zyprexa

danu3 · Dec 7, 2004

I am a prenursing student. However I do have some indirect experience with Zyprexa as I have a few friends who take them.

As you already know, the top dosage range is 20mg per day. Above 20mg, there are no trails on it. But in practice, it is common to go above 20mg as my friends' pdoc have done. The highest my friends gone up to is about 30mg per day.

Here are a few recent abstracts which actually talk about going up as high as 50mg day. It is kind of hard to read as I got it off pubmed.

=====================================

1: J Clin Psychiatry. 2004 Aug;65(8):1138-43.

Variables associated with high olanzapine dosing in a state hospital.

Botts S, Littrell R, de Leon J.

Mental Health Research Center at Eastern State Hospital, University of Kentucky,

Lexington, KY 40508, USA.

BACKGROUND: Olanzapine has a U.S. Food and Drug Administration-approved dosing

range of 10 to 20 mg/day but is often used at doses exceeding this range.

Olanzapine is largely metabolized by cytochrome P450 (CYP) 1A2. Smoking, which

induces CYP1A2, is expected to increase clearance of olanzapine by 40%; however,

dosage adjustment in smokers is not currently recommended. Additionally, female

gender is expected to reduce clearance by 30%. Many institutions target

high-dose olanzapine prescribers in an effort to reduce unnecessary drug costs.

However, factors such as smoking or gender may necessitate increased doses.

METHOD: A retrospective review of all patients receiving olanzapine during an

inpatient stay at a state psychiatric hospital in Kentucky during 2001 was

conducted. Demographic information and smoking status were collected for all

patients. Olanzapine doses of > 20 mg/day were considered high doses.

RESULTS:

Nine percent (48/522) of olanzapine patients were prescribed high doses. The

percentages were similar in women and men (10% vs. 9%, p =.69) and in smokers

and nonsmokers (9% vs. 9%, p =.82). Moreover, the mean maximum olanzapine dose

was also similar in men and women (15.4 +/- 7.2 vs. 14.9 +/- 7.3 mg/day, p

=.51). The odds of receiving a high dose of olanzapine were increased 2.1 for

patients with a schizophrenia spectrum diagnosis (DSM-IV schizophrenia or other

psychotic disorder). The odds of receiving a high dose of olanzapine were

increased with each incremental increase in length of stay (intermediate length

of stay [8-60 days], OR = 5.6; long-term length of stay [> 60 days], OR = 12.0,

relative to acute length of stay [

CONCLUSIONS: Neither gender nor

smoking status was associated with receiving a high dose of olanzapine. The

association of increased length of stay with high dose suggests that treatment

resistance may be an important factor in receiving high daily doses of

olanzapine.

PMID: 15323601 [PubMed - indexed for MEDLINE]

2: Pharmacopsychiatry. 2004 Mar;37(2):63-8.

Olanzapine plasma concentration, average daily dose, and interaction with

co-medication in schizophrenic patients.

Bergemann N, Frick A, Parzer P, Kopitz J.

Department of Psychiatry, University of Heidelberg, Germany.

[email protected]

BACKGROUND: Olanzapine, a thienobenzodiazepine, is one of the relatively new

atypical antipsychotic drugs. The lowest threshold of effective olanzapine

plasma levels in inpatient treatment is assumed to be 9 ng/ml. Very little is

known about the plasma concentration in patients at various oral doses of

olanzapine or about the clinically relevant interactions with co-medications.

METHODS: In 71 schizophrenic patients (age 32.6 +/- 12.1, range 18-63 years; 31

women, 40 men), plasma olanzapine levels were assessed in 377 tests by

high-performance liquid chromatography (HPLC) with electrochemical detection.

Fifty-six of these plasma levels were assessed while patients were receiving

olanzapine as monotherapy; otherwise, the plasma levels were assessed with the

patients receiving various co-medications.

