Background
Olanzapine, an atypical antipsychotic
Overview on atypical antipsychotics
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have low or no risk of triggering extrapyramidal effects at doses at which an antipsychotic effect is achieved,
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do not increase prolactin levels, or do it minimally,
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significantly reduce the positive and negative symptoms of schizophrenia, and
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have mood stabilizer properties.
Olanzapine
Pharmacology
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Pharmacodynamic properties
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Indications, dosages
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Pharmacokinetic properties
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The benefits of olanzapine as an antiemetic.
Literature review
Methods
Inclusion and exclusion criteria
Bibliographic search
Selection of articles, collection and data analysis
Results
Results of searches in databases
Article selection procedure
Article | Type of study | Population | Results |
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Licup and Baumrucker, 2010 [26] | Literature review | Articles on the use of olanzapine as an antiemetic N = 4 | 2 articles on the use for chemotherapy-induced nausea and vomiting 2 articles on olanzapine in a palliative care setting Effective treatment No side effect reported |
Fonte et al, 2015 [10] | Literature review | Article on the use of olanzapine as an antiemetic N = 22 | 15 articles on the use of olanzapine for the treatment of chemotherapy-induced nausea and vomiting 7 articles on olanzapine in a palliative care setting Effective treatment No significant side effects, except sleepiness reported in some studies |
Felton et al, 2016 [27] | Literature review | Articles on the use of olanzapine in a palliative care population N = 12 | 2 articles on olanzapine for chemotherapy-induced nausea and vomiting 2 articles on olanzapine in a palliative care setting The other articles are on other indications Effective treatment No side effect reported |
Passik et al, 2002 [28] | Prospective single centre study | Hospitalized patients with advanced cancer and refractory nausea and vomiting unrelated to radiotherapy or chemotherapy N = 15 | In terms of nausea: dose-response efficacy (from 2.5 to 10 mg/day) In terms of quality of life: overall improvement only in patients treated at 5 mg/day No significant difference in side effects between patients without treatment and patients treated with different dosages |
MacKintosch, 2016 [29] | Prospective single centre study | Hospitalized cancer patients with refractory nausea and vomiting N = 16 | 2 patients excluded due to treatment for less than 48 h Subjective evaluation: 13 patients (92%) reported improvement of symptoms 1 patient (7%) decided to stop treatment for excessive drowsiness |
Kaneishi et al, 2012 [30] | Retrospective study | Patients hospitalized in the palliative care unit and treated with olanzapine for nausea and vomiting related to malignant bowel obstruction N = 20 | Significant decrease in nausea score and frequency of vomiting after olanzapine treatment 18 patients (90%) reported a subjective improvement of nausea 2 patients (10%) reported excessive drowsiness 1 patient (5%) reported vertigo No decision to stop treatment despite symptoms |
Atkinson, 2014 [31] | Retrospective study | Hospitalized cancer patients with refractory nausea and vomiting N = 4 | Effective treatment Reduced use of rescue medication Reduced treatment cost No side effects reported |
Kaneishi et al, 2016 [32] | Retrospective multicentre study | Patients with advanced cancer hospitalized in the palliative care unit and treated with olanzapine for nausea and vomiting N = 108 | Doses ranged from 2.5 to 10 mg/day Average duration of treatment: 22 days (from 2 to 211 days) No efficacy or safety data reported. |
Jackson and Tavernier, 2003 [33] | Case series | Hospitalized patients with cancer and neurological conditions and refractory nausea and vomiting N = 6 | Effective treatment No side effects reported |
Srivastava et al, 2003 [34] | Case series | Hospitalized cancer patients with refractory nausea and vomiting N = 2 | Effective treatment No side effects reported |
Atreya and Datta, 2016 [35] | Case series | Patients with advanced cancer hospitalized in palliative care unit with refractory nausea and vomiting N = 3 | Effective treatment No side effects reported |
Suzuki et al, 2014 [36] | Case study | 1 patient with refractory nausea and vomiting after brain metastases from colorectal cancer | Effective treatment No side effects reported |
Langley-Degroot et al, 2015 [37] | Case study | 1 patient with refractory nausea and vomiting after dyskeratosis congenita | Effective treatment No side effects reported |
Article | Dosage | Antiemetic treatments previously used | |
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1 | Licup and Baumrucker, 2010 [26] | - Seelines 4 and 10 - 2 other articles cited but no data | No data |
2 | Fonte et al, 2015 [10] | - See lines 4–6–7–9–10–12 - 1 other article cited but no data | No data |
3 | Felton et al, 2016 [27] | - See lines 4 and 6 - 2 other articles cited but no data | No data |
4 | Passik et al, 2002 [28] | 3 dose groups: - 2.5 mg - 5 mg - 10 mg | No data |
5 | MacKintosch, 2016 [29] | 5 mg/day | Haloperidol, promethazine, cyclizine, metoclopramide, ondansetron, levomepromazine, domperidone, prochlorperazine, quetiapine |
6 | Kaneishi et al, 2012 [30] | 2.5 to 7.5 mg/day | No data |
7 | Atkinson, 2014 [31] | No data | No data |
8 | Kaneishi et al, 2016 [32] | 2.5 mg to 10 mg/day | No data |
9 | Jackson and Tavernier, 2003 [33] | Stating dose2.5 mg/day Increment of 2.5 mg Maximum dose of 7.5 mg/day | Patient 1: haloperidol (effective but poor tolerance) Patient 2: promethazine, lorazepam Patient 3: No data Patient 4: dexamethasone, prochlorperazine, promethazine, haloperidol, lorazepam Patient 5: haloperidol, lorazepam Patient 6: No data |
10 | Srivastava et al, 2003 [34] | Stating dose 2.5 mg/day Increment of 5 mg/day Interdose of 5 mg possible | Patient 1: prochlorperazine, metoclopramide, dexamethasone, promethazine, doxepin, scopolamine, meclizine, haloperidol Patient 2: granisetron, lorazepam, metoclopramide, dexamethasone, haloperidol |
11 | Atreya and Datta, 2016 [35] | Stating dose 2.5 mg/day Increase up to 7.5 mg/day | Patient 1: dexamethasone, ondansetron, metoclopramide (stopped at introduction of olanzapine) Patient 2: metoclopramide, haloperidol Patient 3: dexamethasone, ondansetron, scopolamine butylbromide |
12 | Suzuki et al, 2014 [36] | Stating dose 1.25 mg/day | Metoclopramide, granisetron |
13 | Langley-Degroot et al, 2015 [37] | Starting dose 5 mg/day Increment of 10 mg/day | Initially metoclopramide, lorazepam, ondansetron, domperidone, cannabinoids |
Content of articles
Discussion
The place of Olanzapine as an antiemetic in palliative medicine
Efficacy
Applicability
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Pharmacokinetics
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Galenic forms
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Tolerance profile