hidden pixel

Olanzapine Information

Olanzapine (trade name Zyprexa or in combination with fluoxetine Symbyax) is an atypical antipsychotic, approved by the FDA for the treatment of schizophrenia and bipolar disorder.[2] Olanzapine is structurally similar to clozapine, but is classified as a thienobenzodiazepine. The olanzapine formulations are manufactured and marketed by the pharmaceutical company Eli Lilly and Company; the drug went generic in 2011. Sales of Zyprexa in 2008 were $2.2B in the US alone, and $4.7B in total.[3]

Contents

Medical uses

Known FDA approvals are as follows:

Off-label uses

Case-reports, open-label, and small pilot studies suggest efficacy of olanzapine for the treatment of some anxiety spectrum disorders (e.g. generalized anxiety disorder,[9] panic disorder,[10] delusional parasitosis,[11] post-traumatic stress disorder);[12] however, olanzapine has not been rigorously evaluated in randomized, placebo-controlled trials for this use and is not FDA approved for these indications. Other common off-label uses of olanzapine include the treatment of eating disorders (e.g. anorexia nervosa) and as an adjunctive treatment for major depressive disorder without psychotic features. It has also been used for Tourette syndrome and stuttering.[13]

Prevention of psychosis

Olanzapine has been considered as part of an early psychosis approach for schizophrenia. The Prevention through Risk Identification, Management, and Education (PRIME) study, funded by the National Institute of Mental Health and Eli Lilly, tested the hypothesis that olanzapine might prevent the onset of psychosis in people at very high risk for schizophrenia. The study examined 60 patients with prodromal schizophrenia, who were at an estimated risk of 36–54% of developing schizophrenia within a year, and treated half with olanzapine and half with placebo.[14] In this study, patients receiving olanzapine did not have a significantly lower risk of progressing to psychosis. Olanzapine was effective for treating the prodromal symptoms, but was associated with significant weight gain.[15]

Use in elderly

Citing an increased risk of stroke, in 2004 the Committee on the Safety of Medicines (CSM) in the UK issued a warning that olanzapine and risperidone, both atypical antipsychotic medications, should not be given to elderly patients with dementia. In the U.S., olanzapine comes with a black box warning for increased risk of death in elderly patients. It is not approved for use in patients with dementia-related psychosis.[16] However, a BBC investigation in June 2008 found that this advice was being widely ignored by British doctors.[17]

Investigatory Uses

Olanzapine has been investigated for use as an antiemetic, particularly for the control of chemotherapy-induced nausea and vomiting (CINV). A 2007 study demonstrated its successful potential for this use, achieving a complete response in the acute prevention of nausea and vomiting in 100% of patients treated with moderately and highly-emetogenic chemotherapy, when used in combination with palonosetron and dexamethasone.[18]

Adverse effects

This article may contain original research. Please improve it by verifying the claims made and adding references. Statements consisting only of original research may be removed. More details may be available on the talk page. (September 2009)

As with all neuroleptic drugs, olanzapine can cause the (sometimes) irreversible movement disorder tardive dyskinesia, and the rare, but life-threatening, neuroleptic malignant syndrome. Some also associate all antipsychotics with permanent brain damage.[19]

Other recognised side effects may include:

Metabolic effects

The Food and Drug Administration requires all atypical antipsychotics to include a warning about the risk of developing hyperglycemia and diabetes, both of which are factors in the metabolic syndrome. These effects may be related to the drugs' ability to induce weight gain, although there are some reports of metabolic changes in the absence of weight gain,[22][23] Studies have indicated that olanzapine carries a greater risk of causing and exacerbating diabetes than another commonly prescribed atypical antipsychotic, Risperidone. Of all the atypical antipsychotics, olanzapine is one of the most likely to induce weight gain based on various measures.[24][25][26][27] The effect is dose dependent in humans[28] and animal models of olanzapine-induced metabolic side-effects.[29] Olanzapine may directly affect adipocyte function, promoting fat deposition.[30] There are some case reports of olanzapine-induced diabetic ketoacidosis.[31] Olanzapine may decrease insulin sensitivity,[32][33] though one 3-week study seems to refute this.[34] It may also increase triglyceride levels.[25]

Recent studies have established :

Despite weight gain, a large multi-center randomized National Institute of Mental Health study found that olanzapine was better at controlling symptoms because patients were more likely to remain on olanzapine than the other drugs.[39] One small, open-label, non-randomized study suggest that taking olanzapine by orally dissolving tablets may induce less weight gain,[40] but this has not been substantiated in a blinded experimental setting.