RESULTS: The mean daily oral dose of

olanzapine was 17.5 mg (SD = 7.0, range 5-40 mg), and the mean olanzapine plasma

concentration was 54.2 ng/ml (SD 37.8 ng/ml, range 1.2-208 ng/ml). The plasma

concentration of olanzapine increased linearly with the daily oral dose (r =

0.64, p

covariables showed a significant difference in the dose-corrected plasma levels

of olanzapine among 40 smokers and 31 non-smokers; age and sex did not affect

the dose-corrected plasma levels. However, women received a significantly lower

daily dose of olanzapine under routine clinical study conditions. No differences

could be detected among the dose-corrected plasma concentration of those

patients who were taken off olanzapine because they did not respond (n = 14) or

because of side effects (n = 5) and those who were discharged while still on

olanzapine. Under the co-medication with fluvoxamine, significantly higher

dose-corrected olanzapine plasma concentrations were found than with olanzapine

monotherapy, whereas significantly lower dose-corrected olanzapine plasma

concentrations were detected under lithium and trimipramine co-medication. Under

co-medication with amitriptyline, benperidol, carbamazepine, flupentixol, and

lorazepam, the dose-corrected olanzapine plasma concentrations were no different

than the plasma levels under olanzapine monotherapy.

CONCLUSIONS: The relevance

of therapeutic drug monitoring is emphasized with respect to the data presented

and to the literature. Future studies should examine, in particular, the effects

of a wider range of co-medications in a larger patient sample.

Publication Types:

Clinical Trial

PMID: 15048613 [PubMed - indexed for MEDLINE]

3: Ann Clin Psychiatry. 2003 Sep-Dec;15(3-4):181-6.

Adverse effects and laboratory parameters of high-dose olanzapine vs. clozapine

in treatment-resistant schizophrenia.

Kelly DL, Conley RR, Richardson CM, Tamminga CA, Carpenter WT Jr.

Maryland Psychiatric Research Center, University of Maryland, Baltimore,

Maryland 21228, USA. [email protected]

Patients with treatment-resistant schizophrenia pose a major challenge to

caregivers since only clozapine is documented as having superior efficacy in

this population. Although olanzapine is similar to clozapine in structure and

receptor profile, it has not been proven to have superior efficacy for this

patient group. Nonetheless, olanzapine is being increasingly used in higher

doses as clinicians attempt to find a more effective and tolerable therapy for

refractory patients. Furthermore, there are little data comparing olanzapine and

clozapine in this population. Thirteen patients participated in a randomized

double-blind 16-week crossover study of clozapine therapy (450 mg/day) compared

to high doses of olanzapine (50 mg/day). No patients on olanzapine responded

while 20% responded to clozapine treatment. Olanzapine patients tended to

experience higher rates of anticholinergic effects such as dry mouth (80 vs.

20%) and blurry vision (40 vs. 0%). Clozapine-treated patients had higher rates

of sialorrhea (80 vs. 10%), sweating (50 vs. 10%), dyspepsia (70 vs. 30%), and

lethargy (90 vs. 60%). Neither treatment was associated with significant

akathisia. Liver enzyme elevation and lipids were higher with clozapine

treatment. Mean weight gain in the initial 8 weeks was 3.4 kg for olanzapine and

1.2 kg for clozapine. High doses of olanzapine during 8 weeks of treatment did

not increase lipids and liver enzymes like clozapine did. Olanzapine at 50

mg/day may be associated with more anticholinergic effects and weight gain than

clozapine.

Publication Types:

Clinical Trial

Randomized Controlled Trial

PMID: 14971863 [PubMed - indexed for MEDLINE]

4: J Clin Psychopharmacol. 2003 Aug;23(4):342-8.

Comment in:

Evid Based Ment Health. 2004 Feb;7(1):12.

Effectiveness of rapid initial dose escalation of up to forty milligrams per day

of oral olanzapine in acute agitation.

Baker RW, Kinon BJ, Maguire GA, Liu H, Hill AL.

Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center,

Indianapolis, IN 46285. [email protected]

BACKGROUND: Patients experiencing an acute decompensation of schizophrenia or

bipolar disorder often present in an agitated state. Agitation presents a

barrier to therapy, interrupting the typical physician-patient alliance and

creating a disruptive, even hazardous, environment. Rapid assessment and

effective treatment are necessary to manage agitation and, potentially, to

shorten the time to recovery.

