High-Dose Olanzapine for Treatment-Refractory Schizophrenia
1997; American Psychiatric Association; Volume: 154; Issue: 11 Linguagem: Inglês
10.1176/ajp.154.11.1626
ISSN1535-7228
AutoresBrian Sheitman, John C. Lindgren, John J. Early, Margie Sved,
Tópico(s)Epilepsy research and treatment
ResumoBack to table of contents Previous article Next article Letter to the EditorFull AccessHigh-Dose Olanzapine for Treatment-Refractory SchizophreniaBrian B. Sheitman, M.D., John C. Lindgren, M.D., John Early, R.P.H., M.P.A., and Margie Sved, M.D., Brian B. Sheitman, M.D., John C. Lindgren, M.D., John Early, R.P.H., M.P.A., and Margie Sved, M.D., Raleigh, N.C.Published Online:1 Apr 2006https://doi.org/10.1176/ajp.154.11.1626AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail TO THE EDITOR: Olanzapine, an atypical antipsychotic, has been found superior in efficacy to haloperidol for the treatment of schizophrenia, with fewer extrapyramidal side effects (1, 2). The current guidelines for olanzapine use in schizophrenic patients suggest a maximum dose of 20 mg/day; the safety of doses above this level have not yet been evaluated in clinical trials. However, many patients, including those classified as having responded to olanzapine, continue to have substantial psychopathology after 6 weeks of treatment. The primary purpose of this letter is to describe the treatment-emergent side effects that result from the administration of high doses of olanzapine to patients with treatment-refractory schizophrenia.Eight male patients with chronic schizophrenia and refractory symptoms were treated with a regimen of olanzapine that began at 5 mg/day and was titrated up to 30 mg/day in five patients and to 40 mg/day in three patients. The patients' mean age was 43 years (range=29–61), and the mean length of the current hospitalization was 96 months (range=9–211). Before assessment, patients had been receiving high-dose olanzapine for at least 12 days. Extrapyramidal side effects were assessed by using the Modified Simpson Angus Scale (3); other side effects, including blood dyscrasias, were assessed by patient interview and chart review.Of these eight patients, five were found to have acute extrapyramidal side effects (akathisia [N=1], parkinsonism [N=2], both akathisia and parkinsonism [N=2]). All symptoms were mild; only one patient required treatment with benztropine and propranolol. One additional patient had questionable parkinsonism. Mild daytime drowsiness and dry mouth were reported by five and three patients, respectively. No other side effect was reported by more than one patient. When questioned about how side effects with olanzapine compared with all previous standard antipsychotic medications, four patients reported feeling better, three felt the same, and one felt worse.The treating psychiatrists reported that all patients continued to manifest prominent psychotic symptoms at these doses. However, social functioning improved in four of the eight patients, with two being markedly more organized in thought and behavior.Overall, olanzapine treatment at doses greater than 20 mg/day was well tolerated, although a greater prevalence of extrapyramidal side effects was found at these doses (4). The efficacy of olanzapine at high doses for some refractory schizophrenic patients is suggested by these cases but remains to be firmly established.References1. Tollefson GD, Beasley CM Jr, Tran PV, Street JS, Krueger JA, Tamura RN, Graffeo KA, Thieme ME: Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective