Olanzapine Overdose Research Articles

Management of high dose olanzapine poisoning in a young child under limited resource setting: a case report from Nepal

Introduction: Olanzapine, an atypical antipsychotic, is widely used for treating psychiatric conditions such as schizophrenia and bipolar disorder. Accidental overdose in children is rare but can lead to severe clinical effects. This case report discusses the management of a five-year-old male who accidently ingested 180 mg of olanzapine, the highest reported dose in a child under five years. Case Presentation: A five-year-old boy accidentally ingested 180 mg of Olanzapine, resulting in loss of consciousness and central nervous system depression. He exhibited hyperglycemia, elevated lactate, and prolonged prothrombin time, but no significant cardiovascular issues. Following intubation and supportive care, including intravenous medications and mechanical ventilation, the child gradually improved. He was discharged in stable condition with follow-up instructions. Discussion: Olanzapine toxicity in children presents with a variety of symptoms, including somnolence, hypotension, and neurological impairments, which are dose-dependent. Even in case of an exceptionally high overdose, the absence of cardiovascular toxicity supports safety profile of olanzapine. Common laboratory findings include hyperglycemia, elevated liver enzymes, and metabolic disturbances. Management involves airway protection, supportive care, and monitoring, as no specific antidote exists. Prompt and appropriate care, even in severe cases under limited resource settings, can lead to favorable outcomes. Conclusion: In cases of high dose accidental olanzapine poisoning in children, it is essential to begin quick intervention and comprehensive supportive care to achieve successful outcomes and can be managed even in limited resource settings. Preventive measures are crucial to avoid such incidents and careful monitoring is essential in managing pediatric olanzapine overdose.

A Closer Look at Antipsychotic Adverse Effects: Investigating Anticholinergic Toxidrome Induced by Olanzapine Overdose

Background and Aims: Antipsychotic drugs are critical in managing psychosis but they also carry risks when misused, leading to toxicity. Case Presentation: A patient overdosed on olanzapine, resulting in anticholinergic toxidrome with symptoms like tachycardia and altered mental status. Immediate recognition and management of antipsychotic toxicity-induced toxidromes in emergency settings are crucial. Treatment strategy includes maintaining airway, breathing and circulation along with decontamination. There is no specific antidote. Conclusion: This case underscores the need for emergency physicians to remain vigilant and proactive in identifying and addressing such toxicity by identification of toxidromes to prevent complications and missed diagnosis in emergency department.

OLANZAPINE POISONING IN CHILDREN : A CASE SERIES

Olanzapine is a readily available atypical antipsychotic usually prescribed in adults for psychotic disorders. Olanzapine overdose or poisoning is rarely seen in children. It is often due to accidental intake of drug and sometimes suicidal.We are reporting two case of olanzapine poisoning in children presenting with altered sensorium and pinpoint pupils. The mainstay of treatment of olanzapine poisoning is supportive and symptomatic measures. Both children recovered well and were discharged.

Paediatric safety signals identified in VigiBase: Methods and results from Uppsala Monitoring Centre.

PurposeThe purpose of this study is to uncover previously unrecognised risks of medicines in paediatric pharmacovigilance reports and thereby advance a safer use of medicines in paediatrics.MethodsIndividual case safety reports (ICSRs) with ages less than 18 years were retrieved from VigiBase, the World Health Organization (WHO) global database of ICSRs, in September 2014. The reports were grouped according to the following age spans: 0 to 27 days; 28 days to 23 months; 2 to 11 years; and 12 to 17 years. vigiRank, a data‐driven predictive model for emerging safety signals, was used to prioritise the list of drug events by age groups. The list was manually assessed, and potential signals were identified to undergo in‐depth assessment to determine whether a signal should be communicated.ResultsA total of 472 drug‐event pairs by paediatric age groups were the subject of an initial manual assessment. Twenty‐seven drug events from the two older age groups were classified as potential signals. An in‐depth assessment resulted in eight signals, of which one concerned harm in connection with off‐label use of dextromethorphan and another with accidental overdose of olanzapine by young children, and the remaining signals referred to potentially new causal associations for atomoxetine (two signals), temozolamide, deferasirox, levetiracetam, and desloratadine that could be relevant also for adults.ConclusionsClinically relevant signals were uncovered in VigiBase by using vigiRank applied to paediatric age groups. Further refinement of the methodology is needed to identify signals in reports with ages under 2 years and to capture signals specific to the paediatric population as a risk group.