METHODS: One hundred forty-eight acutely agitated

patients received either: rapid initial dose escalation (RIDE) in which up to 40

mg of oral olanzapine was allowed on days 1 and 2, up to 30 mg on days 3 and 4,

and 5 to 20 mg thereafter; or usual clinical practice (UCP) in which patients

received 10 mg/d olanzapine plus up to 4 mg lorazepam on days 1 and 2, up to 2

mg on days 3 and 4, and olanzapine 5 to 20 mg/d thereafter. The Positive and

Negative Syndrome Scale-Excited Component (PANSS-EC: poor impulse control,

tension, hostility, uncooperativeness, and excitement) measured at 24 hours was

the primary measure. Secondary assessments of agitation and safety were also

performed. RESULTS: Agitation improved significantly from baseline for both

treatment groups; however, improvement with the RIDE strategy was superior to

UCP. The RIDE group improvement was superior on the primary efficacy measure

(PANSS-Excited) at 24 hours; it was superior on all agitation measures at the

end of double-blind treatment. Both treatments were well tolerated, with no

clinically significant differences in safety measures. Treatment was not limited

by oversedation and attention improved from baseline in both groups.

CONCLUSIONS: This study demonstrates the value of olanzapine in the treatment of

acutely agitated patients. A new approach to olanzapine dosing that expands the

initial dose range up to 40 mg/d may offer superior efficacy in rapidly and

effectively controlling the symptoms of agitation.

Publication Types:

Clinical Trial

Multicenter Study

Randomized Controlled Trial

PMID: 12920409 [PubMed - indexed for MEDLINE]

=======================================

-Dan

danu3 · Dec 7, 2004

Oh, another thing, Zyprexa is suppose to calm agitation in some instances. But one of my friend, it actually caused the reverse. The pdoc tried other meds to combat the agitation and it did not help until he took my friend off Zyprexa and went on a different antipsychotics and my friend is find now.

-Dan

margo123 · Dec 7, 2004

Thank you for this info. It makes me a little more comfortable but still have strong reservations about dosing so high. I haven't been greatly impressed by the results I've seen so far with control of mania and agitation by the third day or so.

