Olanzapine for treatment and prevention of acute chemotherapy‐induced vomiting in children: A retrospective, multi‐center review

Abstract

Olanzapine may be an important option to improve CIV control in children. Prospective controlled evaluation of olanzapine for CINV prophylaxis in children is warranted.

Guideline for the Treatment of Breakthrough and the Prevention of Refractory Chemotherapy‐Induced Nausea and Vomiting in Children With Cancer

“…This multicenter, retrospective review described chemotherapy-induced vomiting (CIV) control and adverse effects in children receiving olanzapine. [14] In this cohort, 20 children received olanzapine for breakthrough CINV during 21 chemotherapy blocks. Complete CIV control was reported the day following the first olanzapine dose in 12 chemotherapy blocks (57%).…”

“…It may be reasonable to give olanzapine 0.1 mg/kg/dose (maximum 10 mg/dose) once daily by mouth. This dose is based on the results of the retrospective review [14] and uses the adult dose as the maximum dose. If CINV is not controlled and sedation does not occur or is not troublesome, the dose could potentially be increased to 0.14 mg/kg/dose (maximum 10 mg/dose).…”

Olanzapine for chemotherapy‐induced nausea: Lessons learned from child and adolescent psychiatry

“…In the recent ASCO guidelines for adults, protocols recommend short‐term use of olanzapine 10 mg nightly for 4 days without lab work or other metabolic monitoring . In a pediatric study (N = 60) of olanzapine (0.1 mg/kg) during chemotherapy blocks, there was no associated weight gain . Although short‐term use of olanzapine may mitigate the risk of metabolic consequences, concomitant steroids escalate metabolic risks, and especially noteworthy, adolescents are more vulnerable to metabolic syndrome than adults are …”

Emerging Role of Olanzapine for Prevention and Treatment of Chemotherapy‐Induced Nausea and Vomiting

“…Only one case of sedation reportedly resulted in discontinuation of olanzapine. In 20% of the chemotherapy blocks, increases in transaminase levels were reported . Given the concern for increased risk of adverse effects in the adolescent psychiatric population receiving olanzapine as well as the potential for variable dose‐ranging effects based on pharmacogenetics, it is prudent to conduct further studies to confirm the safety, most appropriate dose, and place in therapy for olanzapine in the pediatric setting with regard to CINV …”