Animal toxicology

In a placebo-compared study of six Macaque monkeys receiving doses of olanzapine higher than those given to humans, for between 17 and 27 months, a significant brain volume and weight decreases (8-11%) were detected.[41] In latter studies of the stored samples, the changes were attributed to astrocyte and oligodendrocyte loss,[42] There was no change in the number of neurons. This study however was contradicted by an earlier primate study, conducted by Selemon et al. in 1999, which found that at therapeutic dosages, olanzapine increased glial counts in monkeys. To date, the effect of olanzapine on glia remains an open question.

Olanzapine has demonstrated carcinogenic effects in multiple studies when exposed chronically to female mice and rats, but not male mice and rats. The tumors found were in either the liver or mammary glands of the animals.[43]

Discontinuation

The British National Formulary recommends a gradual withdrawal when discontinuing anti-psychotic treatment to avoid acute withdrawal syndrome or rapid relapse.[44] Due to compensatory changes at dopamine, serotonin, adrenergic and histamine receptor sites in the central nervous system, withdrawal symptoms can occur during abrupt or over-rapid reduction in dosage. However, despite increasing demand for safe and effective antipsychotic withdrawal protocols or dose-reduction schedules, no specific guidelines with proven safety and efficacy are currently available. Some have suggested using the Ashton Manual http://www.benzo.org.uk/manual/, originally developed for benzodiazapine withdrawal. Support groups such as The Icarus Project http://theicarusproject.net/HarmReductionGuideComingOffPsychDrugs, and other online forums provide resources and social support for those attempting to discontinue antipsychotics and other psychiatric medications. Withdrawal symptoms reported to occur after discontinuation of antipsychotics include nausea, emesis, lightheadedness, diaphoresis, dyskinesia, orthostasis, tachycardia, nervousness, dizziness, headache, excessive non-stop crying, and anxiety.[45][46] Some have argued that additional somatic and psychiatric symptoms associated with dopaminergic super-sensitivity, including dyskinesia and acute psychosis, are common features of withdrawal in individuals treated with neuroleptics.[47][48][49][50] This has led some to suggest that the withdrawal process might itself be schizo-mimetic, producing schizophrenia-like symptoms even in previously healthy patients, indicating a possible pharmacological origin of mental illness in a yet unknown percentage of patients currently and previously treated with antipsychotics. This question is unresolved, and remains a highly controversial issue among professionals in the medical and mental health communities, as well the public.[51] Complicated and long-lasting rebound insomnia symptoms can also occur after withdrawing from antipsychotics.

Overdose

Symptoms of an overdose include tachycardia, agitation, dysarthria, decreased consciousness and coma. Death has been reported after an acute overdose of 450 mg, but also survival after an acute overdose of 1500 mg.[52] There is no known specific antidote for olanzapine overdose, and even physicians are recommended to call a certified poison control center for information on the treatment of such a case.[52] Prescription should be kept in small quantity to reduce risk of overdose as acute bipolar disorder and schizophrenic patients can be at a high risk of suicide (Eli Lilly 2010)

Pharmacology

Zyprexa (olanzapine) 10 mg tablets (AU)

Olanzapine has a higher affinity for 5-HT2 serotonin receptors than D2 dopamine receptors. Affinities are (Ki, nM). Olanzapine binds as an antagonist/inverse agonist at the following receptors[53]:

Olanzapine is a potent antagonist of the muscarinic M3 receptor,[54] which may underlie its diabetes side-effects.[55] Additionally olanzapine also exhibits a relatively low affinity for serotonin 5-HT1, GABAA, beta-adrenergic receptors, and benzodiazepine binding sites.[56][57] The mode of action of olanzapine's antipsychotic activity is unknown. It may involve antagonism of dopamine and serotonin receptors. Antagonism of dopamine receptors is associated with extrapyramidal effects such as tardive dyskinesia, and with therapeutic effects. Antagonism of muscarinic acetylcholine receptors is associated with anticholinergic side effects such as dry mouth and constipation, in addition it may suppress or reduce the emergence of extrapyramidal effects for the duration of treatment, however it offers no protection against the development of tardive dyskinesia. Antagonizing H1 histamine receptors causes sedation and may cause weight gain, although antagonistic actions at serotonin 5-HT2C and dopamine D2 receptors have also been associated with weight gain and appetite stimulation.[58] Olanzapine may display an antiemetic effect due to its blockade of several receptors (specifically acetylcholine, dopamine, histamine, and serotonin 5-HT3) within the chemoreceptor trigger zone.