I am a prenursing student. However I do have some indirect experience with Zyprexa as I have a few friends who take them.
As you already know, the top dosage range is 20mg per day. Above 20mg, there are no trails on it. But in practice, it is common to go above 20mg as my friends' pdoc have done. The highest my friends gone up to is about 30mg per day.
Here are a few recent abstracts which actually talk about going up as high as 50mg day. It is kind of hard to read as I got it off pubmed.
=====================================
1: J Clin Psychiatry. 2004 Aug;65(8):1138-43.
Variables associated with high olanzapine dosing in a state hospital.
Botts S, Littrell R, de Leon J.
Mental Health Research Center at Eastern State Hospital, University of Kentucky,
Lexington, KY 40508, USA.
BACKGROUND: Olanzapine has a U.S. Food and Drug Administration-approved dosing
range of 10 to 20 mg/day but is often used at doses exceeding this range.
Olanzapine is largely metabolized by cytochrome P450 (CYP) 1A2. Smoking, which
induces CYP1A2, is expected to increase clearance of olanzapine by 40%; however,
dosage adjustment in smokers is not currently recommended. Additionally, female
gender is expected to reduce clearance by 30%. Many institutions target
high-dose olanzapine prescribers in an effort to reduce unnecessary drug costs.
However, factors such as smoking or gender may necessitate increased doses.
METHOD: A retrospective review of all patients receiving olanzapine during an
inpatient stay at a state psychiatric hospital in Kentucky during 2001 was
conducted. Demographic information and smoking status were collected for all
patients. Olanzapine doses of > 20 mg/day were considered high doses.
RESULTS:
Nine percent (48/522) of olanzapine patients were prescribed high doses. The
percentages were similar in women and men (10% vs. 9%, p =.69) and in smokers
and nonsmokers (9% vs. 9%, p =.82). Moreover, the mean maximum olanzapine dose
was also similar in men and women (15.4 +/- 7.2 vs. 14.9 +/- 7.3 mg/day, p
=.51). The odds of receiving a high dose of olanzapine were increased 2.1 for
patients with a schizophrenia spectrum diagnosis (DSM-IV schizophrenia or other
psychotic disorder). The odds of receiving a high dose of olanzapine were
increased with each incremental increase in length of stay (intermediate length
of stay [8-60 days], OR = 5.6; long-term length of stay [> 60 days], OR = 12.0,
relative to acute length of stay [
CONCLUSIONS: Neither gender nor
smoking status was associated with receiving a high dose of olanzapine. The
association of increased length of stay with high dose suggests that treatment
resistance may be an important factor in receiving high daily doses of
olanzapine.
PMID: 15323601 [PubMed - indexed for MEDLINE]
2: Pharmacopsychiatry. 2004 Mar;37(2):63-8.
Olanzapine plasma concentration, average daily dose, and interaction with
co-medication in schizophrenic patients.
Bergemann N, Frick A, Parzer P, Kopitz J.
Department of Psychiatry, University of Heidelberg, Germany.
[email protected]
BACKGROUND: Olanzapine, a thienobenzodiazepine, is one of the relatively new
atypical antipsychotic drugs. The lowest threshold of effective olanzapine
plasma levels in inpatient treatment is assumed to be 9 ng/ml. Very little is
known about the plasma concentration in patients at various oral doses of
olanzapine or about the clinically relevant interactions with co-medications.
METHODS: In 71 schizophrenic patients (age 32.6 +/- 12.1, range 18-63 years; 31
women, 40 men), plasma olanzapine levels were assessed in 377 tests by
high-performance liquid chromatography (HPLC) with electrochemical detection.
Fifty-six of these plasma levels were assessed while patients were receiving
olanzapine as monotherapy; otherwise, the plasma levels were assessed with the
patients receiving various co-medications.
RESULTS: The mean daily oral dose of
olanzapine was 17.5 mg (SD = 7.0, range 5-40 mg), and the mean olanzapine plasma
concentration was 54.2 ng/ml (SD 37.8 ng/ml, range 1.2-208 ng/ml). The plasma
concentration of olanzapine increased linearly with the daily oral dose (r =
0.64, p
covariables showed a significant difference in the dose-corrected plasma levels
of olanzapine among 40 smokers and 31 non-smokers; age and sex did not affect
the dose-corrected plasma levels. However, women received a significantly lower
daily dose of olanzapine under routine clinical study conditions. No differences
could be detected among the dose-corrected plasma concentration of those
patients who were taken off olanzapine because they did not respond (n = 14) or
because of side effects (n = 5) and those who were discharged while still on
olanzapine. Under the co-medication with fluvoxamine, significantly higher
dose-corrected olanzapine plasma concentrations were found than with olanzapine
monotherapy, whereas significantly lower dose-corrected olanzapine plasma
concentrations were detected under lithium and trimipramine co-medication. Under
co-medication with amitriptyline, benperidol, carbamazepine, flupentixol, and
lorazepam, the dose-corrected olanzapine plasma concentrations were no different
than the plasma levels under olanzapine monotherapy.
CONCLUSIONS: The relevance
of therapeutic drug monitoring is emphasized with respect to the data presented
and to the literature. Future studies should examine, in particular, the effects
of a wider range of co-medications in a larger patient sample.
Publication Types:
Clinical Trial
PMID: 15048613 [PubMed - indexed for MEDLINE]
3: Ann Clin Psychiatry. 2003 Sep-Dec;15(3-4):181-6.
Adverse effects and laboratory parameters of high-dose olanzapine vs. clozapine
in treatment-resistant schizophrenia.
Kelly DL, Conley RR, Richardson CM, Tamminga CA, Carpenter WT Jr.
Maryland Psychiatric Research Center, University of Maryland, Baltimore,
Maryland 21228, USA. [email protected]
Patients with treatment-resistant schizophrenia pose a major challenge to
caregivers since only clozapine is documented as having superior efficacy in
this population. Although olanzapine is similar to clozapine in structure and
receptor profile, it has not been proven to have superior efficacy for this
patient group. Nonetheless, olanzapine is being increasingly used in higher
doses as clinicians attempt to find a more effective and tolerable therapy for
refractory patients. Furthermore, there are little data comparing olanzapine and
clozapine in this population. Thirteen patients participated in a randomized
double-blind 16-week crossover study of clozapine therapy (450 mg/day) compared
to high doses of olanzapine (50 mg/day). No patients on olanzapine responded
while 20% responded to clozapine treatment. Olanzapine patients tended to
experience higher rates of anticholinergic effects such as dry mouth (80 vs.
20%) and blurry vision (40 vs. 0%). Clozapine-treated patients had higher rates
of sialorrhea (80 vs. 10%), sweating (50 vs. 10%), dyspepsia (70 vs. 30%), and
lethargy (90 vs. 60%). Neither treatment was associated with significant
akathisia. Liver enzyme elevation and lipids were higher with clozapine
treatment. Mean weight gain in the initial 8 weeks was 3.4 kg for olanzapine and
1.2 kg for clozapine. High doses of olanzapine during 8 weeks of treatment did
not increase lipids and liver enzymes like clozapine did. Olanzapine at 50
mg/day may be associated with more anticholinergic effects and weight gain than
clozapine.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 14971863 [PubMed - indexed for MEDLINE]
4: J Clin Psychopharmacol. 2003 Aug;23(4):342-8.
Comment in:
Evid Based Ment Health. 2004 Feb;7(1):12.
Effectiveness of rapid initial dose escalation of up to forty milligrams per day
of oral olanzapine in acute agitation.
Baker RW, Kinon BJ, Maguire GA, Liu H, Hill AL.
Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center,
Indianapolis, IN 46285. [email protected]
BACKGROUND: Patients experiencing an acute decompensation of schizophrenia or
bipolar disorder often present in an agitated state. Agitation presents a
barrier to therapy, interrupting the typical physician-patient alliance and
creating a disruptive, even hazardous, environment. Rapid assessment and
effective treatment are necessary to manage agitation and, potentially, to
shorten the time to recovery.
METHODS: One hundred forty-eight acutely agitated
patients received either: rapid initial dose escalation (RIDE) in which up to 40
mg of oral olanzapine was allowed on days 1 and 2, up to 30 mg on days 3 and 4,
and 5 to 20 mg thereafter; or usual clinical practice (UCP) in which patients
received 10 mg/d olanzapine plus up to 4 mg lorazepam on days 1 and 2, up to 2
mg on days 3 and 4, and olanzapine 5 to 20 mg/d thereafter. The Positive and
Negative Syndrome Scale-Excited Component (PANSS-EC: poor impulse control,
tension, hostility, uncooperativeness, and excitement) measured at 24 hours was
the primary measure. Secondary assessments of agitation and safety were also
performed. RESULTS: Agitation improved significantly from baseline for both
treatment groups; however, improvement with the RIDE strategy was superior to
UCP. The RIDE group improvement was superior on the primary efficacy measure
(PANSS-Excited) at 24 hours; it was superior on all agitation measures at the
end of double-blind treatment. Both treatments were well tolerated, with no
clinically significant differences in safety measures. Treatment was not limited
by oversedation and attention improved from baseline in both groups.
CONCLUSIONS: This study demonstrates the value of olanzapine in the treatment of
acutely agitated patients. A new approach to olanzapine dosing that expands the
initial dose range up to 40 mg/d may offer superior efficacy in rapidly and
effectively controlling the symptoms of agitation.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
PMID: 12920409 [PubMed - indexed for MEDLINE]
=======================================
-Dan

