Olanzapine Abuse

Abstract

Olanzapine is a thienobenzodiazepine that blocks especially the serontonin (5-hydroxytryptamine [5-HT]) 5-HT2A and the dopamine D2 receptors as well as muscarinic (M1), histamine (H1), 5-HT2C, 5-HT3 to 5-HT6, adrenergic (α(l)), and D4 receptors. This case report presents an olanzapine abuse. A 48-year-old, primary school graduate, married woman applied to psychiatry clinic with tachycardia, insomnia, and anxiety complaints. In psychiatric evaluations, it was determined that these complaints have been continuing for 15 years at intervals and that she has been using citalopram 40 mg/day and olanzapine 50 mg/day for the last 3 years. As diabetes mellitus was diagnosed in follow-ups, interruption of olanzapine treatment was planned. The patient stated that she started taking the medicine again upon discomfort, increase in anxiety, dysphoria, insomnia, and nervousness, which started just after olanzapine was interrupted. She said that she was feeling dense stress when she did not take the medicine, and she thought that this situation would recover only by taking that medicine and hence she could not discontinue the medicine. In addition to medications with obvious abuse potential such as benzodiazepines and methylphenidate, and other stimulants, abuse of a number of commonly prescribed psychiatric medications has been reported. There are only 2 cases of olanzapine abuse in literature.

Is There a Potential of Misuse for Quetiapine?

“…syndrome (e.g. tachycardia, insomnia, anxiety, and dysphoria [60]) after discontinuing or switching from olanzapine to another drug. Quetiapine IR preparations, here most typically represented, are short-acting, and therefore more likely to produce a physiological withdrawal reaction than the longer-acting olanzapine.…”

“…The neuro-pharmacological issues behind olanzapine misuse/self-medication potential may be associated, per se, with its anxiolytic/antipsychotic activity [16]; a 'reshuffling' in GABA(A) receptor subtypes over time [58]; and the rewarding glutamatergic stimulation of the ventral tegmental area dopaminergic neurons [55]. It is of further interest that both quetiapine [59] and olanzapine [60] present with different degrees of 5HT 2C and histamine/H1 antagonist properties [22; 60-61]. Finally, quetiapine, clozapine, and olanzapine are unique among SGAs, since they possess levels of anticholinergic activity, a pharmacological element which has been associated with a misusing potential [62].…”

“…Finally, quetiapine, clozapine, and olanzapine are unique among SGAs, since they possess levels of anticholinergic activity, a pharmacological element which has been associated with a misusing potential [62]. However, olanzapine and clozapine are much more potent than quetiapine at inhibiting the muscarinic M1 receptors [60].…”

Concerns about quetiapine

“…32 Quetiapine appears to be the most prevalent, with reports of increasing use of both prescribed and diverted quetiapine by intravenous drug users. 33 Quetiapine appears to be the most documented antipsychotic bought and sold illicitly on the street.…”

Olanzapine as the ideal “trip terminator”? Analysis of online reports relating to antipsychotics' use and misuse following occurrence of novel psychoactive substance‐related psychotic symptoms

“…Moreover, current data here identified from online sources seem to suggest that olanzapine may be taken by users at high dosages, which may suggest the molecule's potential for misuse. Consistent with this, a few cases of misuse of olanzapine have been recently anecdotally described, with larger dosages than advised taken to either obtain euphoric effects (Reeves, ; Lai, ) or to cope with withdrawal symptoms (e.g., anxiety, nervousness, and insomnia; Kumsar and Erol, ) associated with olanzapine rapid tapering down of a 50‐mg/day dosage. Although possibly less frequently misused than quetiapine (Hussain et al ., ; Reeves and Brister, ), the use of olanzapine for recreational purposes is usually linked to its relaxing/anxiolytic actions and is frequently implemented together with other substances and/or alcohol (Mead et al ., ; Sani et al ., ).…”