OLANZAPINE OVERDOSE IN A PATIENT WITH PIN POINT PUPIL AND ALTERED SENSORIUM.

Background- Olanzapine is a highly tolerable and easily affordable atypical antipsychotic drug which has been commonly prescribed in both inpatient and outpatient setting for several mental disorders. Olanzapine overdose is commonly seen in psychiatric patients, who attempt suicide by intoxicating themselves with their own prescribed medications. Increasing olanzapine use is associated with increasing incidence of overdosing.Case Presentation- We are reporting a case of olanzapine over dosage as the cause of pin point pupils and altered sensorium with the exclusion of other differentials. The mainstay of management of olanzapine overdose is general supportive and symptomatic measures.Discussion- Pinpoint pupils with altered sensorium and agitation are always an alarming situation for a clinician because of differentials like organophosphorus poisoning, pontine hemorrhage and opium overdosing. Similar clinical picture due to olanzapine over dosage can be confusing in the emergency department and early identification of such cases is helpful to decrease the risk of fatality. Conclusion- This case highlights the significance of olanzapine overdosing as a differential diagnosis for patients presenting with altered sensorium and pinpoint pupils in the emergency department. Olanzapine overdosage is associated with high morbidity and mortality. Although there is no specific antidote for olanzapine overdose, appropriate history, assessment and early diagnosis is very useful for the better outcome.

Successful intravenous lipid emulsion therapy: Olanzapine intoxication

Olanzapine is an antipsychotic drug used in psychiatric diseases. At high doses it exhibits cardiovascular and neurological sideeffects in particular. Lipid emulsion therapy for the removal of medication from plasma in high-dose lipophilic drug use has recently become very widespread. In the light of current literature, this report discusses the successful treatment of a patient within 4 hrs of olanzapine overdose as an attempted suicide, who presented with agitation and clouded consciousness

Olanzapine Overdose in a Pin Point Pupil with Altered Sensorium

Background:Olanzapine is a highly tolerable and easily affordable atypical antipsychotic drug which has been commonly prescribed in both inpatient and outpatient settings for several mental disorders. Olanzapine overdose is commonly seen in psychiatric patients, who attempt suicide by intoxicating themselves with their own prescribed medications. Increased olanzapine use is associated with increased incidence of overdosing. Case Presentation:We are reporting a case of olanzapine overdosage as a cause of pinpoint pupils and altered sensorium with exclusion of other differentials. The mainstay of managementof olanzapine overdose is general supportive and symptomatic measures. Discussion: Pinpoint pupils with altered sensorium and agitation are always an alarming situation for a clinician, because of differentials like organophosphorus poisoning, pontine hemorrhage and opium overdosing. Due to olanzapine overdosage, similar clinical picture can be confusing in the emergency department and early identification of such cases is helpful to decrease the risk of fatality. Conclusion: This case highlights the significance of olanzapine overdosing as a differential diagnosis for patients presented with altered sensorium and pinpoint pupils in the emergency department. Olanzapine overdosage is associated with high morbidity and mortality. Although there is no specific antidote for olanzapine overdose, appropriate history, assessment and early diagnosis are very useful for the better outcome.

Neuroinfection or Suicide Attempt? Difficult Diagnosis If Lack of Anamnesis

ABSTRACTNeuroinfection often begins with nonspecific symptoms followed by respiratory and circulatory systems failure, seizures, and loss of consciousness. On the other hand, central nervous system depression may be caused by overdose of medications and without pre-hospital history it may be difficult to diagnose appropriately. We report on a case of a teenager who attempted suicide with an overdose of olanzapine. She ingested 150 mg, which caused neuroinfection-like symptoms. She was treated with an initial diagnosis of encephalitis. Dynamically changing clinical status finally guided attending physicians to a suspicion of a suicide attempt. Based on this case we stress that a clear history of suicidal overdose ingestion is important for quick and appropriate treatment.

