Olanzapine intramuscular

Olanzapine intramuscularly can be given short-term, both to initiate dosing with oral olanzapine or another oral antipsychotic and to treat breakthrough agitation in patients maintained on oral antipsychotics... 

An intramuscular injection form of olanzapine, administered at doses from 2.5 to 10 mg, is now available for the management of acute agitation in the inpatient setting. This injectable olanzapine has no role in outpatient care however, a depot formulation of olanzapine is expected in the near future. 

Olanzapine is also available in a short-acting intramuscular injectable form, providing clinicians with another option for treating... 

Breier A, Meehan K, Birkett M, et al A double-blind, placebo-controlled dose-response comparison of intramuscular olanzapine and haloperidol in the treatment of acute agitation in schizophrenia. Arch Gen Psychiatry 59 441 48, 2002... 

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. 

Jones B, Taylor CC, Meehan K (2001) The efficacy of a rapid-acting intramuscular formulation of olanzapine for positive symptoms. J Clin Psychiatry 62(Suppl 2) 22-24... 

Clozapine has been found effective in patients who did not improve during treatment with first-generation antipsychotics, and since the hematological side effects permit only its restricted use, this dmg has a unique indication for treatment- resistanf schizophrenia. Another unique indication for clozapine is the reduction in the risk of recurrent suicidal behavior in schizophrenia or schizoaffective disorders. The indications of clozapine and its two analogues, olanzapine and quetiapine, are summarized in Tab. 13.5. The US labels of these drugs served as the data source [62-64]. Clozapine and olanzapine, but not quetiapine, are available in intramuscular form, which is helpful in the treatment of acutely agitated patients with diagnoses as defined in Tab. 13.5. 

In a double-blind, placebo-controlled, dose-response trial, 270 acutely agitated patients were randomized to receive 1-3 intramuscular injections of olanzapine (2.5, 5, 7.5, or 10 mg), haloperidol (7.5 mg), or placebo within 24 hours (60). Olanzapine had a dose-related effect in reducing agitation olanzapine was better than placebo but not better than haloperidol the most frequently reported adverse event was hypotension, which occurred with olanzapine (n = 7) but not haloperidol or placebo. Acute dystonias did not occur in patients given olanzapine or placebo but occurred in two patients given haloperidol. 

Battaglia J, Lindborg SR, Alaka K, Meehan K, Wright P. Calming versus sedative effects of intramuscular olanzapine in agitated patients. Am J Emerg Med 2003 21 192-8. 

Intramuscular injection Haloperidol, ziprasidone, olanzapine Maximum blood levels achieved in a short period of time... 

Patients receiving the intramuscular formulation of olanzapine should be observed closely for hypotension... 

Intramuscular formulation is not generally recommended to be administered with parenteral benzodiazepines if patient requires a parenteral benzodiazepine it should be given at least 1 hour after intramuscular olanzapine... 

Some of the antipsychotics are available as intramuscular injections for patients who are imable or unwilling to swallow tablets (as is common in psychosis or severe behavioural disturbance). Halo-peridol is most often used for these indications on psychiatric inpatient wards (chlorpromazine i.m. being restricted due to hypotension and skin nodule formation). Olanzapine may be given i.m. 

Activated charcoal causes a fall in olanzapine levels and venlafax-ine moderately raise olanzapine levels. Additive dopaminergic effects have been seen in one patient taking olanzapine and haloperidoL Olanzapine appears not to interact to a clinically relevant extent with aluminium/magnesium hydroxide antacids, ci-metidine or diazepam. However, excessive sedation and hypotension may occur with parenteral benzodiazepines and intramuscular olanzapine. 

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. 

Olanzapine and dmpeiidol In a randomized non-blinded chnical trial, patients attending an emergency department for primary headache were given either intramuscular droperidol 5 mg ( = 42) or off-label olanzapine 10 mg ( = 45). There were no significant differences between the groups... 

A study compared intramuscular haloperidol and intramuscular olanzapine for the management of agitated patients in the emergency room [12 ]. Haloperidol-treated patients required additional medications more frequently than olanzapine-treated patients. 

Another study compared intramuscular levomepromazine and intramuscular olanzapine in agitated elderly patients with schizophrenia [13 ]. Glucose levels significantly decreased in both groups. The most common adverse events with olanzapine were increased BP, somnolence, dizziness and thirst compared with decreased BP, somnolence and dizziness for levomepromazine. 

MacDonald K, Wilson M, Minassian A, Vflke GM, Becker O, TaUian K, et aL A naturaHstic study of intramuscular haloperidol versus intramuscular olanzapine for the management of acute agitation. J CHn Psychopharmacol 2012 32(3) 317-22. 

Suzuki H, Gen K. A naturaHstic comparison of the efficacy and safety of intramuscular olanzapine and intramuscular levomepromazine in agitated elderly patients with schizophrenia Neuropsychiatr Dis Treat 2013 9 1281-7. 

Olanzapine. Usual adult dose 5-20 mg daily (schizophrenia, mania), 5-10 mg hy intramuscular injection for control of agitation. 

---