danu3 · Dec 7, 2004

I don't have any experience with mania and extreme agiataion with Zyprexa. But when my friiends were on it for sz, if I remember correctly, it took around 3 weeks before Zyprexa finally start to kick in for one of my friend. And it took another 6 monthes or so before it really cleared up lots of the delusions and halucinations. But during this time, my friend was agitated. Finally my friend friend wrote the pdoc a long letter stateing the symtoms and the pdoc must have been in a good mood or something and changed the meds and now my friend is fine (actually the recovery so far is quite amazing in that you can't tell my friend has sz unless you are told. Quite amazing once they find a combination that works).

Your gut feeling might be right since you are with the pt a lot longer than the pdocs. But the problem is that you need "proof", can't tell the pdoc you "feel" the zyprexa is causing it although you might be right. They you probably tick off the pdoc and will probably be accuse of "practicing medicine".

Here are two more abstracts from pubmed which might be of interests to you. One basically say Zyprexa is effective for agitation (what the pdoc at your facility is doing) and another article talks about Zyprexa overdose in which one of the symptom is agitation (overdose range can start as low as 30mg depending on the person and it can go really high, like over 800mg, according to the article). It looks like Zyprexa is relatively "safe" in that you can go relatively high dosage before overdosing occur for lots of people and one can recover from it fairly quickly. Hmmm... does your pt has miosis? If so, you might have something to stand on using the article below.

If you want the actual article, you might try the Stanford Health Library (do a search on "stanford health library" with google) and ask them to get it for you (they have access to the medical library and all kinds of internal paid medical database at Stanford). I know the head librarian there also and I can give you his name privately if you need to do some heavy duty research, just let me know.

