Case Reports of Postmarketing Adverse Event Experiences With Olanzapine Intramuscular Treatment in Patients With Agitation

Marder, Stephen R.; Sorsaburu, Sebastian; Dunayevich, Eduardo; Karagianis, Jamie; Dawe, Ian; Falk, Deborah M.; Dellva, Mary Anne; Carlson, Janice; Cavazzoni, Patrizia; Baker, Robert W.

doi:10.4088/jcp.08m04411gry

Cited by 49 publications

(36 citation statements)

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“…Respiratory depression was more frequent with olanzapine and quetiapine. In a study of fatalities documented in postmarketing safety reports, Marder et al (43) found the frequency of respiratory effects was second only to cardiovascular effects for olanzapine. Two other reports found quetiapine to be associated with respiratory depression in severe cases (44,45).…”

Section: Discussionmentioning

confidence: 99%

Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014

Nelson

Spyker

2017

AJP

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Objective: The authors sought to determine the relative morbidity and mortality associated with drugs used to treat depression and to examine specific clinical effects associated with serious outcomes.Method: The National Poison Data System, which receives exposure reports from regional poison centers serving the United States, Puerto Rico, and the District of Columbia, was queried for single drug exposures in individuals 12 years and older during the period 2000-2014. Medications included were antidepressants, atypical antipsychotics, anticonvulsants, lithium, and other medications used in the treatment of depression. The main outcomes were the morbidity index (the number of serious outcomes per 1,000 exposures) and the mortality index (the number of fatal outcomes per 10,000 exposures).Results: During this 15-year period, there were 962,222 single substance exposures to the 48 medications studied. Serious outcomes rose 2.26-fold and in linear fashion over the 15 years. While tricyclic and monoamine oxidase inhibitor medications were associated with high morbidity and mortality, several newer agents also appeared hazardous. Lithium, quetiapine, olanzapine, bupropion, and carbamazepine were associated with high morbidity indices. Lithium, venlafaxine, bupropion, quetiapine, olanzapine, ziprasidone, valproic acid, carbamazepine, and citalopram were associated with higher mortality indices.Conclusions: Serious outcomes after overdose or nonintentional exposures to medications used to treat depression have risen dramatically over the past 15 years. The present data suggest that the morbidity and mortality risks vary substantially among these medications. These differences become important when selecting treatments for patients with depression, especially those at increased risk for suicide.

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Section: Discussionmentioning

confidence: 99%

Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014

Nelson

Spyker

2017

AJP

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“…A critical risk may be represented by elderly, potentially at risk of altered level of consciousness and falls [132].…”

Section: Adverse Effectsmentioning

confidence: 99%

An update of safety of clinically used atypical antipsychotics

Orsolini

Tomasetti

Valchera

et al. 2016

Expert Opinion on Drug Safety

117

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A critical issue in the treatment with atypical APs is represented by their metabolic side effect profile (e.g. weight gain, lipid and glycaemic imbalance, risk of diabetes mellitus and diabetic ketoacidosis) which may limit their use in particular clinical samples. Electrolyte imbalance, ECG abnormalities and cardiovascular adverse effects may recommend a careful baseline and periodic assessments.

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“…Rationale for combining an anticholinergic or benzodiazepine with the antipsychotic agent may be to mitigate potential extrapyramidal side effects, added calming effect, or to intensify the level of sedation 4,11,12. Despite an absence of strong evidence supporting the safe use of parenteral olanzapine-benzodiazepine combination, it is used in psychiatric emergency departments 13-16…”

Section: Introductionmentioning

confidence: 99%

Coadministration of intramuscular olanzapine and benzodiazepines in agitated patients with mental illness

Williams

2018

Mental Health Clinician

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Introduction:Intramuscular antipsychotics are commonly used to manage agitated patients. In 2005, Eli Lilly placed a warning on olanzapine's prescribing information following post-marketing reports of fatal drug reactions when intramuscular olanzapine was used in the setting of benzodiazepines. Data is lacking examining this drug combination.Methods:A medication use evaluation was conducted at a county psychiatric hospital surveying the usage of concomitant intramuscular olanzapine and lorazepam from October 1, 2016, to July 20, 2017. A literature search was conducted to review available evidence.Results:Ninety-one instances of the drug combination were discovered, with no serious adverse events following administration. Of these 91 patients, 41 received both medications within 60 minutes of each other. No instances of hypotension, bradycardia, bradypnea, or oxygen desaturation occurred following administration. The literature review yielded 1 randomized, placebo-controlled clinical trial, 3 retrospective chart reviews, and several case studies.Discussion:Data detailing a causal relationship between olanzapine/benzodiazepine combinations and serious adverse effects is lacking. Available evidence does not consistently support a strong cause and effect relationship. The results of this medication use evaluation are not consistent with the Food and Drug Administration warning. Further controlled research is needed to help define the actual risk of using concomitant intramuscular olanzapine and benzodiazepines.

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Case Reports of Postmarketing Adverse Event Experiences With Olanzapine Intramuscular Treatment in Patients With Agitation

Cited by 49 publications

References 0 publications

Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014

Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014

An update of safety of clinically used atypical antipsychotics

Coadministration of intramuscular olanzapine and benzodiazepines in agitated patients with mental illness

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