Olanzapine IM versus haloperidol IM for acute agitation in schizophrenia

ABSTRACT

Patients with schizophrenia presenting with agitated or violent behavior require pharmacological tranquilization. Olanzapine is the first atypical antipsychotic to have a short acting intramuscular preparation for control of agitation. There is a need to review the efficacy and safety of olanzapine intramuscular compared to intramuscular haloperidol. Objectives: To compare the efficacy of olanzapine intramuscular with haloperidol intramuscular in controlling acute agitation among patients with schizophrenia. Methodology: The authors searched the Cochrane Schizophrenia Group Register (November 2004), Cochrane Database for studies, Cochrane Controlled Trials Register (Issue 1, 2002), MEDLINE (1992 to the present), Clinical Trials.gov, Lilly Trial Registry and ClinicalTrialresults.org. Authors also hand-searched references of journal articles and contacted pharmaceuticals for relevant literature. Articles included in the meta analysis were randomized clinical trials comparing the efficacy of intramuscular olanzapine to intramuscular haloperidol for controlling agitation among patients with schizophrenia. Included studies had participants 18 years old and above who had schizophrenia and were acutely agitated. Intervention included olanzapine intramuscular 10-20 mgs compared with haloperidol 5-10 mgs. Outcomes included were decreased in agitation as measured by time to tranquility, change in PANSS scale or other appropriate scale and mean dose to achieve tranquility. Secondary outcomes measures were occurrence of adverse events, patient and care giver satisfaction and economic costs. Analysis: Two authors independently assessed the quality of the studies. Data were extracted using the Cochrane Data Extraction Form. Missing data from the studies furnished by ClinicalTrialresults.org. Data that were continuous were sing mean change. Difference in mean change was analyzed using inverse variance, fixed effects method at 95% confidence interval. Data that were dichotomous were analyzed using odds or risk ratio using Mantel-Haenszel method at 95% confidence interval. Results: Pooled data from the studies did not show that olanzapine intramuscular was not equal to haloperidol intramuscular in decreasing acute agitation among patients with schizophrenia. In terms of treatment emergent adverse events, the risk for treatment emergent adverse events was more for haloperidol IM compared olanzapine IM. Conclusions: It cannot be said that olanzapine IM and haloperidol IM are not equal in decreasing agitation among patients with schizophrenia. In terms of treatment emergent adverse events, the risk for extrapyramidal side effects and dystonia was more for haloperidal IM compared to olanzapine IM while the risk for abnormal blood pressure was more for olanzapine IM compared to haloperidol IM. There is need to assess other factors like economic cost, patient and caregiver satisfaction which the studies in this meta-analysis did not include.