Effectiveness and safety of oral olanzapine treatment transitioned from rapid-acting intramuscular olanzapine for agitation associated with schizophrenia

Abstract

ObjectiveTo assess the effectiveness and safety of oral olanzapine treatment transitioned from rapid-acting intramuscular olanzapine (RAIM) in patients with acute agitation associated with schizophrenia in a real-world clinical setting.MethodsThe postmarketing surveillance study with a 3-day observational period after the last RAIM administration was conducted (original study). Following this, an extended study was added for patients who received oral olanzapine after RAIM administration during the original study period, in order to additionally observe them for 7 days after initial RAIM administration. Effectiveness and safety from initial RAIM administration were evaluated using the Positive and Negative Syndrome Scale-Excited Component score and treatment-emergent adverse events (TEAEs), respectively.ResultsThe effectiveness and safety analysis set included a total of 521 and 522 patients, respectively. A majority of patients received 10 mg of RAIM (475/522 patients, 91.0%). The mean ± SD total Positive and Negative Syndrome Scale-Excited Component score was 23.6±6.2 (n=318) at baseline (before initial RAIM administration), 17.4±6.8 (n=280) at 2 hours after initial administration, 16.2±6.8 (n=246) 2 days after final administration, 14.9±6.2 (n=248) 3 days after final administration, 13.8±5.9 (n=242) 4 days after final administration, 13.2±5.8 (n=221) 7 days after initial administration, and 13.4±6.2 (n=351) at final observation (with the last observation carried forward approach), showing that reduction in agitation seen with RAIM was sustained with oral dose of olanzapine. The most common TEAEs were dyslalia and somnolence (each event occurred in four patients), and abnormal hepatic function and constipation (occurred in three patients). One serious adverse event of sudden cardiac death occurred after transitioned to oral olanzapine with many other antipsychotic drugs.ConclusionIn the treatment of acute agitation associated with schizophrenia, RAIM could be generally transitioned to oral olanzapine without exacerbating adverse events or losing treatment effect.

Effect of olanzapine combined with risperidone in the treatment of schizophrenia and its influence on cognitive function

“… 15 Olanzapine is a new type of antipsychotic drug with high affinity, which can bind with multiple receptors such as 5-hydroxytryptamine, dopamine D, α - epinephrine and histamine H. The biggest difference between olanzapine and risperidone is that olanzapine can prevent the discharge of dopaminergic neurons (midbrain limbic system), protect the striatum motor function of patients, and improve the cognitive impairment of patients. 16 From the perspective of pharmacological effect, olanzapine combined with risperidone may produce some synergistic effects similar to that of the second generation antipsychotics combined with the first generation drugs.…”

Olanzapine for the Prevention and Treatment of Chemotherapy-Induced Nausea and Vomiting: A Review to Identify the Best Way to Administer the Drug

“…Olanzapine is absorbed well orally and has a bioavailability of about 85% [ 40 ]. In the treatment of agitation associated with schizophrenia, switching from intramuscular injections to oral preparations may help treat the disease in the long term and improve patients’ compliance to treatment [ 46 ]. Previous studies have shown that almost all patients who received intramuscular injections of olanzapine experienced agitation [ 47 ].…”

“…A study exploring the efficacy and safety of oral versus intramuscular olanzapine in schizophrenia indicated that intramuscular injection of 10 mg olanzapine effectively reduced acute agitation within 24 h among patients with schizophrenia. When switching from intramuscular injection to oral administration, the reduction in irritability lasted up to four days after oral administration, and patients who took olanzapine orally did not have dystonia, which could be induced by intramuscular injection [ 46 ]. As for the intravenous injection, the literature almost exclusively mentions the use of intravenous olanzapine among patients with anxiety in the emergency department [ 48 ].…”