An open pilot trial of olanzapine for delirium in the Korean population

Abstract

This study was performed to assess the efficacy and safety of olanzapine for the treatment of delirium in a Korean population. An open trial of olanzapine was conducted in Korean patients with delirium caused by multiple medicosurgical conditions. All subjects were evaluated by Delirium Rating Scale (DRS), which is known to be one of the most sensitive scales for delirium. In addition, other data for profiles of side-effects were collected and analyzed. Twenty patients were treated by olanzapine with doses of 5.9 ± 1.5 mg/day. The initial dose was 4.6 ± 0.9 mg/day and maximal dose of olanzapine was 8.8 ± 2.2 mg/day. The average duration of treatment was 6.6 ± 1.7 days and the day of maximal response was 3.8 ± 1.7 treated days. The scores of DRS were significantly improved from 20.0 ± 3.6 at the time of pretreatment to 9.3 ± 4.6 at the posttreatment. All subjects showed no definite serious side-effects including anticholinergic and extrapyramidal symptoms. Olanzapine treatment for patients with delirium was effective and safe. This newer drug may be a useful alternative agent to classical antipsychotics in the treatment of delirium.

Delirium: Guidelines for general hospitals

“…The usefulness of new atypical antipsychotics has been debated in the literature. Some evidence indicate that olanzapine [118][119][120][121] and quetiapine [122] have efficacy similar to that of haloperidol, with fewer side effects, in delirious patients; risperidone showed similar efficacy and side effects [123]. Numerous authors advocate that results from trials in dementia patients suffering from behavioral and psychological symptoms allow the recommendation of new atypical antipsychotics in delirium.…”

Delirium: pathophysiology, recognition, prevention and treatment

“…The current literature on atypical antipsychotic use in delirium is limited to open trials, case reports and reviews. Thus, the authors cannot recommend this drug class as first-line treatment for delirium symptoms but several reports suggest their efficacy and safety [81][82][83][84][85][86][87]. A further reason why the authors are less enthusiastic about the use of atypical antipsychotics is that, with the very recent exception of ziprasidone (Geodon ® , Pfizer Inc., NY, USA), (now available intramuscularly), none of these drugs are available in parenteral form, thus complicating or preventing their administration to some agitated or combative patients.…”

A pilot trial of quetiapine for the treatment of patients with delirium

“…Recently, several studies using both prospective (Horikawa et al, 2003;Kim et al, 2001;Breitbart et al, 2002) and retrospective methods (Sipahimalani and Masand, 1998) demonstrated that risperidone and olanzapine, which have superior pharmacological profiles in lowering the EPS via a simultaneous blockade of the serotonin and dopamine receptors, could be alternative agents to typical antipsychotics in the treatment of delirium. The efficacy and safety of quetiapine for treating delirium was also examined in case reports (Al-Samarrai et al, 2003;Torres et al, 2001), a retrospective chart review (Schwartz and Masand, 2000) and an open trial with a small sample (Kim et al, 2003).…”