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Title: Olanzapine Comparable to Haloperidol, Causes Fewer Extrapyramidal Symptoms

URL: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=R
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Can J Psychiatry 2003;48:716-721. "Intramuscular olanzapine and intramuscular haloperidol in acute schizophrenia: antipsychotic efficacy and extrapyramidal safety during the first 24 hours of treatment"
02/06/2004 03:02:00 PM
By Emma Hitt, PhD

Intramuscular (I.M.) olanzapine appears to be comparable to I.M. haloperidol for reducing the symptoms of acute schizophrenia during the first 24 hours of treatment, according to the findings of a new randomised trial. In addition, olanzapine has a more favourable overall extrapyramidal symptoms (EPS) safety profile. Padraig Wright, MD, with Eli Lilly and Company, Surrey, United Kingdom, and colleagues had previously reported that I.M. olanzapine 10.0 mg had efficacy comparable to I.M. haloperidol 7.5 mg for reducing acute agitation in patients with schizophrenia and that I.M. olanzapine a more rapid onset of action. In the current report, the researchers describe additional findings from the same study on the antipsychotic efficacy and extrapyramidal safety of I.M. olanzapine and I.M. haloperidol during the first 24 hours of treatment of acute schizophrenia. The researchers randomised 311 patients (2:2:1) with acute schizophrenia to receive I.M. olanzapine (10.0 mg), I.M. haloperidol (7.5 mg) or I.M. placebo (n = 54). At 2 hours and 24 hours after the first injection, I.M. olanzapine was comparable to I.M. haloperidol, and superior to I.M. placebo for reducing mean change scores from baseline on the Brief Psychiatric Rating Scale (BRPS) Positive. The BPRS Total at 2 hours and 24 hours and the Clinical Global Impressions scale at 24 hours were also improved in the treatment groups versus the placebo group. However, patients treated with I.M. olanzapine had significantly fewer incidences of treatment-emergent parkinsonism (4.3% olanzapine versus 13.3% haloperidol, [P = .036). In contrast, rates of akathisia were not significantly different between treatment groups (P = .065). By comparison, patients receiving I.M. olanzapine required significantly less anticholinergic treatment (4.6% olanzapine versus 20.6% haloperidol, P < .001). In addition, mean EPS safety scores improved significantly from baseline during I.M. olanzapine treatment, compared with a general worsening during I.M. haloperidol treatment. "Overall, the data from this clinical trial suggest that I.M. olanzapine is an efficacious, yet safer, alternative to I.M. haloperidol for the treatment of both acute agitation and psychotic symptomatology in patients with schizophrenia," Dr Wright and colleagues conclude. According to the researchers early clinical improvement predicts a more favourable eventual outcome, therefore, "the rapid alleviation of agitation and early reduction of positive symptoms during treatment with IM olanzapine could improve the prognosis of some patients with schizophrenia," they suggest.

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