Metabolism

Olanzapine is metabolized by the cytochrome P450 system isoenzymes 1A2 and 2D6 (minor pathway). Drug metabolism may be increased or decreased by agents that induce (e.g. cigarette smoke) or inhibit (e.g. fluvoxamine or ciprofloxacin) CYP1A2 activity, respectively.

Controversy, lawsuits and settlements

Further information: Eli Lilly controversies#Zyprexa

According to a New York Times article published on December 17, 2006,[59] "Eli Lilly has engaged in a decade-long effort to play down the health risks of Zyprexa, its best-selling medication for schizophrenia, according to hundreds of internal Lilly documents and e-mail messages among top company managers", most of which had been disclosed as the result of lawsuits by individuals who had taken the drug, though other documents had been stolen.[60] These had been sent to a number of journalists by a lawyer advocate for individuals with a psychiatric diagnosis opposed to forced psychiatric treatment. Eli Lilly filed a protection order to stop the dissemination of certain Eli Lilly documents about Zyprexa which they, and the judge, believed to be confidential and "not generally appropriate for public consumption".[60] Temporary injunctions required those who had received the documents to return them and that the documents be removed from websites which had posted them.[61] In his final judgement, Judge Weinstein issued a permanent judgement against further dissemination of the documents and requiring their return by a number of parties named by Lilly.[60] These health risks include an increased risk for diabetes through Zyprexa's links to obesity and its tendency to raise blood sugar. Zyprexa is Lilly’s top-selling drug, with sales of $4.2 billion last year.

The documents, given to The New York Times by Jim Gottstein, show that Lilly executives kept important information from doctors about Zyprexa’s links to obesity and its tendency to raise blood sugar — both known risk factors for diabetes. The Times of London also obtained copies of the documents and reported that as early as October 1998, Lilly considered the risk of drug-induced obesity to be a "top threat" to Zyprexa sales.[62] In another document, dated October 9, 2000, senior Lilly research physician Robert Baker noted that an academic advisory board he belonged to was "quite impressed by the magnitude of weight gain on olanzapine and implications for glucose."[62]

Lilly’s own published data, which it told its sales representatives to play down in conversations with doctors, has shown that 30 percent of patients taking Zyprexa gain 22 pounds or more after a year on the drug, another study showed 16% of Zyprexa patients gained at least 30 kg (66 pounds) in one year, and some patients have reported gaining 100 pounds or more. But Lilly was concerned that Zyprexa’s sales would be hurt if the company was more forthright about the fact that the drug might cause unmanageable weight gain or diabetes, according to the documents, which cover the period 1995 to 2004. In 2006, Lilly paid $700 million to settle 18,000 lawsuits from people who said they had developed diabetes or other diseases after taking Zyprexa. Thousands more suits are still pending.[63]

In 2002, British and Japanese regulatory agencies warned that Zyprexa may be linked to diabetes, but even after the FDA issued a similar warning in 2003, Lilly did not publicly disclose their own findings.

Eli Lilly agreed on January 4, 2007 to pay up to $500 million to settle 18,000 lawsuits from people who claimed they developed diabetes or other diseases after taking Zyprexa. Including earlier settlements over Zyprexa, Lilly has now agreed to pay at least $1.2 billion to 28,500 people who claim they were injured by the drug. At least 1,200 suits are still pending, the company said. About 20 million people worldwide have taken Zyprexa since its introduction in 1996.[64] On January 8, 2007, Judge Jack B. Weinstein refused the Electronic Frontier Foundation's motion to stay his order.[65]

On January 15, 2009 Eli Lilly pled guilty to a misdemeanor charge of illegally marketing Zyprexa for off-label use, and agreed to pay $1.4 billion.[66] Although Lilly had evidence that it is not effective for dementia, Zyprexa was marketed for elderly Alzheimer's patients.[67] The drug carries an F.D.A. warning that it increases the risk of death in older patients with dementia-related psychosis.[68]

In order to make up for the costs for settling the lawsuits and shrinking sales figures for Zyprexa in the U.S.A. the company increased the prices for this medication in Germany in May 2007 by 18 percent. [69][70] In Canada a class action lawsuit was settled in Ontario, Quebec and British Columbia.

