Clinical outcome and olanzapine plasma levels in acute schizophrenia

Mc, Mauri; Steinhilber, Cpc; Marino, Rebecca; Invernizzi, Emanuele; Fiorentini, A.; Cerveri, Giancarlo; Baldi, Ml; Barale, Francesco

doi:10.1016/j.eurpsy.2004.09.009

Cited by 69 publications

(43 citation statements)

References 28 publications

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“…This is a limitation of our study, and plasma levels for both ziprasidone and olanzapine were rather low but can still be considered to reach a clinical effective range (Perry et al, 1997;Daniel et al, 1999;Miceli et al, 2000;Mauri et al, 2005). Despite the fact that the doses for olanzapine and ziprasidone are not entirely equivalent in their D(dopamine) 2 blocking ability, it is not likely that D 2 effects account for the results observed.…”

Section: Discussionmentioning

confidence: 79%

Effects of Olanzapine and Ziprasidone on Glucose Tolerance in Healthy Volunteers

Sacher

Mossaheb

Spindelegger

et al. 2007

Neuropsychopharmacol

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Atypical antipsychotics have been linked to a higher risk for glucose intolerance, and consequentially the development of type 2 diabetes mellitus (DM2). We have therefore set out to investigate the acute effects of oral administration of olanzapine and ziprasidone on whole body insulin sensitivity in healthy subjects. Using the standardized hyperinsulinemic euglycemic clamp technique we compared whole body insulin sensitivity of 29 healthy male volunteers after oral intake of either olanzapine 10 mg/day (n ¼ 14) or ziprasidone 80 mg/day (n ¼ 15) for 10 days. A significant decrease (po0.001) in whole body insulin sensitivity from 5.7 ml/h/kg ( ¼ mean, SM ¼ 0.4 ml/h/kg) at baseline to 4.7 ml/h/kg ( ¼ mean, SM ¼ 0.3 ml/h/kg) after oral intake of olanzapine (10 mg/day) for 10 days was observed. The ziprasidone (80 mg/day) group did not show any significant difference (5.2 ± 0.3 ml/h/kg baseline vs 5.1 ± 0.3 ml/h/kg) after 10 days of oral intake. Our main finding demonstrates that oral administration of olanzapine but not ziprasidone leads to a decrease in whole body insulin sensitivity in response to a hyperinsulinemic euglycemic challenge. Our finding is suggestive that not all atypical antipsychotics cause acute direct effects on glucose disposal and that accurate determination of side effect profile should be performed when choosing an atypical antipsychotic.

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Section: Discussionmentioning

confidence: 79%

Effects of Olanzapine and Ziprasidone on Glucose Tolerance in Healthy Volunteers

Sacher

Mossaheb

Spindelegger

et al. 2007

Neuropsychopharmacol

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“…There was no significant improvement in negative symptoms (as evaluated by means of PANSSn) in either group during this shortterm study, thus confirming that, as in the case of other antipsychotics, more time is required to detect a significant improvement in negative symptoms such as blunted affect, emotional withdrawal, or poverty of speech. 19 However, it is worth noting the greater variability in clinical responses in the group of patients treated at low starting and maintenance doses; furthermore, the higher doses seemed to be more effective on anxiety and suspiciousness. The more rapid and effective management of these clinical dimensions is an important goal in the treatment of critical periods of acute psychosis, especially in a psychiatric ward.…”

Section: Discussionmentioning

confidence: 95%

“…A recent study found a positive curvilinear relationship between plasma OLZ levels and clinical improvement; 19 and, because plasma OLZ levels were also positively related to oral OLZ doses, it can be argued that intermediate dosages of 10 to 20 mg/d are responsible for the better clinical response. However, the present study found no significant differences in clinical efficacy between the patients treated with the lower and high doses, although it must be pointed out that the finding of only a trend toward higher plasma levels in the group treated with the higher doses was probably because of the high degree of interindividual variability in plasma OLZ levels, as has also been reported in the case of other antipsychotic drugs.…”

Section: Discussionmentioning

confidence: 98%

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A Single-blind, Randomized Comparison of Olanzapine at a Starting Dose of 5 mg Versus 20 mg in Acute Schizophrenia

Mauri¹,

Colasanti²,

Rossattini³

et al. 2006

Clinical Neuropharmacology

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Acute psychotic episodes represent critical situations during the course of schizophrenia. Olanzapine (OLZ), a second-generation antipsychotic, is efficacious in acute settings at dosages of 5 to 20 mg/d, and it can be considered a first-line treatment for patients with an acute episode of schizophrenia. The aim of this study was to evaluate the efficacy and tolerability of OLZ at a starting dose of 5 mg versus 20 mg in acute schizophrenic patients and to compare titration versus nontitration.Fifty-one schizophrenic inpatients were randomly assigned to receive OLZ at 5 mg/d (26 patients, group 1) or 20 mg/d (25 patients, group 2) as a starting dosage during an exacerbation phase. In group 1, the OLZ dosage was increased to a mean dosage of 10.55 (+/- 4.00) mg/d. Group 2 received OLZ at a fixed dose of 20 mg throughout the hospitalization period. Olanzapine was significantly and clinically effective on Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale, PANSS positive symptoms, and Hamilton Rating Scale for Depression in both groups. There were no significant differences between groups 1 and 2 in the percent improvement in BPRS, Positive and Negative Syndrome Scale, PANSS positive symptoms, PANSS negative symptoms, or Hamilton Rating Scale for Depression; but group 2 was significantly superior in the mean percent improvement in the BPRS items of anxiety (P < 0.001) and suspiciousness (P < 0.05). In conclusion, the higher doses evidence more efficacy on anxiety and suspiciousness, so it seems to be useful to begin therapy with a full dose of the drug to obtain the maximum effect without any significant side effects.

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“…Perry et al suggested that a minimum concentration of 23 ng/ml was needed to be effective, but did not draw any link with improvements in BPRS scores [14]. Mauri et al described a curvilinear relationship with clinical efficacy between 20 and 50 ng/ml of olanzapine serum concentration [15]. Lane et al, however, failed to establish any correlation between olanzapine blood level and improvements in schizophrenic symptoms, although they did find one for depressive symptoms, with a plasma concentration of 36 ng/ml being a good predictor of response [16].…”

Section: Discussionmentioning

confidence: 99%

Very-high-dose olanzapine for treatment-resistant schizophrenia

Batail¹,

Bleher²,

Lozachmeur³

et al. 2012

OJPsych

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Clinical outcome and olanzapine plasma levels in acute schizophrenia

Abstract: Olanzapine plasma level determination seems to be a useful tool in optimizing acute treatment particularly for more problematic cases.

Cited by 69 publications

References 28 publications

Effects of Olanzapine and Ziprasidone on Glucose Tolerance in Healthy Volunteers

Effects of Olanzapine and Ziprasidone on Glucose Tolerance in Healthy Volunteers

A Single-blind, Randomized Comparison of Olanzapine at a Starting Dose of 5 mg Versus 20 mg in Acute Schizophrenia

Very-high-dose olanzapine for treatment-resistant schizophrenia

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