and schizophreniform disorders: results of an international collaborative trial. Am J Psychiatry 1997; 154:457–465Link, Google Scholar2. Beasley CM Jr, Tollefson G, Tran P, Satterlee W, Sanger T, Hamilton S: Olanzapine versus placebo and haloperidol: acute phase results of the North American double-blind olanzapine trial. Neuropsychopharmacology 1996; 14:111–123Crossref, Medline, Google Scholar3. Simpson GM, Angus JWS: A rating scale for extrapyramidal side effects. Acta Psychiatr Scand Suppl 1970; 212:1–58Google Scholar4. Beasly CM: Safety of olanzapine. J Clin Psychiatry Monograph 1997; 15(2):19–21Google Scholar FiguresReferencesCited byDetailsCited bySchizophrenia and Related Psychoses2 December 2021Journal of Pharmacology and Experimental Therapeutics, Vol. 360, No. 1Overview of Pharmacological Treatments and Guidelines28 January 2014CNS Spectrums, Vol. 18, No. 2Open Journal of Psychiatry, Vol. 02, No. 04Schizophrenia8 March 2013Expert Review of Neurotherapeutics, Vol. 9, No. 7Pakistan Journal of Biological Sciences, Vol. 10, No. 23Clinical Therapeutics, Vol. 28, No. 6Olanzapine for schizophrenia20 April 2005 | Cochrane Database of Systematic Reviews, Vol. 9Persistent Choreoathetosis in a Fatal Olanzapine Overdose: Drug Kinetics, Neuroimaging, and NeuropathologyLarry E. Davis, M.D., Mark W. Becher, M.D., Wieslawa Tlomak, M.D., Blaine E. Benson, Pharm.D., Roland R. Lee, M.D., and Ellen C. Fisher, B.S.1 January 2005 | American Journal of Psychiatry, Vol. 162, No. 1Schizophrenia Research, Vol. 73, No. 2-3Expert Opinion on Drug Safety, Vol. 4, No. 4The Efficacy of High-Dose Olanzapine Versus Clozapine in Treatment-Resistant Schizophrenia: A Double-Blind Crossover StudyJournal of Clinical Psychopharmacology, Vol. 23, No. 6High-Dose Olanzapine-Induced Improvement of Preexisting Type 2 Diabetes Mellitus in Schizophrenic Patients24 June 2016 | The International Journal of Psychiatry in Medicine, Vol. 33, No. 4Olanzapine in Chinese treatment‐resistant patients with schizophrenia: An open‐label, prospective trial28 August 2003 | Psychiatry and Clinical Neurosciences, Vol. 57, No. 5Effectiveness of Rapid Initial Dose Escalation of up to Forty Milligrams per Day of Oral Olanzapine in Acute AgitationJournal of Clinical Psychopharmacology, Vol. 23, No. 4The Neuroscience and Clinical Psychopharmacology of First‐ and Second‐Generation Antipsychotic Drugs25 October 2007Treatment‐Resistant Schizophrenia25 October 2007Current Opinion in Psychiatry, Vol. 16Clinical Neuropharmacology, Vol. 26, No. 2Expert Review of Neurotherapeutics, Vol. 3, No. 3Expert Review of Neurotherapeutics, Vol. 2, No. 1Lethal catatonia responding to high-dose olanzapine therapy1 July 2016 | Journal of Psychopharmacology, Vol. 15, No. 4Current Psychiatry Reports, Vol. 3, No. 5D2 receptor occupancy under recommended and high doses of olanzapine: an iodine-123-iodobenzamide SPECT study2 July 2016 | Journal of Psychopharmacology, Vol. 14, No. 4Refractory schizophrenia and atypical antipsychotics2 July 2016 | Journal of Psychopharmacology, Vol. 14, No. 4Progress in Neuro-Psychopharmacology and Biological Psychiatry, Vol. 24, No. 4Journal of Clinical Psychopharmacology, Vol. 20, No. 3Expert Opinion on Pharmacotherapy, Vol. 1, No. 2High-Dose Olanzapine Therapy in Schizophrenia28 June 2016 | Annals of Pharmacotherapy, Vol. 33, No. 11Olanzapine: Psychopharmacology, Clinical Efficacy, and Adverse Effects20 July 2017 | Hospital Pharmacy, Vol. 34, No. 4Risperidone and clozapine combination for the treatment