Chemistry

Olanzapine can be prepared starting from malononitrile and propionaldehyde:[71]

See also

Notes and references

  1. ^ Burton, Michael E.; Shaw, Leslie M.; Schentag, Jerome J.; Evans, William E. (May 1, 2005). Applied Pharmacokinetics & Pharmacodynamics: Principles of Therapeutic Drug Monitoring. Lippincott Williams & Wilkins; Fourth Edition edition. pp. 815. ISBN 978-0-7817-4431-7.
  2. ^ "Olanzapine Prescribing Information" (PDF). Eli Lilly and Company. 2009-03-19. http://pi.lilly.com/us/zyprexa-pi.pdf. Retrieved 2009-09-06.
  3. ^ "Lilly 2008 Annual Report" (PDF). Lilly. 2009. http://files.shareholder.com/downloads/LLY/696621960x0x296463/611E167A-61C9-4C03-8866-ACF5FA7C8953/English.PDF. Retrieved 2009-08-06.
  4. ^ treatment resistant depression defined as major depressive disorder in adult patients who do not respond to two separate trials of different antidepressants of adequate dose and duration in the current episode
  5. ^ "NDA 20-592" (PDF). Food and Drug Administration. 1996-09-06. http://www.accessdata.fda.gov/drugsatfda_docs/nda/96/020592_Original_Approval_Pkg%20.pdf. Retrieved 2009-09-06.
  6. ^ "NDA 21-520" (PDF). Food and Drug Administration. 2003-12-24. http://www.accessdata.fda.gov/drugsatfda_docs/appletter/2003/21520ltr.pdf. Retrieved 2009-09-06.
  7. ^ "NDA 20-592 / S-019" (PDF). Food and Drug Administration. 2004-01-14. http://www.accessdata.fda.gov/drugsatfda_docs/appletter/2004/20592se1-019ltr.pdf. Retrieved 2009-09-06.
  8. ^ Forbes.com
  9. ^ Pollack MH, Simon NM, Zalta AK, Worthington JJ, Hoge EA, Mick E, Kinrys G, Oppenheimer J. (2006). "Olanzapine augmentation of fluoxetine for refractory generalized anxiety disorder: a placebo controlled study.". Biol Psychiatry. 59 (3): 211–5. doi:10.1016/j.biopsych.2005.07.005. PMID 16139813.
  10. ^ Sepede G, De Berardis D, Gambi F, Campanella D, La Rovere R, D'Amico M, Cicconetti A, Penna L, Peca S, Carano A, Mancini E, Salerno RM, Ferro FM. (2003). "Olanzapine augmentation in treatment-resistant panic disorder: a 12-week, fixed-dose, open-label trial.". J Clin Psychopharmacol. 107 (5): 394–6. PMID 16415705.
  11. ^ Meehan, W.J.; Badreshia, S.; Mackley, C.L. (2006-03). "Successful treatment of delusions of parasitosis with olanzapine". Arch Dermatol 142 (3): 352–355. doi:10.1001/archderm.142.3.352. PMID 16549712. http://archderm.ama-assn.org/cgi/content/full/142/3/352.
  12. ^ Jakovljević M, Sagud M, Mihaljević-Peles A. (2006). "Olanzapine in the treatment-resistant, combat-related PTSD—a series of case reports.". Acta Psychiatrica Scandinavica 26 (1): 45–9. doi:10.1111/j.1600-0447.1951.tb10961.x. PMID 12752037.
  13. ^ Stuttering Foundation of America - A look at genetic and neurological correlates of stuttering
  14. ^ McGlashan, T.H.; et al. (1 May 2003). "The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. I. Study rationale and design". Schizophrenia Research (Amsterdam: Elsevier) 61 (1): 7–18. doi:10.1016/S0920-9964(02)00439-5. PMID 12648731.
  15. ^ McGlashan, Thomas H.; et al. (May 2006). "Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis". American Journal of Psychiatry (Arlington, VA: American Psychiatric Association) 163 (5): 790–99. doi:10.1176/appi.ajp.163.5.790. PMID 16648318. http://ajp.psychiatryonline.org/cgi/content/full/163/5/790. Retrieved 2007-12-03.
  16. ^ "Important Safety Information for Olanzapine". Zyprexa package insert. Eli Lilly & Company. 2007. Archived from the original on 2007-11-23. http://web.archive.org/web/20071123225813/http://www.zyprexa.com/common_pages/safety.jsp. Retrieved 2007-12-03. "Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. [...] ZYPREXA (olanzapine) is not approved for the treatment of elderly patients with dementia-related psychosis."