Clinical Findings of Emergence After Olanzapine Overdosage: Pediatric Case Report and Review of Literature

Introduction: Olanzapine is an atypical antipsychotic drug of the thienobenzodiazepine group; its clinical use has increased in the last 2 decades. Especially in pediatric cases, the clinical experience in overdose of olanzapine and other atypical antipsychotics is limited. Overdosage of atypical antipsychotic drugs, including olanzapine, predominately causes central nervous system depression and anticholinergic effects.Case Report: We present the case report of a 3-year-old female child who ingested 20 mg of olanzapine, which resulted in clinical findings, such as mental status changes, peripheral edema and rapid atrial rhythm, temporary prolonged P-R interval, and T-wave inversion. Conclusion: According to the current literature, olanzapine seems to be a medium-level safe atypical antipsychotic drug in terms of clinical use. Therefore, the pediatric cases should be monitored closely with accidental olanzapine overdosage

Compartment Syndrome of the Leg Requiring Emergent Fasciotomy Resulting from Multi-Drug Overdose

A paucity of literature exists linking acute extremity compartment syndrome associated with cocaine or olanzapine overdose. LJ, a 38-year male, was initially seen at an outside hospital for acute encephalopathy and left lower extremity swelling shortly after cocaine and suspected olanzapine overdose. On presentation, totalcreatinine kinase levels were >1000 units/liter but quickly rose to 23,000 units/liter after 12 hours. He was transferred to a tertiary care center for surgical evaluation. Upon the exam, it was quickly determined that he had compartment syndrome and he was urgently taken to the operating room for a four-compartment lower extremity fasciotomy. Acute compartment syndrome is a limb threatening condition generally diagnosed clinically. Cocaine, a potent vasoconstrictor, is widely reported to cause rhabdomyolysis from ischemia of skeletal muscle tissue and direct toxicity to myocytes resulting in leakage of creatinine kinase. Other complications including cardiovascular, respiratory, neurological, and gastrointestinal disturbances have also been well documented. Olanzapine, an atypical antipsychotic, has also been reported to cause rhabdomyolysis. However, myositis with lower extremity compartment syndrome is a rare occurrence and requires quick diagnosis and aggressive treatment in order to achieve limb salvage. The potential causality of compartment syndrome from either cocaine, olanzapine, or both will be examined in this case report.

Acute Olanzapine Overdose in a Toddler

We describe a 17-month-old female presented with an acute overdose of olanzapine, an atypical antipsychotic. She displayed prolonged extrapyramidal symptoms as compared with that in previous reports and prolactin levels above the upper limits of normal ranges. This is the first report to measure serum prolactin levels in an olanzapine-overdosed toddler and the second to calculate olanzapine's elimination half-life.

Cardiotoxicity in a Citalopram and Olanzapine Overdose

BackgroundThis is a case of a citalopram and olanzapine overdose causing seizures and severe cardiotoxicity. Case ReportA 21-year-old man presented unresponsive, with seizures, to an Emergency Department. The patient’s initial electrocardiogram demonstrated a widened QRS of 160 ms and a normal QT/QTc interval of 400/487 ms consistent with cardiac sodium channel blockade. Within 30 min of arrival, peak citalopram and olanzapine levels were measured to be 522 ng/mL and 505 ng/mL, respectively. Measured levels remained supratherapeutic until 13.6 h and 42.6 h after arrival for citalopram and olanzapine, respectively. The patient developed bradycardia and hypotension that required multimodal therapies including sodium bicarbonate boluses, vasopressors, and transvenous pacing. Seizures and cardiotoxicity continued while citalopram, but not olanzapine, was supratherapeutic. ConclusionsThis case describes cardiotoxicity directly correlated with supratherapeutic citalopram levels in overdose.

