A Pilot Exploration of the Antiemetic Activity of Olanzapine for the Relief of Nausea in Patients with Advanced Cancer and Pain

Abstract

This open-label pilot study explored the antiemetic activity of olanzapine, an atypical antipsychotic, in patients with advanced cancer requiring opioid analgesics for pain. Fifteen patients received 2 days of a washout and placebo "run-in" followed by two day periods on each of three doses of olanzapine (2.5 mgs, 5 mgs, and 10 mgs). Patients completed a daily food journal as well as the Mini Mental State Exam, Simpson Angus Scale, Barnes Akathisia Scale, and the Functional Assessment of Cancer Therapy-General across four time periods, with special attention being placed on the nausea item. Eleven women and 4 men with varied primary cancer sites participated. The average age of the sample was 58 years (SD = 16.8). All three dose levels were associated with significant reductions in nausea compared to baseline. Diary entries recorded by the subjects suggested substantial benefits to overall well being and the 5mg condition was associated with statistically significant improvement in overall quality of life over baseline (F = 12.0, p < 0.005). No extrapyramidal symptoms were noted and mental status exams were not changed over the course of the eight days. These results suggest an antiemetic effect for olanzapine and indicate the need for a controlled trial.

Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far-advanced cancer

“…Seven uncontrolled studies were also located electronically that met the review criteria [8,9,16,23,24,25,26]. Hand searching revealed one randomized trial [27] and two uncontrolled studies [28,29] that had been missed by the electronic search.…”

“…The evidence for many other antiemetics that are used routinely in palliative care, such as haloperidol, prochlorperazine, cyclizine and methotrimeprazine was weak or nonexistent [8,9,17,29]. This was also the case for newer agents such as olanzepine and synthetic cannabis derivatives [25,26,39]. One RCT of the dopamine antagonist levosulpride found it to be superior to metoclopramide [27].…”

Incidence of Nausea and Vomiting Induced by Oxycodone Administered with Prochlorperazine in Japanese Cancer Patients

“…For example, olanzapine, which blocks multiple neurotransmitters, including dopaminergic, serotonergic, adrenergic, histaminergic, and muscarinic receptors 16 , is a strong candidate for future usage.…”

Olanzapine for Preventing Nausea and Vomiting Induced by Moderately and Highly Emetogenic Chemotherapy

“…In 2002, Passik et al (2002) conducted a small clinical trial in 15 patients with advanced cancer requiring opioid analgesics, accompanied with moderate nausea, but no vomiting. The subjects received 2 days of washout and placebo "run-in" followed by 2 day periods of treatment with olanzapine (2.5, 5, and 10mg, respectively).…”