Olanzapine in the Management of Cancer Pain

Abstract

In cancer patients, cognitive impairment, psychological distress, and anxiety may accompany and aggravate pain. Neuroleptics are frequently used to control these symptoms and may be used to treat pain that has been unresponsive to more conventional approaches. Because of prominent side effects of traditional neuroleptics and conflicting data regarding their analgesic efficacy, their use in the treatment of pain remains controversial. Olanzapine, an atypical neuroleptic, might offer advantages because of its safer side effect profile. It has also been shown to have an independent antinociceptive activity in animals. The use of olanzapine in the management of cancer pain has not been previously described. We prospectively collected the data on 8 cancer patients with severe pain, uncontrolled in spite of aggressive opioid titration, who received olanzapine to treat severe anxiety and mild cognitive impairment. Patients did not meet criteria for delirium and their cognitive impairment was defined as cognitive disorder not otherwise specified (NOS) according to DSM-IV. Patients received 2.5 to 7.5 mg of olanzapine daily. In all patients, opioid requirements had escalated rapidly prior to starting olanzapine. Levels of pain, sedation, and opioid use were measured 2 days before and 2 days after olanzapine was started. Cognitive state was assessed daily. All 8 patients had marked reduction of the daily pain scores. The average daily opioid use decreased significantly in all patients. Cognitive impairment and anxiety resolved within 24 hours of initiating olanzapine. In these 8 patients, decreased pain scores and opioid requirements may have resulted from improvement in cognitive function and the known anxiolytic effect of olanzapine. Other mechanisms may include independent or adjuvant analgesic effects of olanzapine. We conclude that olanzapine may be useful in the treatment of patients with uncontrolled cancer pain associated with cognitive impairment or anxiety. Further studies to evaluate possible analgesic effect of olanzapine are needed.

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

“…These include clinical presentation of olanzapine overdose, which is indistinguishable from opioid intoxication (O'Malley et al, 1999;Kochhar et al, 2002;Palenzona et al, 2004) and analgesic/antinociceptive properties of clozapine, olanzapine, and rispiridone observed in both human (Kiser et al, 2001;Silberstein et al, 2002;Fe-Bornstein et al, 2002;Khojainova et al, 2002;Gorski and Willis, 2003) and rodent (Schreiber et al, 1997(Schreiber et al, , 1999Weizman et al, 2003) models and ascribed to the opioid mechanisms (Schreiber et al, 1997(Schreiber et al, , 1999Weizman et al, 2003). Taken together, these results suggest that SGAs are likely to have positive impact on the incentive/ motivational reward aspects (including drive to procure food), but at the cost of worsened, or at least not improved opioid-mediated hedonic capacity.…”

Adjuvant Analgesics in Cancer Pain Management

“…The second-generation (atypical) agent olanzapine (Zyprexa ® ; Eli Lilly and Company; Indianapolis, IN) was reported to decrease pain intensity and opioid consumption, and improve cognitive function and anxiety, in a recent case series of cancer patients [42]. Apart from this limited observation, evidence that commercially available neuroleptic drugs have analgesic properties is very meager.…”

Analgesic Step Ladder Treatment in Cancer Patients With Pain

“…Bu özellikleriyle kanserli hastalarda tercih edilebilir. [33,34] Ventafridda ve ark. yaptıkları çalışmada, nöroleptik veya benzodiazepin kullanım oranını %66.1 olarak bildirmişlerdir.…”