Olanzapine Lorazepam

First, optimize current mood stabilizer or initiate mood-stabilizing medication lithium,0 valproate,0 or carba-mazepine0 Consider adding a benzodiazepine (lorazepam or clonazepam) for short-term adjunctive treatment of agitation or insomnia if needed Alternative medication treatment options carbam-azepine0 if patient does not respond or tolerate, consider atypical antipsychotic (e.g., olanzapine, quetiapine, risperidone) or oxcarbazepine. 

Agitation (acute, severe) Lorazepam Ziprasidone Risperidone Trazodone Olanzapine Quetiapine Haloperidol... 

Brief Severe Agitation. Acute management of severe agitation with physical aggression requires more definitive treatment. The first choice is haloperidol given in low doses (0.25-1 mg) as needed. Lorazepam can also be helpful if used briefly. Risperidone, olanzapine, quetiapine, or trazodone can also be used but are not available in injectable forms. 

In situations characterized by agitation, Gilmer and Busch (484) have recommended lorazepam in small doses (0.5 mg) given intravenously by slow push or intramuscularly. The anticipated availability of acute parenteral (i.m.) novel antipsychotics (e.g., olanzapine, ziprasidone) may be reasonable alternatives. 

Antipsychotic drugs are also indicated for schizoaffective disorders, which share characteristics of both schizophrenia and affective disorders. No fundamental difference between these two diagnoses has been reliably demonstrated. They are part of a continuum with bipolar psychotic disorder. The psychotic aspects of the illness require treatment with antipsychotic drugs, which may be used with other drugs such as antidepressants, lithium, or valproic acid. The manic phase in bipolar affective disorder often requires treatment with antipsychotic agents, although lithium or valproic acid supplemented with high-potency benzodiazepines (eg, lorazepam or clonazepam) may suffice in milder cases. Recent controlled trials support the efficacy of monotherapy with atypical antipsychotics in the acute phase (up to 4 weeks) of mania, and olanzapine and quetiapine has been approved for this indication. 

Phenothiazines and related drugs, e.g., chlorpromazine (Largactil/ Thorazine). Some tricyclic antidepressants, e.g., amitriptyline Dibenzodiazepine derivatives and thienobenzodiazepines, e.g., clozapine, olanzapine Benzodiazepines, e.g., diazepam (Valium), nitrezepam (Librium) and lorazepam Barbiturates Opiates... 

Akathisia has been reported in 16% of patients taking olanzapine (SEDA-21, 56). Three patients developed severe akathisia during treatment with olanzapine (20-25 mg/day) (87). In two, the akathisia resolved after withdrawal of olanzapine and in one of those olanzapine was well tolerated when reintroduced in combination with lorazepam. In the third patient, the akathisia was controlled by dosage reduction. A 33-year-old man with AIDS and a prior history of extrapyramidal symptoms with both typical antipsychotic drugs and risperidone developed dose-dependent akathisia with olanzapine 15-19 mg/day the akathisia responded to dosage reduction and beta-blockade (88). 

The authors of the second case stated that, in spite of decades of experience with haloperidol, an associated literature search has revealed only very rare instances of hemotoxicity, and since lorazepam is not known to cause leukopenia, olanzapine may have been the more likely offender the simultaneous effect of both antipsychotic drugs, olanzapine and haloperidol, is unknown. 

Kinon BJ, Ahl J, Rotelli MD, McMullen E. Efficacy of accelerated dose titration of olanzapine with adjunctive lorazepam to treat acute agitation in schizophrenia. Am J Emerg Med 2004 22 181-6. 

The combined regimen is safe and effective, although severe cardiovascular or respiratory adverse effects may occur with high doses of clozapine when combined with diazepam and lorazepam. There are no reports of pharmacokinetic interactions between olanzapine and benzodiazepines (studied mainly with diazepam). 

Intramuscular lorazepam 2 mg, given 1 hour after intramuscular olanzapine 5 mg increased the drowsiness seen with either drug alone. The pharmacokinetics of both drugs were not affected. One case report de-... 

Zacher JL, Roche-Desilets J, Hypotension secondary to the combination of intramuscular olanzapine and intramuscular lorazepam. JC/zh Psychiatry (2005) 66,1614-15. 

A 19-year-old man with a depressive disorder, taking olanzapine, lorazepam, and aripipra-zole, took an intentional overdose of40-45 tablets of dapsone 100 mg (a total of 4—4.5 g). He became drowsy but was conscious and responded to oral commands. There were signs of cyanosis and sinus tachycardia. The serum methemoglobin concentration was increased at... 

Higher medication doses can often be used in fit younger adults, e.g. haloperidol 5 mg, olanzapine 5 mg, lorazepam 1-2 mg. Take extra care with antipsychotics if you suspect a postictal state, or alcohol withdrawal, as they lower the seizure threshold. 

Antipsychotic - only if meet criteria for oral antipsychotics (above) Olanzapine 2.5 mg (7.5 mg/24 h) Never with IM lorazepam (leave at least 1-2 h gap)... 

Thieme, D. Sachs, H. Improved screening capabilities in forensic toxicology by application of liquid chromatography-tandem mass spectrometry, Anal.ChimActa, 2003, 492, 171-186. [hair LC-MS alprazolam dothiepin piritramide cocaine lorazepam lormetazepam clonazepam flimitrazepam bromazepam midazolam flurazepam nitrazepam temazepam medazepam nordazepam diazepam methylclonazepam triazolam oxazepam haloperidol benperidol sulpiride amisulpride mirtazapine citalopram olanzapine paroxetine fluoxetine sertraline zopiclone zolpidem risperidone quetiapine fentanyl pipamperone meperidine buprenorphine propoxyphene pentazocine phenazocine EDDP ... 

A case series described three patients who experienced hypothermia (core or rectal temperatures S33.0°C) with olanzapine a 51-year-old female on olanzapine 30mg per day, lorazepam and L-thyroxine a 48-year-old female on olanzapine 10 mg orally and 3 mg lorazepam and a 69-year-old male patient on olanzapine only [184 ]. Hyperthermia has also been described in a 77-year-old male with dementia occurring 6 days after initiation of olanzapine [185 ]. 

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