of refractory schizophrenia13 November 2007 | Acta Psychiatrica Scandinavica, Vol. 99, No. 4Enhancing the Tolerability of Tacrine With PropanthelineRAYMOND A. FABER, M.D., , and PAULO J. NEGRO, M.D., 1 January 1999 | American Journal of Psychiatry, Vol. 156, No. 1British Experience With High-Dose Olanzapine for Treatment-Refractory SchizophreniaCHRISTOPHER Q. MOUNTJOY, M.B., B.S., F.R.C.PSYCH., ALEXANDER M. BALDACCHINO, M.D., M.R.C.PSYCH., M.PHIL., and JEAN H. STUBBS, M.SC., M.R.PHARM.S., 1 January 1999 | American Journal of Psychiatry, Vol. 156, No. 1Antipsychotic drugsCurrent Medical Research and Opinion, Vol. 15, No. 2British Journal of Psychiatry, Vol. 174, No. S38Clarithromycin-Induced ManiaAHMED ABOUESH, M.D., and William R. Hobbs, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Violent Behavior Associated With DonepezilW. P. BOUMAN, M.D., and G. PINNER, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Etiology of Borderline Personality DisorderJUDITH P. SALZMAN, ED.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Drs. Zanarini and Frankenburg ReplyMARY C. ZANARINI, ED.D., and FRANCES R. FRANKENBURG, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Science of AddictionAVIEL GOODMAN, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Dr. O'Brien RepliesCHARLES P. O'BRIEN, M.D., PH.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Use of Psychotropic Medications During LactationJAMES G. LONGHURST, M.D., and ERICA WEISS, M.D. , 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Drs. Stowe and Owens ReplyZACHARY N. STOWE, M.D., and MICHAEL J. OWENS, PH.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Association Between Age at Onset of Schizophrenia and Obstetric ComplicationsRAINER T. SCHAUB, M.D., FRIEDEL M. REISCHIES, M.D., and PETER SCHLATTMAN, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Dr. Verdoux and Colleagues ReplyHÉLÈNE VERDOUX, M.D., , JOHN R. GEDDES, M.R.C.PSYCH., NORIYOSHI TAKEI, M.D., PH.D., and ROBIN M. MURRAY, D.SC., F.R.C.PSYCH., F.R.C.P., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Treatment of Borderline Personality DisorderEDWARD R. SHAPIRO, M.D., and ERIC M. PLAKUN, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Drs. Sharfstein and Quaytman ReplySTEVEN S. SHARFSTEIN, M.D., and MILES S. QUAYTMAN, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Use of Herbal Products and Symptoms of Bipolar DisorderNARESH P. EMMANUEL, M.D., CATHIE JONES, B.A., and R. BRUCE LYDIARD, PH.D., M.D. , 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Antidepressants in Depressed Patients With Irritable Bowel SyndromeIRINA EFREMOVA, M.D., and GREGORY ASNIS, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Response of the Parkinsonian Symptoms of Multiple System Atrophy to ECTW. MICHAEL HOOTEN, M.D., GABRIELLE MELIN, M.D., and JARRETT W. RICHARDSON, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Cocaine and CatatoniaJAY A. GINGRICH, M.D., PH.D., FRANCES RUDNICK-LEVIN, M.D. , CARLOS ALMEIDA, M.D., LORRAINE INNES, M.D., and HOLLY SCHNEIER, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Sertraline in the Treatment of Clozapine-Induced Obsessive-Compulsive BehaviorM. SADIQUR RAHMAN, M.D., JEFFERY J. GRACE, M.D., MICHELE T. PATO, M.D., and BARBARA PRIEST, R.N., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Catatonia Treated With Transcranial Magnetic StimulationNIMROD GRISARU, M.D., BELLA CHUDAKOV, M.D., YURI YAROSLAVSKY, M.D., and R. H. BELMAKER, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Olanzapine Overdose Cause of Acute Extrapyramidal SymptomsR. ANDREW CHAMBERS, M.D., ANNMARIE CARACANSI, M.D., and GORDON WEISS, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Suicide Attempts Among Seropositive Women in New York CityJANE M. SIMONI, PH.D., DAWN K. NERO, M.A., and BETH A. WEINBERG, 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Gabapentin Treatment of Alcohol WithdrawalHUGH MYRICK, M.D., ROBERT MALCOLM, M.D., and KATHLEEN T. BRADY, M.D., PH.