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Oral Olanzapine May Effectively Treat Agitation in Schizophrenia or Bipolar Disorder
A DGReview of :"Effectiveness of Rapid Initial Dose Escalation of up to Forty Milligrams per Day of Oral Olanzapine in Acute Agitation"
Journal of Clinical Psychopharmacology
08/29/2003
By Emma Hitt, PhD
Rapid initial dose escalation of oral olanzapine may be useful in treating agitated schizophrenics or patients with bipolar disorder.
Olanzapine is currently used as first-line therapy for schizophrenia and for manic or mixed episodes of bipolar disorder. Acutely agitated patients are often treated with a typical antipsychotic such as haloperidol and then switched to olanzapine or another atypical antipsychotic after the acute stabilisation phase.
Robert W. Baker, MD, Lilly Research Laboratories, Indianapolis, Indiana, United States, and colleagues tested 148 acutely agitated patients to determine whether rapid initial dose escalation of olanzapine could eliminate the need for this two-step process.
The rapid initial dose escalation (RIDE) group received up to 40 mg/day of oral olanzapine on Days 1 and 2, up to 30 mg/day on Days 3 and 4, and 5 to 20 mg/day thereafter. The usual clinical practice (UCP) group received 10 mg/day olanzapine plus up to 4 mg lorazepam on Days 1 and 2, up to 2 mg/day on Days 3 and 4, and olanzapine 5 to 20 mg/day thereafter.
After 24 hours of treatment, the researchers measured the level of agitation in each patient using the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC).
Agitation improved significantly from baseline for both groups. However, the RIDE group achieved superior improvement on the primary efficacy measure (PANSS-Excited) at 24 hours (P=.006), and on all agitation measures at the end of double-blind treatment.
Both treatments were well tolerated, with no significant differences in safety measures, the researchers note. Treatment was not limited by oversedation, and attention improved in both groups.
"A novel strategy allowing broader flexibility of oral olanzapine dosing up to 40 mg/d in acutely agitated patients may offer treatment simplification by reducing the need of adjunctive use of other psychotropic agents...and [may] lead to better clinical outcomes," the team concludes.
J Clin Psychopharmacol 2003;23:342-348.
"Effectiveness of Rapid Initial Dose Escalation of up to Forty Milligrams per Day of Oral Olanzapine in Acute Agitation"
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