Skytorial: Five pearls on olanzapine 😁
Between agitation and nausea/vomiting, olanzapine has a wide range of use.
Olanzapine is generally not a front-line agent (e.g., haloperidol or ondansetron often are). But sometimes, it really comes in clutch....
Between agitation and nausea/vomiting, olanzapine has a wide range of use.
Olanzapine is generally not a front-line agent (e.g., haloperidol or ondansetron often are). But sometimes, it really comes in clutch....
Comments
Proving a negative is methodologically impossible.
However, available evidence indicates that olanzapine has minimal interaction with HERG receptors and doesn't affect QT much at all.
More on this here: https://emcrit.org/pulmcrit/intravenous-olanzapine-haloperidol/
Neither olanzapine nor haldol is FDA approved for IV administration
But available evidence indicates that they can be given safely as slow IV push
It's cruel and unusual to give IM olanzapine when you have IV access
more https://emcrit.org/pulmcrit/iv-olanzapine/
olanzapine hits the D2, M1, H1, and 5HT3 receptors so it's like the meropenem of anti-emetics
olanzapine is effectively a combination of ondansetron plus prochlorperazine
the main side-effect is sedation, but in many situations, that's kinda helpful
antipsychotics work via hitting a wide variety of receptors!
just because one antipsychotic fails to work doesn't mean a different agent that hits different receptors will also fail.
Olanzapine's half-life is 20-50 hr. It's metabolism can be prolonged in older age & hepatic/renal dysfunction
Scheduled olanzapine can accumulate in older patients with organ dysfunction.
Quetiapine is often better here
2. IV Zyprexa sometimes limited to monitored patients b/c of risk for resp depression.
3. Some don't Rx to elderly, others never IV b/c ❤️ risk (they tell RNs).
4. I 💜 it & wish we gave it more.
5. Why haldol never approved IV? 👀
I'd love to have droperidol for procedural sedation (benefit from short half-life).
for other stuff (n/v, agitation), IV haldol is very similar to droperidol if dosed adequately
I see it come onto formulary for the sedation and short half life and then practice balloons rapidly.
Definitely try to leverage haldol and olanzapine in NV after first and second line agents
We were using olanzapine in #Palliativecare before it became "cool" to use it in oncology (CINV)
#OncSky