Comparison of Olanzapine to Risperidone in Substance‐Abusing Individuals with Schizophrenia

Abstract

A 14-week double blind study compared the efficacy of olanzapine to risperidone in reducing marijuana/cocaine craving and use in individuals with schizophrenia. The study consisted of three phases: a two-week assessment phase, a two-week cross-taper phase onto olanzapine/risperidone, and a ten-week period of maintenance on olanzapine/risperidone. The proportion of cocaine-positive urines decreases over time for both groups with a trend for a greater reduction for the olanzapine group compared to risperidone group. In the last six weeks, marijuana craving was more likely for the risperidone group compared to the olanzapine group, although there was no group difference in the proportion of negative marijuana urines. The data suggest some potential for the utility of olanzapine for the treatment of cocaine dependence in individuals with schizophrenia.

Pharmacotherapies for cannabis dependence

“…The atypical antipsychotics olanzapine and risperidone were compared for the management of psychosis in patients with a history of cannabis use (Akerele 2007; Robinson 2006; Van Nimwegen 2008). The two medications were found to have similar efficacy on psychotic symptoms with no evidence of a differential effect on cannabis craving or use.…”

Pharmacotherapy of patients with schizophrenia and substance abuse

“…Another double-blind RCT in cocaine-dependent schizophrenia patients found significantly greater psychopathological improvement in the 'general psychopathology' subscale of the Positive and Negative Syndrome Scale (PANSS) and a significant reduction of craving, at least in one subscale (energy), with olanzapine than with haloperidol [41] . In a double-blind, randomized study comparing olanzapine with risperidone, the olanzapine group showed a trend towards a greater reduction of the proportion of cocaine-positive urines [42] .…”

“…Four RCTs are available for olanzapine, three comparing olanzapine with haloperidol treatment [39][40][41] and one comparing olanzapine with risperidone [42] . In the first, randomized, double-blind study in patients with cannabisinduced psychosis, olanzapine was as effective as haloperidol but caused fewer EPS [39] .…”

A Randomized Trial of Clozapine Versus Other Antipsychotics for Cannabis Use Disorder in Patients With Schizophrenia

“…Unfortunately, available data are somewhat mixed and not overly promising (Green, Noordsy, Brunette, & O’Keefe, 2008) for risperidone (Green, Burgess, Dawson, Zimmet, & Strous, 2003; Smelson et al, 2002; Smelson et al, 2004), olanzapine (Akerele & Levin, 2007; M.F. Brunette et al, 2008; Noordsy et al, 2001; Petrakis, Leslie, Finney, & Rosenheck, 2006; Smelson et al, 2006), quetiapine (E.…”