Olanzapine overdose presenting with pinpoint pupils and semi consciousness: a case report

Olanzapine overdose presenting with pinpoint pupils and semi consciousness: a case report

A CASE OF TOXIC CYSTIC LEUKOENCEPHALOPATHY AFTER ANTI-PSYCHOTIC OVERDOSE

We present the case of a 41-year-old lady who was admitted following an overdose of olanzapine, venlafaxine, quetiapine and propranolol. She was intubated in ITU and treated for aspiration pneumonia,...

Nonfatal Suicidal Overdose of Olanzapine in an Adolescent

The atypical antipsychotic olanzapine is increasingly being used for various psychiatric conditions. There are few reports of olanzapine overdose in adolescent population. We report a case of 16-year-old adolescent who ingested 750 mg olanzapine, the highest reported nonlethal dose of olanzapine in adolescents. He presented with tachycardia, hypotension, generalized myoclonus, hyperpyrexia, muscular rigidity, leukocytosis and elevated creatine phosphokinase (CPK) levels. He recovered from the toxicity with minimal intervention.

Case reports of atypical (second generation) antipsychotic overdose in adolescents

Introduction Atypical (second generation) antipsychotics are increasingly being used in psychiatry, due to better efficacy and side effect profile. Reports of intentional overdose with these drugs in adolescents are rare. Cardiovascular toxicity was common with first generation (older) antipsychotic medications, but less common with second generation antipsychotic medications. Aim To describe various presentations and cardiovascular system effects of atypical antipsychotic overdose in adolescents. Methods Retrospective study of case notes of adolescents admitted to paediatric ward with atypical antipsychotic overdose. Description We report three adolescents who presented to our hospital during a single month with an overdose of atypical antipsychotics, which had been prescribed to family members or friends. 1)15 year old male presented with agitation, dystonia, constricted pupils and a GCS fluctuating between 6 to 11. ECG showed sinus tachycardia, ST depression and tall T-waves. History of Olanzapine overdose was revealed retrospectively (Olanzapine level - 373 mcg/ml). 2)15 year old female with a history of Clozapine overdose presented with a GCS of 8 along with hyper-salivation. She had tachycardia, hypotension and prolonged QTc interval. 3)13 year old girl with Quetiapine overdose presented with a GCS of 14 and prolonged QTc interval on ECG. Results All patients needed High Dependency Care to monitor for potential cardio-respiratory problems. Their baseline blood tests were normal. They responded well to supportive treatment and made a full recovery. Summary All 3 adolescents with atypical antipsychotic overdose presented with depressed consciousness and ECG changes. Other signs included agitation and pupillary constriction with Olanzapine (mimicking Opioid overdose) and hyper-salivation with Clozapine. All had normal blood tests and made a complete recovery within 48 hours. Conclusions With increasing access to atypical antipsychotics, overdose with these medications should be considered in the differential diagnosis of children presenting with unexplained sedation and electrocardiographic changes. Olanzapine should be thought in addition to opioid and alpha 2 adrenergic agonists overdose in patients with depressed mental status and miosis.

Lipid Resuscitation

Lipid Resuscitation

Olanzapine Intoxication-Related Transient Diabetes Insipidus

Olanzapine is a second-generation atypical antipsychotic agent approved for the treatment of psychotic disorders and mania. The effects of olanzapine intoxication include central nervous system depression, hyperthermia, myosis, tachycardia, and orthostatic hypotension. Heretofore, only one case has been reported to develop polyuria after olanzapine overdose (560 mg). We describe a case that developed diabetes insipidus following massive olanzapine ingestion and returned to normal after desmopressin treatment.

