority of them have been associated with an increased risk for cerebrovascular events and death in this population. Specifically, increased risk has been found with olanzapine, aripiprazole, risperidone, and quetiapine. The other 2 atypical anti- psychotics, clozapine and ziprasidone, have not been studied in elderly populations. Although these medications are all classified as atypical antipsychotics, they exert varying degrees of blockade at dopamine, muscarinic, histaminic, and adrenergic receptors. Among these drugs, olanzapine has the greatest affinity for muscarinic receptors and, hence, may be associated with a greater risk for anticholinergic effects, including urinary retention.. The aim of this report was to discuss the possibility that administration of olanzapine may provoke acute urinary retention (AUR) in some patients.. We describe the development of AUR leading to acute renal failure subsequent to olanzapine administration in 2 geriatric patients with benign prostatic hypertrophy (BPH).. Given the cases presented, we recommend that clinicians measure electrolytes, blood urea nitrogen, and creatinine every 2 or 3 days for 1 or 2 weeks after initiating olanzapine treatment and after each dose increase. This is especially important for cognitively impaired elderly patients with BPH, as they may not be able to provide clear feedback regarding adverse effects of the medication.

Topics: Acute Disease; Acute Kidney Injury; Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Blood Urea Nitrogen; Creatinine; Drug Monitoring; Electrolytes; Humans; Male; Olanzapine; Prostatic Hyperplasia; Receptors, Muscarinic; Urinary Retention

Topics: Adult; Benzodiazepines; Dose-Response Relationship, Drug; Humans; Male; Olanzapine; Urinary Retention