Olanzapine Overdose Mimicking Opioid Intoxication☆,☆☆,★,★★
Section snippets
INTRODUCTION
We present the cases of 4 patients with toxic effects related to olanzapine ingestion. All patients exhibited marked miosis and depressed mental status, findings usually associated with opioid or α 2 -adrenergic agonist intoxication but which have not been previously described with neuroleptic agents. We suggest that olanzapine intoxication be added to the list of ingestions that can cause miosis.
Olanzapine (Zyprexa) is a thienobenzodiazepine neuroleptic agent. It has similar receptor affinity,
CASE REPORTS
Four patients presented to 2 hospitals in the Denver area over a period of 9 months with alterations in mental status believed to be caused by drug ingestion. Involvement by our toxicology service in case 1 was by telephone consultation, and in the other cases it was by direct bedside management. Our approach in each case involved stabilization, decontamination, exclusion of life-threatening toxic effects, and supportive care. In all cases, serum was collected at the time of presentation and
DISCUSSION
All 4 patients had profound mental status depression and miosis after deliberate ingestion of olanzapine. This is not consistent with previous published reports. We believe that this finding is a direct consequence of olanzapine toxicity.
Phase 2 clinical trials of olanzapine revealed comparable or superior efficacy, compared with haloperidol, in the treatment of various aspects of schizophrenia, with a lower incidence of adverse events.3 Adverse events reported in clinical trials were
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Cited by (52)
Forensic Investigation of Antipsychotic-Related Deaths
2016, Life-Threatening Effects of Antipsychotic DrugsFatal water intoxication during olanzapine treatment: A case report
2014, Legal MedicineCitation Excerpt :Indeed, although haloperidol and risperidone were detected in the therapeutic range, olanzapine was detected high concentration (610 ng/mL). In previously reported cases of olanzapine overdose, the blood drug concentration in live patients with toxic manifestations was approximately 250–2800 ng/mL [14–16], and that in cadavers was approximately 2100–4500 ng/mL [17–19]. In the present case, the blood olanzapine concentration (610 ng/mL) was lower than the historic mean, suggesting that the cause of death was unlikely to be olanzapine intoxication.
Adverse Effects and Toxicity of the Atypical Antipsychotics: What Is Important for the Pediatric Emergency Medicine Practitioner?
2012, Clinical Pediatric Emergency MedicineCitation Excerpt :Overdoses of olanzapine have been characterized by profound and prolonged CNS depression and unpredictable fluctuation between sedation and agitation; this may be caused by anticholinergic toxicity in conjunction with the drug's long half-life in overdose. In 1999, a case series of 4 patients reported olanzapine overdose mimicking opioid intoxication, severe CNS depression, miosis, and hypotension—with the exception of tachycardia instead of the expected bradycardia with opioid toxicity.22 An unintentional ingestion of 1 ziprasidone tablet in a 30-month-old resulted in coma requiring intubation, tachycardia, hypotonia, and miosis.23
Toxicology in the ICU - Part 1: General overview and approach to treatment
2011, ChestCitation Excerpt :It may be more accurately referred to as an antimuscarinic toxidrome, and is characterized by the combination of mydriasis, dry flushed skin, delirium, hyperthermia, tachycardia, urinary retention, and hypoactive bowel sounds.27–30 Mydriasis is not always present, especially if coexisting α antagonism is present.31 Progression and severity of anticholinergic effects are often dose related.29,30
Toxin-Induced Neurologic Emergencies
2009, Clinical Neurotoxicology: Syndromes, Substances, Environments, Expert Consult - Online and PrintA systematic review of cardiovascular effects after atypical antipsychotic medication overdose
2009, American Journal of Emergency MedicineCitation Excerpt :There were no case series reporting only summary data for quetiapine or olanzapine ingestions. We identified 102 reports [4,11,17,18,24,30,31,38-123, 124-129] describing 185 patients with case level data (including cases with undefined age) [105]. One hundred eighty-two patients ingested a single AAPMs, and 3 patients ingested 2 AAPMs [11,56,109].
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From Rocky Mountain Poison and Drug Center, Denver, CO.
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Address for reprints: Gerald F O’Malley, DO, Rocky Mountain Poison and Drug Center, 8802 East Ninth Avenue, Denver, CO 80220-6800; 303-739-1100, fax 303-739-1119;E-mail [email protected].
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0196-0644/99/$8.00 +0
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