Post-injection delirium/sedation syndrome in patients with schizophrenia treated with olanzapine long-acting injection, I: analysis of cases

BackgroundAn advance in the treatment of schizophrenia is the development of long-acting intramuscular formulations of antipsychotics, such as olanzapine long-acting injection (LAI). During clinical trials, a post-injection syndrome characterized by signs of delirium and/or excessive sedation was identified in a small percentage of patients following injection with olanzapine LAI.MethodsSafety data from all completed and ongoing trials of olanzapine LAI were reviewed for possible cases of this post-injection syndrome. Descriptive analyses were conducted to characterize incidence, clinical presentation, and outcome. Regression analyses were conducted to assess possible risk factors.ResultsBased on approximately 45,000 olanzapine LAI injections given to 2054 patients in clinical trials through 14 October 2008, post-injection delirium/sedation syndrome occurred in approximately 0.07% of injections or 1.4% of patients (30 cases in 29 patients). Symptomatology was consistent with olanzapine overdose (e.g., sedation, confusion, slurred speech, altered gait, or unconsciousness). However, no clinically significant decreases in vital signs were observed. Symptom onset ranged from immediate to 3 to 5 hours post injection, with a median onset time of 25 minutes post injection. All patients recovered within 1.5 to 72 hours, and the majority continued to receive further olanzapine LAI injections following the event. No clear risk factors were identified.ConclusionsPost-injection delirium/sedation syndrome can be readily identified based on symptom presentation, progression, and temporal relationship to the injection, and is consistent with olanzapine overdose following probable accidental intravascular injection of a portion of the olanzapine LAI dose. Although there is no specific antidote for olanzapine overdose, patients can be treated symptomatically as needed. Special precautions include use of proper injection technique and a post-injection observation period.Trial RegistrationClinicalTrials.gov ID; URL: http://http//www.clinicaltrials.gov/: NCT00094640, NCT00088478, NCT00088491, NCT00088465, and NCT00320489.

Post-injection delirium/sedation syndrome in patients with schizophrenia treated with olanzapine long-acting injection, II: investigations of mechanism

BackgroundOlanzapine long-acting injection (LAI) is a salt-based depot antipsychotic combining olanzapine and pamoic acid. The slow intramuscular dissolution of this practically insoluble salt produces an extended release of olanzapine lasting up to 4 weeks. However, in a small number of injections (< 0.1%), patients experienced symptoms suggestive of olanzapine overdose, a phenomenon that has been termed "post-injection delirium/sedation syndrome" (PDSS). The authors conducted a series of parallel investigations into the possible reasons PDSS events occur.MethodsHealthcare providers involved in the PDSS cases were queried for clinical information around the events. Plasma samples from patients experiencing PDSS were collected when possible (12/30 cases) and olanzapine concentrations compared with the known pharmacokinetic profile for olanzapine LAI. Product batches and used vials from the PDSS cases were evaluated for compliance with established manufacturing standards and/or possible user error. Because this depot formulation depends upon slow dissolution at the intramuscular injection site, in-vitro experiments were conducted to assess solubility of olanzapine pamoate in various media.ResultsInjection administrators reported no unusual occurrences during the injection. No anomalies were found with the product batches or the remaining suspension in the used vials. Olanzapine concentrations during PDSS events were higher than the expected 5-73 ng/mL range, with concentrations exceeding 100 ng/mL and in some cases reaching >600 ng/mL during the first hours after injection but then returning to the expected therapeutic range within 24 to 72 hours. Solubility and dissolution rate of olanzapine pamoate were also found to be substantially greater in plasma than in other media such as those approximating the environment in muscle tissue.ConclusionsManufacturing irregularities, improper drug reconstitution, and inappropriate dosing were ruled out as possible causes of PDSS. In-vitro solubility and in-vivo pharmacokinetic investigations suggest that PDSS is related to exposure of the injected product to a substantial volume of blood. This exposure is most likely the result of unintended partial intravascular injection or blood vessel injury during the injection (occurring even with proper injection technique) with subsequent seepage of the medication into the vasculature, which would produce higher than intended olanzapine concentrations and symptoms consistent with PDSS.Trial RegistrationClinicalTrials.gov ID; URL: http://http//www.clinicaltrials.gov/: NCT00094640, NCT00088478, NCT00088491, NCT00088465, and NCT00320489