Olanzapine‐induced limb edema simulating episodic angioedema with eosinophilia

Honma, Masaru; Minami-Hori, Masako; Tsuji, Hitomi; Komatsu, Shigetsuna; Iizuka, Hajime

doi:10.1111/j.1346-8138.2012.01545.x

Cited by 11 publications

(8 citation statements)

References 4 publications

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“…The mechanism of edema secondary to olanzapine is unclear and has been related to olanzapine induced receptor profile (6). Another suggested mechanism is allergic reaction which was supported with histopathological findings and moderate eosinophilia (7). In our case we did not run histopathological studies.…”

Section: Discussionmentioning

confidence: 53%

Olanzapine Associated Acute Peripheral Edema and Pericardial Effusion: A Case Report

Arslan

Bulut

Naki

2018

Archives of Neuropsychiatry

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Olanzapine is a potent atypical antipsychotic drug used for the treatment of schizophrenia and bipolar disorder with approved efficiency. Olanzapine is superior to the typical antipsychotic drugs with low incidence of extrapyramidal side effects, especially tardive dyskinesia. The most common side effects associated with olanzapine are constipation, dyspepsia, weight gain, somnolence, asthenia, dry mouth and dizziness. Peripheral edema associated with olanzapine is rarely reported and as far as we know there is no report in the literature about peripheral edema concomitant with pericardial effusion related to olanzapine. The mechanism of these side effects associated with olanzapine is still unclear and there are different hypotheses in the literature. Herein we report the first case that developed both peripheral edema and pericardial effusion after olanzapine administration. Although very rarely encountered, clinicians should be aware of these possible side-effects.

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Section: Discussionmentioning

confidence: 53%

Olanzapine Associated Acute Peripheral Edema and Pericardial Effusion: A Case Report

Arslan

Bulut

Naki

2018

Archives of Neuropsychiatry

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“…Finally, an allergic reaction against to olanzapine has been suggested as the cause of olanzapine induced edema. Although, in that case, immunoglobulin levels have been normal, allergic mechanism between the limb edema and olanzapine have been proven with histopathological findings and moderate eosinophilia (Honma et al, 2012). Similarly, Terao et al (1988) and Conney and Nagy (1995) have explained the risperidone associated edema by allergic pathways.…”

Section: Case Reportmentioning

confidence: 82%

Bilateral pedal edema associated with olanzapine treatment: A case report

Toz¹,

Taşdemir²,

Özer³

et al. 2015

JNBS

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Peripheric edema could be caused by various medical conditions as well as pharmacologic agents such as antihypertensives, nonsteroidal antiinflamatory drugs, endocrine agents and immunotherapies. Olanzapine is an atypical antipsychotic that is widely prescribed for the treatment of schizophrenia and bipolar affective disorder. Most common adverse reactions of olanzapine are weight gain, postural hypotension, constipation, dizziness, akathisia, sedation. Peripheral edema was reported as an infrequent side effect, which affected 3% of the olanzapine treated patients. In this report, we aim to draw attention of psychiatrists on this rare adverse effect by presenting a 56-year-old case, who applied to our hospital with severe depressive and obsessive-compulsive symptoms and hospitalized because of suicide risk. Before psychiatric admission, he wasn't taking any medication. He was diagnosed as major depression with psychotic features and obsessive-compulsive disorder. He was started on olanzapine 10 mg/day, quetiapine 300 mg/day and fluoxetine 40 mg/day. Two weeks after initiation of olanzapine, he was found to have bilateral pedal edema without ulceration and temperature change but minimal redness was observed. He had no history suggestive of cardiac, renal and liver dysfunction or allergic reaction against to any drug that could explain his existing edema. Possible medical conditions which may cause edema were ruled out by laboratory tests and physical examination. Olanzapine was stopped immediately and the therapy was modified to risperidone 1 mg/day. After discontinuation of olanzapine, edema was gradually resolved within two weeks. Because olanzapine associated edema has been seen rarely, it could be overlooked by psychiatrists in comparison to its more common side effects. Although it shows self-limited and benign course, patients may feel discomfort and their compliance to treatment may decrease. Also, it may interfere with differential diagnosis of other medical conditions which may cause edema. In conclusion, we suggest that patients should be observed carefully for edema during olanzapine treatment.

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“…Peripheral or localized edematous reactions have been reported more frequently in olanzapine and olanzapine/fluoxetine groups, compared with placebo (15% vs 2%), in clinical trials. 5 The available literature 11,12,14,[20][21][22][23][24][25] suggests this reaction may occur at any dose of olanzapine, and it may not necessarily be dose dependent in nature, as noted by the cases describing persons who experienced edema with initiation of the drug (Table). Furthermore, timing of edema onset and resolution appears to be variable, ranging from 2 days to 2 months.…”

Section: Discussionmentioning

confidence: 99%

Whole-body edema with olanzapine: A case report and literature review

Cook

Shipman

Fowler

2020

Mental Health Clinician

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Olanzapine is a second-generation antipsychotic (SGA) that has been shown to promote disease remission in persons with treatment-resistant depression when used in combination with fluoxetine. However, tolerability of treatment augmentation with SGAs may be limited because of common adverse effects, such as weight gain, hypertriglyceridemia, and elevated glucose. Data exist pertaining to rare localized edematous reactions or angioedema with use of SGAs, but diffuse whole-body edema has yet to be documented. A 47-year-old white female with treatment-resistant depression presented with a 5-day history of weight gain and swelling of her torso and extremities. Five days prior, she had initiated olanzapine/fluoxetine 6/50 mg daily following failure of fluoxetine 40 mg daily monotherapy. The patient was noted to have gained 3.6 kg since her last appointment and exhibited profuse pitting edema on her forearms, lower limbs, hands, and chest. Olanzapine/fluoxetine was discontinued and the patient was prescribed a 3-day course of a loop diuretic for symptomatic management. A follow-up visit 5 days later noted complete resolution of symptoms. Because of the temporal relationship of symptoms with initiation of olanzapine, we recommend monitoring for edema with initiation and/or titration of therapy.

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Olanzapine‐induced limb edema simulating episodic angioedema with eosinophilia

Cited by 11 publications

References 4 publications

Olanzapine Associated Acute Peripheral Edema and Pericardial Effusion: A Case Report

Olanzapine Associated Acute Peripheral Edema and Pericardial Effusion: A Case Report

Bilateral pedal edema associated with olanzapine treatment: A case report

Whole-body edema with olanzapine: A case report and literature review

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