Somnolence olanzapine

Somnolence. As one would expect, given the histamine H] receptor antagonism, somnolence is a common side effect of olanzapine. Somnolence and psychomotor slowing are dose dependent, and patients often become tolerant to this side effect over time. 

Olanzapine Moderate weight gain, somnolence 10-15 5 mg/day increments 5-20... 

The efficacy of adding olanzapine to either valproate or lithium alone in acute manic or mixed bipolar episodes has been studied in a 6-week, double-blind, randomized, placebo-controlled trial (110). Compared with valproate or lithium alone, the addition of olanzapine provided better efficacy. Olanzapine was associated with somnolence, dry mouth, weight gain, increased appetite, tremor, and slurred speech. 

Several reviews have echoed the efficacy and tolerability of olanzapine (1-3). In several reviews it has been emphasized that the most common adverse effects are somnolence and weight gain, since about 40% of patients gain weight (especially if on a high starting dose and if they were underweight before treatment) sexual dysfunction can also be a problem for many patients (4—6). 

The efficacy of olanzapine in treatment-refractory childhood-onset schizophrenia has been examined in eight patients (mean age 15 years) over 8 weeks (22). There was a 17% improvement in the BPRS total score. Olanzapine was moderately well tolerated. The most common adverse events were increased appetite (n = 6), constipation (n = 5), nausea/vomiting (n = 6), headache (n = 6), somnolence (n = 6), insomnia (n = 7), difficulty in concentrating (n = 5), sustained tachycardia (n = 6), transient rises in liver transaminases (n = 7), and increased agitation (n = 6). 

In a retrospective study in 499 in-patients with schizophrenia or schizoaffective disorder (39) 259 subjects were taking olanzapine and 240 risperidone. Treatment was considered effective in most cases (74% with olanzapine and 78% with risperidone). There were adverse effects in 19% of the patients taking olanzapine and 22% of those taking risperidone they were mainly somnolence (n = 15 and n = 17 respectively) and extrapyramidal symptoms (n = 9 and n = 6 respectively) there were also three cases of weight gain with olanzapine. 

The efficacy and safety of olanzapine in particular disorders or particular groups of patients have been previously studied (SEDA-24, 67), and new studies have been published. For example, in a 4-week open trial, 94 elderly psychiatric in-patients (aged 65 years or older) were treated with a mean daily dose of olanzapine of 10 mg (range 2.2-20). The most common adverse effects were somnolence (18%), dizziness (18%), and weakness... 

Dystonia, hypertonia, and increased salivation were reported significantly more often in patients taking haloperidol (8.3% versus 0% for the three effects) somnolence (25%), anxiety (12%), and headache (12%) were the most frequent events in patients taking olanzapine. 

Although mania has been associated with olanzapine (SEDA-24, 68 SEDA-25, 68 SEDA-26, 62), it has also been used in the treatment of acute mania. In a 12-week, double-blind, double-dummy, randomized trial, 120 patients with bipolar disorder type I hospitalized for an acute manic episode were randomly assigned to either sodium valproate (n = 63) or olanzapine (n = 57) and were followed in hospital for up to 21 days (60). Valproate and olanzapine had similar short-term effects on clinical or health-related quality of life outcomes in bipolar disorder adverse effects that occurred in a higher percentage of olanzapine-treated than valproate-treated patients included somnolence (47% versus 29%), weight gain (25% versus 10%), rhinitis (14% versus 3%), edema (14% versus 0%), and slurred speech (7% versus 0%) no adverse events occurred significantly more often with valproate. 

Olanzapine has been proposed as a treatment for acute mania. In a randomized, double-blind, placebo-controlled study for 3 weeks, patients were assigned to either olanzapine 10 mg/day (n = 70) or placebo (n = 69) (67). Significantly more olanzapine-treated patients responded (49%) compared with those assigned to placebo (24%). Somnolence, dizziness, dry mouth, and weight gain occurred significantly more often with olanzapine, but there were no statistically significant differences with respect to measures of parkinsonism, akathisia, and dyskinesia. 

A 22-year-old man took about 800 mg of olanzapine his olanzapine serum concentration reached a maximum of 200 ng/ml (257). His vital signs were stable at all times, but he started to become progressively somnolent, with short periods of aggressive agitation. Gastric lavage was performed and after 10 hours he was alert and oriented. 

Observational studies Numerous open studies of ziprasidone promoted by Pfeer, the marketing authorization holder, have previously been published [SEDA-32, 111] and further studies, similarly promoted, have emerged. Of 185 subjects who were switched from olanzapine or risperidone to ziprasidone, 72 completed a 1-year extension study [136 ]. The most common adverse effects were insomnia (23%) and somnolence (11%) no patient had a corrected QT interval over 500 ms at any time during the study. 

In a 3-week double-blind study patients with mild to moderate mania were randomized to divalproex (n = 201 500-2500 mg/ day), olanzapine (n = 205 5-20 mg/day), or placebo (n = 105) [343 ]. Those who completed the first part of the study continued with a 9-week double-blind extension. Olanzapine was significantly more efficacious than placebo at 3 weeks and significantly more efficacious than divalproex at 12 weeks. Adverse effects caused withdrawal from the study in 13% (28/215) of those who took olanzapine and 9.5% (19/ 201) of those who took divalproex. Significantly more of those who took olanzapine reported weight increase and somnolence compared with divalproex or placebo. Significantly more of those who took divalproex reported nausea and insomnia compared with olanzapine. Those who took... 

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. 

Nervous system A study comparing somnolence with asenapine, olanzapine, risperidone and haloperidol relative to placebo evaluated 10 clinical trials of patients with schizophrenia or bipolar disorder [36 -]. The duration and incidence of somnolence was greatest for asenapine and olanzapine (maximal for olanzapine) and with shorter time to onset than the other antipsychotics and placebo patients with bipolar disorder were the most sensitive. 

Four SGA long-acting injections are currently available risperidone microspheres, olanzapine pamoate, paliperidone palmitate and aripiprazole extended-release injection. The extended-release characteristics are achieved differently with each drug. A case analysis of clinical frials with olanzapine pamoate (2000-2008) reported an occurrence of postinjection delirium/sedation syndrome in approximately 0.07% of injections or 1.4% of patients [78 ]. A review of the published literature and clinical trial databases for olanzapine pamoate, risperidone microspheres and paliperidone palmitate found only one other case of postinjection delirium/sedation syndrome occurring in a patienf on placebo in a paliperidone palmitate trial. In four randomised, double-blind, placebo-controlled trials of paliperidone palmitate, the most common treatment-emergent adverse event was somnolence/sedation overall treatment discontinuation rates due to adverse events were similar to placebo. 

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