==================

Med Sci Monit. 2004 May;10(5):PI74-80. Epub 2004 Apr 28. , *

The clinical picture of olanzapine poisoning with special reference to fluctuating mental status.

Palenzona S, Meier PJ, Kupferschmidt H, Rauber-Luethy C.

Swiss Toxicological Information Centre, Zurich, Switzerland.

BACKGROUND: Olanzapine is an atypical antipsychotic drug that is increasingly used in intentional drug overdoses. Although acute olanzapine overdose is predominantly associated with anticholinergic symptoms and central nervous system depression, miosis and unpredictable fluctuations between somnolence/coma and agitation/ aggression have been suggested as typical signs of olanzapine intoxication in single case reports. AIMS: To confirm the suggestion that fluctuating central nervous system changes and miosis are characteristic signs of olanzapine intoxication. To estimate the dose-response relationship as a guide for the provision of optimal management of olanzapine intoxicated patients.

METHODS: Retrospective analysis of all well-documented cases of olanzapine intoxication reported to the Swiss Toxicological Information Centre between January 1997 and October 2001. Inclusion criteria for detailed analysis were patient age > or = 16 yr, acute olanzapine monointoxication, ingested dose > 20 mg, and a causal relationship between olanzapine overdose and clinical effects. The Poisoning Severity Score of the European Association of Poison Centres and Clinical Toxicologists (EAPCCT) assessed the intoxication severity.

RESULTS: Out of a total of 131 cases of olanzapine overdose, 26 cases fulfilled the inclusion criteria. The ingested olanzapine doses ranged from 30 to 840 mg. The most frequent findings were somnolence (77%), agitation (42%), and miosis (31%). The Poisoning Severity Score was "minor" in 14 (54%), "moderate" in 11 (42%), and "severe" in 1 (4%) patients. Nine patients (35% of all patients) with moderate olanzapine poisoning (120-840 mg) showed unpredictable fluctuations between somnolence and agitation. Five of these patients also demonstrated marked miosis. All patients recovered within 48h. One patient with severe poisoning (560 mg) had coma and convulsions. Moderate (and severe) symptoms occurred only at ingested doses above 120 mg. There was a statistically significant association between increasing ingested olanzapine doses and poisoning severity.

CONCLUSIONS: Although olanzapine is tolerated relatively well in acute overdose, unpredictable and transient fluctuations between central nervous system depression and agitation, frequently associated with miosis, appear to be characteristic findings in moderate to high olanzapine overdoses. They are transient in nature and require careful clinical monitoring but rarely require specific therapeutic interventions.

PMID: 15083933 [PubMed - indexed for MEDLINE]

-Dan

danu3 · Dec 7, 2004

Ooops! I messed up. I only posted the second abstract. Here is the first abstract:

---------------------

Olanzapine in the treatment of agitation in hospitalized patients with schizophrenia and schizoaffective and schizofreniform disorders.

Turczynski J, Bidzan L, Staszewska-Malys E.

Department of Developmental, Psychotic, and Geriatric Psychiatry, Medical University of Gdansk, Gdansk, Poland. [email protected]

BACKGROUND: Olanzapine is an atypical antipsychotic with proven therapeutic effect, though it is rarely used in agitated patients. This study was to assess the effectiveness and safety of a 20-mg initial dose of olanzapine to control agitation of hospitalized patients with schizophrenia and schizoaffective and schizofreniform disorders.

MATERIAL/METHODS: A group of 95 patients aged 18-65 years was observed for 7 days. Effectiveness was assessed according to the CGI and PANSS (including the positive and negative symptoms and excitement subscale PANSS-EC) scales. Adverse events were also recorded.

RESULTS: Two therapeutic groups were distinguished: patients treated with olanzapine alone (OLZ) and those whose condition necessitated at least one administration of benzodiazepines (OLZ + BZ). Although these groups differed with respect to baseline symptom severity, improvement was similar. In the OLZ group, improvement according to the CGI scale was observed after 2 h and persisted to the end of the study. In the OLZ + BZ group there was improvement after 1 h, but not after 2 h. Significant improvement reappeared after 6 h and persisted. Improvement measured by the PANSS-EC scale was noted in the OLZ group after 2 h and in the OLZ + BZ group after 6 h, persisting in both groups from the 12th hr to the end of the observation.

