Seizures, Coma, and Coagulopathy following Olanzapine Overdose

Bhanji, Nadeem H.; Chouinard, Guy; Hoffman, Lawrence H.; Margolese, Howard C.

doi:10.1177/070674370505000214

Cited by 14 publications

(12 citation statements)

References 5 publications

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“…We suggest that the sedating effect as well as weight gain 12 associated with olanzapine treatment can lead to a sedentary lifestyle, and thus induce predisposing conditions for VTE. The strong affinity of olanzapine for 5‐HT2A receptors increasing coagulability 13 or the olanzapine‐induced increase in serum anticardiolipin antibodies 14 may be other explanations. A cohort study or case–control studies are needed to better elucidate the possible role of olanzapine in VTE etiopathogenesis.…”

Section: Discussionmentioning

confidence: 99%

Four cases of venous thromboembolism associated with olanzapine

Malý

Masopust

Hosák

et al. 2009

Psychiatry Clin Neurosci

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Aims: Psychiatric disorders and treatment with conventional antipsychotic medications have been associated with venous thromboembolism, but only a few data on recent antipsychotics such as olanzapine are available. Methods:We describe four subjects treated with olanzapine who developed venous thromboembolism, and were hospitalized at the University Hospital in Hradec Kralove during the period 2004-2006. Results: We found a combination of several clinical and laboratory risk factors in our patients. Conclusions:A cohort study or case-control studies are needed to better elucidate the possible role of olanzapine in etiopathogenesis of venous thromboembolism.

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Section: Discussionmentioning

confidence: 99%

Four cases of venous thromboembolism associated with olanzapine

Malý

Masopust

Hosák

et al. 2009

Psychiatry Clin Neurosci

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“…Pharmacokinetic properties, for all antidepressants, except fluoxetine, predict that they will achieve steady state within 5-14 days after dosage reduction (Table 3) 69 . As outlined above, discontinuation symptoms have been detected in patients for varying periods of time, from a number of days, to weeks and months, and, in some cases, for more than a year 9,22,23,[70][71][72] . These records have generally been derived from patients who abruptly cease their medication; it may be possible that in more cautious reductions discontinuation symptoms are likely to be shorter.…”

Section: Practical Application Of These Principlesmentioning

confidence: 97%

“…A third study reported that 86.7% responded that the syndrome had lasted at least two months, 58.6% at least one year, and 16.2% for more than three years 21 . Case reports identify symptoms enduring for a year or longer 22,23 .…”

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confidence: 99%

Tapering of SSRI treatment to mitigate withdrawal symptoms

Horowitz

Taylor

2019

The Lancet Psychiatry

178

226

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All antidepressant classes are associated with a withdrawal syndrome. SSRI withdrawal syndrome occurs often and can be severe, and may compel patients to re-commence their medication. Although the withdrawal syndrome can be differentiated from recurrence of the underlying disorder, it may also be mistaken for recurrence, leading to long-term unnecessary medication. Authorities currently recommend short tapers, of between two to four weeks, down to therapeutic minimum, or half minimum doses before complete cessation. Studies have demonstrated that these tapers show minimal benefit over abrupt discontinuation, and are often not tolerated by patients. Tapers over months and down to doses significantly lower than minimum therapeutic doses have shown greater success rates. Other medications associated with withdrawal symptoms are tapered to reduce their biological effect at receptors by fixed amounts in order to minimise withdrawal effects. These are exponential tapering programmes which reduce to very small doses. We examined the PET imaging data of serotonin transporter occupancy by SSRIs to demonstrate that hyperbolically reducing doses of SSRI will reduce their effect on serotonin transporter inhibition in a linear manner. We therefore suggest that SSRIs are tapered hyperbolically and slowly to doses much lower than therapeutic minimums, in line with tapering regimes for other medications associated with withdrawal symptoms. Withdrawal symptoms will then be minimised.

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“…In that study of 29 952 users of antipsychotic drugs, the adjusted odds ratio for developing venous thromboembolism was 7.1 (95% confidence interval (CI) 2.3–22.0) for current users of conventional antipsychotic drugs compared with non‐users. Although not conclusive, recent adverse drug reaction monitoring system reports, 5,6 retrospective autopsy or clinical data 7–9 and case reports 3,10–15 support such an association between atypical antipsychotics and venous thromboembolism. Most of these reports concern clozapine.…”

Section: Introductionmentioning

confidence: 99%

IN VITRO EFFECTS OF ANTIPSYCHOTICS ON HUMAN PLATELET ADHESION AND AGGREGATION AND PLASMA COAGULATION

Axelsson

Hägg²,

Eriksson

et al. 2007

Clin Exp Pharma Physio

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1. Several studies suggest an association between venous thromboembolism and the use of antipsychotic drugs, especially clozapine, but the biological mechanisms are unknown. It has been suggested that antipsychotic drugs enhance aggregation of platelets and thereby increase the risk of venous thrombosis. The purpose of the present study was to examine the effects of clozapine and its main metabolite, N-desmethyl clozapine, as well as olanzapine, risperidone and haloperidol, on platelet adhesion and aggregation and on plasma coagulation in vitro. 2. Blood was collected from healthy subjects free of medication. Platelet adhesion to different protein surfaces and aggregation were measured in microplates. The coagulation methods of activated partial thromboplastin time (APTT) and prothrombin time were performed in platelet-poor plasma. 3. Clozapine was the only compound that increased platelet adhesion and aggregation and shortened APTT. The effect appeared at therapeutic concentrations and was significant but weak. 4. This weak effect of clozapine on haemostasis may explain, in part, the association of this compound and venous thromboembolism.

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Seizures, Coma, and Coagulopathy following Olanzapine Overdose

Cited by 14 publications

References 5 publications

Four cases of venous thromboembolism associated with olanzapine

Four cases of venous thromboembolism associated with olanzapine

Tapering of SSRI treatment to mitigate withdrawal symptoms

IN VITRO EFFECTS OF ANTIPSYCHOTICS ON HUMAN PLATELET ADHESION AND AGGREGATION AND PLASMA COAGULATION

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