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Behavioral Complications Associated With DonepezilSTEVEN P. WENGEL, M.D., , WILLIAM H. ROCCAFORTE, M.D., WILLIAM J. BURKE, M.D., BARBARA L. BAYER, R.N., M.S.N., DENNIS P. MCNEILLY, PSY.D., and DEBRA KNOP, R.N., M.S.N.1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Atypical Neuroleptic Malignant Syndrome and Atypical AntipsychoticsPETER F. BUCKLEY, M.D., and Samia Hasan, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Schizophrenia and Intellectual DeclineJAMES GOLD, PH.D. , 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Letters to the EditorANTHONY DAVID, M.D., M.R.C.PSYCH., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Letters to the EditorJANICE R. STEVENS, M.D. , CARL M. STEVENS, PH.D., , and RICHARD J. WYATT, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Drs. Russell and Murray ReplyAILSA J. RUSSELL, M.SC.CLIN.PSYCH., and ROBIN M. MURRAY, D.SC., F.R.C.PSYCH., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Fluoxetine and NorfluoxetineJEFFREY A. MATTES, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Dr. Amsterdam and Colleagues ReplyJAY D. AMSTERDAM, M.D., , JAN FAWCETT, M.D., FREDERIC M. QUITKIN, M.D., FREDERICK W. REIMHERR, M.D., JERROLD F. ROSENBAUM, M.D., DAVID MICHELSON, M.D., and CHARLES M. BEASLEY, M.D.1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Delirium Following Cessation of Alcohol ConsumptionBRYON ADINOFF, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Letters to the EditorMAX FINK, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Dr. Kranzler and Colleagues ReplyHENRY R. KRANZLER, M.D., , DAVID HERSH, M.D., and ROGER E. MEYER, M.D.1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Risk Factors for Neuroleptic Malignant SyndromeKEITH G. RASMUSSEN, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Letters to the EditorANDREW FRANCIS, PH.D., M.D., SANJAY CHANDRAGIRI, M.D., , and GEORGIOS PETRIDES, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Dr. Sachdev RepliesPERMINDER SACHDEV, M.D., PH.D., F.R.A.N.Z.C.P., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Suicide Risk in SchizophreniaEDUARD VIETA, M.D., EVARISTO NIETO, M.D., and CRISTOBAL GASTO, M.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 11Dr. Heilä and Colleagues ReplyHANNELE HEILÄ, M.D., MARKUS M. HENRIKSSON, M.D., PH.D., MAURI J. MARTTUNEN, M.D., PH.D., ERKKI T. ISOMETSÄ, M.D., PH.D., MARTTI E. HEIKKINEN, M.D., PH.D., and JOUKO K. LÖNNQVIST, M.D., PH.D., 1 November 1998 | American Journal of Psychiatry, Vol. 155, No. 115-HT2 and D2 Receptor Occupancy of Olanzapine in Schizophrenia: A PET InvestigationShitij Kapur, M.D., Ph.D., F.R.C.P.C., Robert B. Zipursky, M.D., F.R.C.P.C., Gary Remington, M.D., Ph.D., F.R.C.P.C., Corey Jones, B.Sc., Jean DaSilva, Ph.D., Alan A. Wilson, Ph.D., and Sylvain Houle, M.D., Ph.D., F.R.C.P.C.1 July 1998 | American Journal of Psychiatry, Vol. 155, No. 7 Volume 154Issue 11 November 1997Pages 1626-1626 Metrics History Published online 1 April 2006 Published in print 1 November 1997
Referência(s)