Pulmonary embolism possibly associated with olanzapine treatment

Abstract

study in which indicators of insulin sensitivity were associated with suicide risk. 1 The explanation for the reverse J shaped association seen when diabetes was included as a fifth category alongside insulin resistance may be due to patients with a clinical diagnosis of diabetes developing depression as a result of this diagnosis.We based our assessment of depression on current use of medication and self reports of past diagnoses and current mood rather than clinical assessment with international diagnostic criteria. However, the consistency of our findings across the three different assessments supports a causal association, and any measurement error in our assessment of depression would tend to dilute the results. Insulin resistance is positively associated with diabetes and cardiovascular disease, and we do not believe that our results should be used to discourage appropriate interventions to prevent and treat insulin resistance. Further, these are novel findings and need to be replicated in other studies. However, if our findings are confirmed there may be an indication for assessing depressive symptoms among individuals receiving treatments that affect insulin resistance, since depressive symptoms are often disabling and could affect compliance with treatment and quality of life. (Accepted 30 September 2003) Drug points Pulmonary embolism possibly associated with olanzapine treatmentInger Marie Waage, Ane Gedde-Dahl Antipsychotic drugs have been associated with an increased risk of venous thromboembolism. 1 We report for the first time the case of a patient who developed a pulmonary embolism after starting treatment with olanzapine.A 28 year old man was admitted to hospital due to a psychotic disorder. Treatment with olanzapine (10 mg/ day) was started, and the dose was gradually increased to 30 mg/day. He also received levomepromazine (50 mg/ day), oxazepam (10 mg/day), and flunitrazepam (1 mg/ day). After 10 weeks, the patient complained of respiratory pain and he had two episodes of haemoptysis. Clinical examination showed no auscultatory findings, no dyspnoea, no tachypnoea, no fever, and normal blood pressure and heart rate. Blood analysis showed raised concentrations of C reactive protein (113 mg/l (normal range < 10 mg/l)), fibrinogen (6 g/l (2-4 g/l)), and d-dimer (0.89 mg/l ( < 0.50 mg/l)). Spiral computed tomography showed a pulmonary embolism in the left lower lobe. Standard anticoagulant treatment was started, and the patient recovered. Olanzapine was discontinued, and his medication changed to quetiapine.Recent reports suggest an association between clozapine and venous thromboembolic events.2-5 However, thromboembolic complications have not previously been described in patients taking olanzapine. The sedating effects as well as the weight gain associated with this antipsychotic treatment can lead to a more sedentary lifestyle, thus creating predisposing conditions for venous thrombosis. In this case, the patient was overweight (body mass index 28.5), but his weight had not substantially chan...

Risk of venous thromboembolism due to antipsychotic drug therapy

“…Except for weight lifting, an exercise possibly associated with deep vein thrombosis [54], he had no known risk factors. In another case report massive pulmonary embolism was reported in 25-year-old man with no identified risk factors for VTE, but who had been treated with olanzapine for 3 weeks [35]. Subsequently, the patient also developed pulmonary embolism on two further occasions during treatment with risperidone (3 and 19 weeks after the commencement of treatment, respectively).…”

“…The subjects had a variety of clinical and laboratory risk factors. A case of pulmonary embolism was reported in a 28-year-old male 10 weeks after starting treatment with olanzapine due to a psychotic disorder [35]. Except for overweight, no risk factors for VTE were described.…”

“…In US nursing home residents a 1.9-and a 2.0-fold increase in the rate of hospitalisation for VTE was reported for olanzapine and risperidone, respectively [16]. A possible association between VTE and olanzapine has also been suggested in a limited number of case series [22,23] and case reports [34][35][36][37][38][39][40][41]. In one case series [22] three elderly subjects (an 89-year-old male, a 78-year-old male and an 83-year-old female) developed first time VTE within the first 6 weeks of olanzapine treatment.…”

An unusual complication of a long-acting injectable antipsychotic: deep venous thrombosis caused by olanzapine pamoate

“…On the other hand, clozapine is the most reported second-generation antipsychotic with epidemiological evidence of DVT [12]. In contrary to clozapine, there are only a few published case reports about the olanzapine-DVT relationship in which the oral form was utilized [15,16].…”

Deep venous thrombosis and pulmonary embolism in psychiatric settings

“…On the association between VTE and other atypical antipsychotic drugs, 4 casereports (Table II) [24][25][26][27] and 3 previously mentioned studies [4][5][6] were found. The study of Hamanaka et al was based on small numbers (4 patients) 4 and Parkin et al 9 didn't find an increased risk.…”