CONCLUSIONS: Olanzapine is an antipsychotic which, used alone or in combination with benzodiazepines, is effective and well tolerated in treatment of agitation in schizophrenic patients. Further studies are warranted.

PMID: 15114282 [PubMed - indexed for MEDLINE]

margo123 · Dec 7, 2004

Thank you for passing this on to me. It alleviates some of my concerns. I have come to see in twelve yrs of psych nursing that controlling mania can become an extremely confusing and clouded issue. Pts get bombarded with so much medicine in an effort to curtail the episode, that staff begins to wonder if some of the meds are "fueling the fire" so to speak. My experience with using zyprexa at this high dose is limited but my observations and my gut instinct tell me that it isn't the ticket in most cases. Over the years, all told, most of my nursing colleages agree with me that IV haldol and ativan bring the patient out of mania faster and safer than anything. The beauty of using haldol IV is that you don't get the unpleasant side effects. I also think zyprexa is a great drug for psychosis. I've seen many folks clear up in a couple of days on low doses.

Hukilau · Dec 8, 2004

Withdrawal sx on the 5th day of not drinking would be unusual but not unheard of. There is also the possibility that he had some with him and it was not really the 5th day without drinking.

Murt · Dec 8, 2004

very true, the last comment about withdrawl still being relivant.

The risk for Delirium Tremens is judged by many to be highest a week after the latest intake of alcohol.

danu3 · Dec 9, 2004

Thank you for passing this on to me. It alleviates some of my concerns. I have come to see in twelve yrs of psych nursing that controlling mania can become an extremely confusing and clouded issue. Pts get bombarded with so much medicine in an effort to curtail the episode, that staff begins to wonder if some of the meds are "fueling the fire" so to speak. My experience with using zyprexa at this high dose is limited but my observations and my gut instinct tell me that it isn't the ticket in most cases. Over the years, all told, most of my nursing colleages agree with me that IV haldol and ativan bring the patient out of mania faster and safer than anything. The beauty of using haldol IV is that you don't get the unpleasant side effects. I also think zyprexa is a great drug for psychosis. I've seen many folks clear up in a couple of days on low doses.

Yea... that is one of those problems with a large "cocktail" of meds. After a while, you don't know what is interacting with what and it really becomes more of an art than a science at this point in terms of trying desparatly getting the right mix of meds.

Sometimes I wonder with high dosage of the newer medication, are we repeating some of the same mistake we made with the older meds like Haldol. Haldol, if I understood the history right, used to be prescribe at a much higher dosage simply because we don't have much experience with it. Now we find in literature that at a lower dosage in lots of cases, it is acctually more effective.

It would be nice if someday they can come up with a test to figure out what is the right dosage for ALL meds.

-Dan

ps. Got a personal question for you, this has been asked in other threads. In your case, how did you get into psych nursing? Did you go straight into it after nursing school or did you have a few years of med/surg nursing? Since I am a prenursing student, I am just looking around at different nursing areas and psych seemed to be one of the areas I might take a more detail look.

margo123 · Dec 9, 2004

I worked ICCU for five years right out of nursing school. I still apppreciate the good solid med-surg base I got there. Psych patients are getting more physically ill all the time. I really love working psych. It sure isn't ever boring! By the way, I spoke with my director today and she said that the patient ended up in the intensive care unit due to severe tachycardia. The cardiologist thought it was all the zyprexa. He's doing ok now. Mind is clear, manic episode is passed. Started Depakote today.

Yea... that is one of those problems with a large "cocktail" of meds. After a while, you don't know what is interacting with what and it really becomes more of an art than a science at this point in terms of trying desparatly getting the right mix of meds.
Sometimes I wonder with high dosage of the newer medication, are we repeating some of the same mistake we made with the older meds like Haldol. Haldol, if I understood the history right, used to be prescribe at a much higher dosage simply because we don't have much experience with it. Now we find in literature that at a lower dosage in lots of cases, it is acctually more effective.
It would be nice if someday they can come up with a test to figure out what is the right dosage for ALL meds.
-Dan
ps. Got a personal question for you, this has been asked in other threads. In your case, how did you get into psych nursing? Did you go straight into it after nursing school or did you have a few years of med/surg nursing? Since I am a prenursing student, I am just looking around at different nursing areas and psych seemed to be one of the areas I might take a more detail look.