Olanzapine-induced Tardive Oculogyric Crises

Abstract

Tardive syndromes are much lower in prevalence in second generation antipsychotics (SGA) than in the typical antipsychotics. Although, olanzapine, which is an SGA, has a high risk of causing weight gain, metabolic syndrome, raised blood sugar, and dyslipidemias; it is widely used as the risk of developing extrapyramidal syndromes (EPS) is low. Among the various forms of EPS, tardive syndromes are the most feared, tardive dyskinesia, tardive akathisia, and tardive dystonia are the commonest tardive syndromes, the others being less common. Tardive oculogyric crises (TOC) are a rare form of tardive dystonia. This patient had TOC with prolonged unsupervised treatment with low-dose olanzapine. Added to that, she developed weight gain that was alarmingly high and such high gain in weight with olanzapine, to our knowledge, has not been reported. She responded to a low dose of trihexiphenydyl, and on stopping olanzapine and adding aripiprazole, has started losing weight.

Olanzapine-induced oculogyric crisis in a patient with mania without psychotic symptoms: a case report

“…A major fraction of the cases reported with OGC has been contributed by the use of neuroleptic drugs, which involves the disruption of dopamine pathways and comprise the major portion of the drug-induced OGC 1 , 3 , 13 . Atypical antipsychotics like olanzapine are less commonly reported to cause OGC as compared to typical antipsychotics like haloperidol, perphenazine which is in contradiction to our case 14 . Erden Ferahkaya 15 suggests that while atypical antipsychotics are indeed safer than typical antipsychotics in relation to extrapyramidal adverse effects, they are potential to cause dystonic features like OGC.…”

Movement disorders and other motor abnormalities in adults with 22q11.2 deletion syndrome

“…Strikingly, two patients (Patients 2 and 3) showed parkinsonism while receiving clozapine; a side effect assumed to be (near) absent in clozapine treatment [Seeman, ]. Moreover, one patient developed oculogyric crises while receiving olanzapine (Patient 5) and another (Bassett et al, ) on quetiapine; this is an extremely rare side effect of these medications [Bavle and Kumar, ]. Our clinical experience suggests that patients with 22q11.2DS might be more prone to develop antipsychotic‐induced movement disorders, including those associated with other psychotropic medications such as (mood‐stabilizing) anti‐epileptic drugs, lithium, and antidepressants [Haddad and Dursun, ].…”

Improvement of Tardive Dyskinesias with Olanzapine

“…Furthermore, it should be noted that some studies have reported the development of TD in relation to the use of olanzapine and clozapine [28][29][30][31][32][33].…”