Olanzapine drug withdrawal

Of 39 patients taking lithium, 18% had neutrophilia and 15% had raised activity of polymorphonuclear elas-tase (a marker of granulocyte activation) (345). In keeping with these observations, a chart review of 38 patients taking clozapine showed an increase in leukocyte count when lithium was added (42). A man with olanzapine-induced neutropenia (with a prior history of risperidone-induced neutropenia), which normalized with drug withdrawal, had no difficulty when the drug was reintroduced after the patient had been treated with lithium (43). 

In one study, excessive appetite was a more frequent adverse event in patients treated with olanzapine versus haloperidol (24 versus 12%) (817). Loss of weight has been observed after withdrawal of neuroleptic drugs (818). 

A non-obese 51-year-old man without a history of diabetes mellitus had a serum glucose concentration of 89 mmol/1 and was non-ketotic. Treatment with olanzapine had been started less than 6 months before about 2 months before the event, his blood glucose concentration was 6.0 mmol/1, and 8 days after withdrawal the glucose concentration returned to normal he no longer required insulin nor any other hypoglycemic drug. 

Recreational drug users note the same effects. Several comment on similarities between olanzapine and quetiapine and the benzodiazepine drugs, such as diazepam (Valium), because of the intense sedation. However none report the euphoria that characterises benzodiazepine effects. One correspondent reported protracted insomnia after stopping olanzapine, comparing it to benzodiazepine withdrawal (Sixseal.com 2007). 

Furthermore, at the times they were being evaluated, the patients continued to take the olanzapine, which, like all neuroleptics, suppresses the appearance of TD symptoms while at the same time causing or worsening the underlying disorder (see subsequent section). Therefore, the only way to determine an accurate rate of TD is to withdraw the patients from the offending drug before the final evaluation. In this study, the actual rate of TD would have been much higher than 3% per year if the patients had been withdrawn from the olanzapine before the final TD evaluation. 

There has been one comprehensive meta-analysis including over 80 studies and over 30 000 patients (489). A meta-analysis of trials of neuroleptic drugs showed the following mean weight gains in kg after 10 weeks of treatment clozapine, 4.5 olanzapine, 4.2 thioridazine, 3.2 sertindole, 2.9 chlorpromazine, 2.6 risperidone, 2.1 haloperidol, 1.1 fluphenazine, 0.43 ziprasidone 0.04 molindone, —0.39 placebo, —0.74 (490,491). In one study, excessive appetite was a more frequent adverse event in patients treated with olanzapine versus haloperidol (24 versus 12%) (185). Loss of weight has been observed after withdrawal of neuroleptic drugs (492). 

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). 

A 65-year-old man who had had primary insomnia for 20 years, was given olanzapine 2.5 mg/day at nighttime because of lack of response to various anxiolytics he developed fecal incontinence during the 20 days of olanzapine treatment in combination with two anxiolytic drugs. The frequency of incontinence varied from 1 to 3 times a day, and withdrawal of olanzapine resulted in complete recovery. 

A 26-year-old man, who had previously taken a variety of psychotropic medications, including typical neuroleptic drugs and risperidone, without sexual adverse effects, took olanzapine 10 mg at bedtime (240). Soon after, he developed priapism 24 hours after withdrawal of olanzapine, the adverse effect disappeared. 

Restless leg syndrome has been associated with olanzapine in three cases, in which it started after the beginning of treatment with olanzapine and resolved after withdrawal all three patients were subsequently treated with other atypical antipsychotic drugs (risperidone, quetiapine, or aripiprazole) without recurrence [105 ]. 

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