Off-Label Use of Intravenous Olanzapine for Agitation After Neurologic Injury

Abstract

Background: Small studies have described the off-label use of intravenous (IV) olanzapine for the management of acute agitation. Objective: The purpose of this study was to evaluate the efficacy and safety of IV olanzapine to manage acutely agitated patients with neurological injuries. Methods: This was a retrospective analysis of IV olanzapine use in patients admitted to the neurotrauma and neurovascular intensive care units at a single academic center. The primary endpoint was the requirement of additional IV olanzapine, IV benzodiazepine, or IV haloperidol within 60 minutes from the time of first IV olanzapine dose. Secondary safety endpoints included QTc prolongation and respiratory depression. Results: Forty-six patients received IV olanzapine during the study period. One patient required an additional dose of IV olanzapine and two patients received benzodiazepine or antipsychotic agents within 60 minutes of IV olanzapine administration. One patient had a post-administration QTc level >500 ms. Two patients had an increased oxygen requirement, but none required intubation. Conclusion: IV olanzapine appears to be efficacious in reducing the need for sedatives and antipsychotics with low risk for QTc prolongation and respiratory depression in acutely agitated patients with neurological injuries.

Safety of Intravenous Olanzapine Administration at a Tertiary Academic Medical Center

“…Previous data in the ICU population are limited to case reports, poster abstracts, and studies involving smaller sample sizes. [5][6][7]9 The majority of patients received multiple doses of IVP olanzapine, which has not been well established in previous studies in the ICU population. 9 The inpatient population is important to analyze because most previous studies on IVP olanzapine took place in the ED setting, where repeat dosing and extended durations of therapy are uncommon.…”

“…[5][6][7]9 The majority of patients received multiple doses of IVP olanzapine, which has not been well established in previous studies in the ICU population. 9 The inpatient population is important to analyze because most previous studies on IVP olanzapine took place in the ED setting, where repeat dosing and extended durations of therapy are uncommon. Additionally, we focused on safety end points of clinical significance by assessing whether hypotensive or bradycardic events required any clinical intervention or were self-resolving in nature.…”

“…1 Previous studies have demonstrated the off-label usage of intravenous push (IVP) olanzapine across multiple indications. 2-11 IVP olanzapine is seen as a useful option in acute agitation because it can be given rapidly in patients with IV access. 3-9 Further rationale for the off-label usage of IVP olanzapine is the thought of a faster onset of action compared with the IM route of administration, which can take up to 45 minutes to reach peak concentrations.…”

“…2-11 IVP olanzapine is seen as a useful option in acute agitation because it can be given rapidly in patients with IV access. 3-9 Further rationale for the off-label usage of IVP olanzapine is the thought of a faster onset of action compared with the IM route of administration, which can take up to 45 minutes to reach peak concentrations. 1 In addition to acute agitation, IVP olanzapine has been used off-label for the treatment of chemotherapy-induced nausea and vomiting.…”

Olanzapine Pharmacokinetics: A Clinical Review of Current Insights and Remaining Questions

“… 96 When examining the safety of IV olanzapine in 46 acutely agitated patients with neurological injuries, olanzapine was found to be low risk for respiratory depression with only four patients requiring additional oxygen support, and no patients requiring intubation. 97 …”