Propuesta para América Latina de un algoritmo para el manejo de pacientes agitados con olanzapina y su transición a la vía oral. / [Proposal for Latin America of an algorithm for the management of agitated patients with olanzapine and its switch to oral administration]

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.