ABSTRACT
Behavioral emergencies are a common and serious problem. However, partly because of the inherent dangers of this situation, there is little research to guide the clinical responses to this challenge. The traditionally accepted treatment for such patients involves the use of a typical antipsychotic and a benzodiazepine. Beside the atypical antipsychotics side-effects profile, the utility of this medications in the emergency setting has been relatively unexplored. The recent availability of rapidly dissolving tablets and intramuscular preparations of some atypical agents has provided useful alternatives in some cases. Not less important is the transition to the continuation and maintenance periods. The increased risk of relapses during the transition from acute treatment is one of the most common reasons for the prolonged use of higher doses of typical antipsychotics during the management of the acute episode, and is also a very important limitating factor to release the patient from the institutional (inpatient) services. Those higher doses expose the patient to potential dangerous side effects like acute dystonia, akathisia, ataxia, ortostatic hypotension and cardiac arhytms. This article proposed an algorithm for the control of agitated patients with different preparations of olanzapine in Latin America, following the recommendations of the Eli Lilly Latin America Advisory Board and an extensive review of the literature and data on file of such company about olanzapine in the control of agitated patients and their transition to the maintenance phase.
Subject(s)
Algorithms , Antipsychotic Agents/therapeutic use , Pirenzepine/analogs & derivatives , Pirenzepine/therapeutic use , Psychomotor Agitation/drug therapy , Administration, Oral , Antipsychotic Agents/administration & dosage , Benzodiazepines , Humans , Latin America , Mental Health Services , Olanzapine , Pirenzepine/administration & dosageABSTRACT
Behavioral emergencies are a common and serious problem. However, partly because of the inherent dangers of this situation, there is little research to guide the clinical responses to this challenge. The traditionally accepted treatment for such patients involves the use of a typical antipsychotic and a benzodiazepine. Beside the atypical antipsychotics side-effects profile, the utility of this medications in the emergency setting has been relatively unexplored. The recent availability of rapidly dissolving tablets and intramuscular preparations of some atypical agents has provided useful alternatives in some cases. Not less important is the transition to the continuation and maintenance periods. The increased risk of relapses during the transition from acute treatment is one of the most common reasons for the prolonged use of higher doses of typical antipsychotics during the management of the acute episode, and is also a very important limitating factor to release the patient from the institutional (inpatient) services. Those higher doses expose the patient to potential dangerous side effects like acute dystonia, akathisia, ataxia, ortostatic hypotension and cardiac arhytms. This article proposed an algorithm for the control of agitated patients with different preparations of olanzapine in Latin America, following the recommendations of the Eli Lilly Latin America Advisory Board and an extensive review of the literature and data on file of such company about olanzapine in the control of agitated patients and their transition to the maintenance phase.
ABSTRACT
Behavioral emergencies are a common and serious problem. However, partly because of the inherent dangers of this situation, there is little research to guide the clinical responses to this challenge. The traditionally accepted treatment for such patients involves the use of a typical antipsychotic and a benzodiazepine. Beside the atypical antipsychotics side-effects profile, the utility of this medications in the emergency setting has been relatively unexplored. The recent availability of rapidly dissolving tablets and intramuscular preparations of some atypical agents has provided useful alternatives in some cases. Not less important is the transition to the continuation and maintenance periods. The increased risk of relapses during the transition from acute treatment is one of the most common reasons for the prolonged use of higher doses of typical antipsychotics during the management of the acute episode, and is also a very important limitating factor to release the patient from the institutional (inpatient) services. Those higher doses expose the patient to potential dangerous side effects like acute dystonia, akathisia, ataxia, ortostatic hypotension and cardiac arhytms. This article proposed an algorithm for the control of agitated patients with different preparations of olanzapine in Latin America, following the recommendations of the Eli Lilly Latin America Advisory Board and an extensive review of the literature and data on file of such company about olanzapine in the control of agitated patients and their transition to the maintenance phase.
