Uncommon Side Effects Associated with Olanzapine

Abstract

A 29-year-old African-American male was admitted for an inpatient forensic evaluation. Due to the presence of auditory and visual hallucinations with paranoid ideation, the patient was started with olanzapine, 5 mg each morning and 10 mg each evening. The patient was continued on the Albuterol and thephylline. On admission, LDH was 193, SGOT 62, and SGPT 75. Serum electrolytes were normal and physical examination was normal with no dependent edema. Blood pressure was 130/84 mm/Hg. Twelve days later olanzapine was increased to 20 mg/day for continued auditory hallucination. On the same day, pitting edema (++) was noted on both feet and blood pressure was 160/90 mm/Hg. The patient was therefore started on hydrochlorothiazide and a potassium supplement. Patient liver enzymes were slightly in the upper level of therapeutic range upon admission. Patient exhibited improvement with lessening of auditory and visual hallucinations, but edema continued. On day 20, LDH was 263, SGOT was 103, and SGPT was 141. Systolic blood pressures ranged between 140 and 160 and diastolic pressures were 76 to 90. Hypotension is common with typical and atypical antipsychotics, but transient hypertension is uncommon.Bilateral dependent edema progressed from ++ to +++ during the rest of his hospital course. However, edema and an increase in liver transaminases have become more common side effects of olanzapine, but this is not frequently encountered in the literature. Patient admission EKG showed sinus tachycardia and nonspecific T-wave abnormality, but chest X-ray, EEG, and CT scan of head were all normal on admission. Olanzapine was discontinued and Risperdol was started at 2 mg/day. Fourteen days after discontinuation of the olanzapine, the edema completely cleared, transaminases returned to baseline, and blood pressures returned to normal. Hydrochlorothiazide and the potassium supplement were therefore discontinued.This patient developed dependent pedal edema with transient increases in transaminase levels from the use of olanzapine, which was not dose dependent. Complete resolution of his edema, lowering of transaminases, and stabilization of blood pressure were noted after the discontinuation of olanzapine. Further research needs to be performed in order to identify vulnerable patients who reveal edema and blood pressure elevation with this medication. Bibliography: Pharmacopsychiatry 2003; 36: 83´ Georg Thieme Verlag Stuttgart´New York´ISSN 0032-0943Olanzapine (Zyprexa) is one of the novel atypical antipsychotics that act as a serotonin-dopamine receptor antagonist. Its use is increasing in frequency among psychiatrists to treat both the positive and negative symptoms of schizophrenia. It is also becoming a commonly prescribed antipsychotic because of its low association with dystonia and other extrapyramidal side effects. More commonly, sedation, weight gain, and transient, nondose-dependent, symptomatic elevations in liver enzymes are seen with the use of this drug [1, 2, 3]. This is a case of a patient who had elevation of transami...

Safety Profile of Antipsychotic Drugs: Analysis Based on a Provincial Spontaneous Reporting Systems Database

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Olanzapin ve Mirtazapin'in Birlikte Kullanımıyla İlişkili Periferik Ödem: Olgu Sunumu

“…Üçüncü vaka ise 60 yaşında obezitesi, dispnesi ve hipertansiyonu olan bir hastada mirtazapin kullanımından sonra ortaya çıkan ödem vakasıdır. Bu vakaların hiçbirinde ödem oluştuğu sırada diyet ve sıvı alımında bir değişiklik saptanmamıştır (13)(14)(15)(16)(18)(19)(20)(21)(22)(23). Bizim vakamız, şizofreni dışında ek bir tanı olmaksızın 30 mg/g olanzapin tedavisine, 30 mg/g mirtazapin eklenmesinden sonra ortaya çıkan ödem vakasıdır.…”

A Male Case of Monosymptomatic Hypochondriacal Psychosis Responding to Olanzapine

“…With regard to side effects, there have been no side effects in this case. However, careful attention is still required because excessive body weight gain, glucose intolerance, and dyslipidemia seems to be associated with olanzapine in some patients [1], and other side effects were also reported recently [3,6].…”