ABSTRACT
BACKGROUND: An intramuscular (IM) formulation of olanzapine has been developed because there are no rapid-acting IM atypical antipsychotic drugs currently available in the United States for treating acute agitation in patients with schizophrenia. METHODS: Recently hospitalized acutely agitated patients with schizophrenia (N = 270) were randomized to receive 1 to 3 IM injections of olanzapine (2.5, 5.0, 7.5, or 10.0 mg), haloperidol (7.5 mg), or placebo within 24 hours. A dose-response relationship for IM olanzapine in the reduction of agitation was assessed by measuring the reduction in Positive and Negative Syndrome Scale Excited Component (PANSS-EC) scores 2 hours after the first injection. Safety was assessed by recording adverse events and with extrapyramidal symptom scales and electrocardiograms at 24 hours after the first injection. RESULTS: Olanzapine exhibited a dose-response relationship for reduction in agitation (F(1,179)= 14.4; P<.001). Mean PANSS-EC reductions 2 hours after the first injection of olanzapine (2.5 mg = -5.5; 5.0 mg = -8.1; 7.5 mg = -8.7; 10.0 mg = -9.4) were superior to those with placebo (-2.9; P =.01 vs olanzapine at 2.5 mg; P<.001 for each other olanzapine dose) but not with haloperidol (-7.5). A dose of 5.0, 7.5, or 10.0 mg of olanzapine caused a greater reduction in agitation than placebo 30 minutes after the first injection. There were no differences between treatment groups for hypotension, the most frequently reported adverse event, or for clinically relevant changes in the QTc interval. There was a greater incidence of treatment-emergent parkinsonism during treatment with IM haloperidol (16.7%) than with 2.5 (P =.03), 5.0 (P =.03), or 7.5 mg (P =.01) of IM olanzapine (0%) or with placebo (0%) (P =.01). CONCLUSIONS: Intramuscular olanzapine at a dose of 2.5 to 10.0 mg per injection exhibits a dose-response relationship in the rapid treatment of acute agitation in patients with schizophrenia and demonstrates a favorable safety profile.
Subject(s)
Antipsychotic Agents/therapeutic use , Haloperidol/therapeutic use , Pirenzepine/analogs & derivatives , Pirenzepine/therapeutic use , Psychomotor Agitation/drug therapy , Schizophrenia/drug therapy , Acute Disease , Adolescent , Adult , Aged , Antipsychotic Agents/administration & dosage , Benzodiazepines , Dose-Response Relationship, Drug , Double-Blind Method , Drug Administration Schedule , Female , Haloperidol/administration & dosage , Humans , Injections, Intramuscular , Male , Middle Aged , Olanzapine , Pirenzepine/administration & dosage , Placebos , Psychiatric Status Rating Scales , Schizophrenia/diagnosis , Schizophrenic Psychology , Treatment OutcomeABSTRACT
This double-blind study investigated the efficacy and safety of rapid-acting intramuscular olanzapine in treating agitation associated with Alzheimer's disease and/or vascular dementia. At 2 h, olanzapine (5.0 mg, 2.5 mg) and lorazepam (1.0 mg) showed significant improvement over placebo on the PANSS Excited Component (PANSS-EC) and Agitation-Calmness Evaluation Scale (ACES), and both 5.0 mg olanzapine and lorazepam showed superiority to placebo on the Cohen-Mansfield Agitation Inventory. At 24 h, both olanzapine groups maintained superiority over placebo on the PANSS-EC; lorazepam did not. Olanzapine (5.0 mg) and lorazepam improved ACES scores more than placebo. Simpson-Angus and Mini-Mental State Examination scores did not change significantly from baseline. Sedation (ACES > or =8), adverse events, and laboratory analytes were not significantly different from placebo for any treatment. No significant differences among treatment groups were seen in extrapyramidal symptoms or in corrected QT interval at either 2 h or 24 h, and no significant differences among treatment groups were seen in vital signs, including orthostasis. Intramuscular injection of olanzapine may therefore provide substantial benefit in rapidly treating inpatients with acute dementia-related agitation.