  17. ^ "Doctors 'ignoring drugs warning'". BBC News. 17 June 2008. http://news.bbc.co.uk/1/hi/programmes/file_on_4/7457132.stm. Retrieved 2008-06-22.
  18. ^ "A phase II trial of olanzapine, dexamethasone, and palonosetron for the prevention of chemotherapy-induced nausea and vomiting: a Hoosier oncology group study.". PubMed Journal Article. Support Care Cancer. 2007. http://www.ncbi.nlm.nih.gov/pubmed/17375339. Retrieved 2011-09-02. "For the first cycle of chemotherapy, the complete response (no emesis, no rescue) for the acute period (24 h post-chemotherapy) was 100%, the delayed period (days 2-5 post-chemotherapy) 75%, and the overall period (0 120 h post-chemotherapy) 75% in 8 patients receiving HEC and was 97, 75, and 72% in 32 patients receiving MEC. Patients with no nausea for the acute period was 100%, the delayed period 50%, and the overall period 50% in 8 patients receiving HEC and was 100, 78, and 78% in 32 patients receiving MEC."
  19. ^ Breggin, P (2007). Brain disabling treatments in psychiatry. Springer Publishing Compan. pp. 320. ISBN 0-8261-2934-X. http://books.google.fi/books?id=hBd0V7Ex8PUC&lpg=PR11&dq=neuroleptics%20withdrawal%20death&pg=PA85#v=onepage&q=neuroleptics%20withdrawal%20death&f=false.
  20. ^ Makkos Z, Csonka A (December 2006). "[Akathisia in the course of olanzapine treatment]" (in Hungarian). Neuropsychopharmacol Hung 8 (4): 215–7. PMID 17211056.
  21. ^ Olanzapine Side Effects - drugs.com
  22. ^ Ramankutty, G (2002). "Olanzapine-induced destabilization of diabetes in the absence of weight gain". Acta Psychiatrica Scandinavica 105 (3): 235–236. doi:10.1034/j.1600-0447.2002.2c257a.x. http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0447.2002.2c257a.x/abstract.
  23. ^ Lambert, MT; Copeland, Sampson, Duffy (2006). "New-onset type-2 diabetes associated with atypical antipsychotic medications". Progress in Neuro-Psychopharmacology and Biological Psychiatry 30 (5): 919–923. doi:10.1016/j.pnpbp.2006.02.007. http://www.sciencedirect.com/science/article/B6TBR-4JMKN26-1/2/1bec785c94339e91c2043f4670228f2c.
  24. ^ Moyer, Paula (2005-10-25). "CAFE Study Shows Varying Benefits Among Atypical Antipsychotics". Medscape Medical News (WebMD). http://www.medscape.com/viewarticle/515435. Retrieved 2007-12-03.
  25. ^ a b AstraZeneca Pharmaceuticals (4 April 2006). "Efficacy and Tolerability of Olanzapine, Quetiapine and Risperidone in the Treatment of First Episode Psychosis: A Randomised Double Blind 52 Week Comparison". AstraZeneca Clinical Trials. AstraZeneca PLC. Archived from the original on 2007-11-13. http://web.archive.org/web/20071113125708/http://www.astrazenecaclinicaltrials.com/Article/526695.aspx. Retrieved 2007-12-03. "At week 12, the olanzapine-treated group had more weight gain, a higher increase in [ body mass index ], and a higher proportion of patients with a BMI increase of at least 1 unit compared with the quetiapine and risperidone groups (p<=0.01)."
  26. ^ Wirshing DA, Wirshing WC, Kysar L, Berisford MA (1999). "Novel antipsychotics: comparison of weight gain liabilities". Journal of Clinical Psychology 60: 358–63.
  27. ^ "NIMH study to guide treatment choices for schizophrenia" (Press release). National Institute of Mental Health. 19 September 2005. http://www.eurekalert.org/pub_releases/2005-09/niom-nst091905.php. Retrieved 2006-12-18.
  28. ^ Nemeroff, CB (1997). "Dosing the antipsychotic medication olanzapine". Journal of Clinical Psychiatry 58 (Suppl, 10): 45–49. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Retrieve&list_uids=9265916&dopt=abstractplus.
  29. ^ Weston-Green, KL; Huang, Deng (March 2011). "Olanzapine treatment and metabolic dysfunction: a dose response study in female Sprague Dawley rats". Behavioural Brain Research 217 (2): 337–46. PMID 21056063. http://www.sciencedirect.com/science/article/pii/S0166432810007242.
  30. ^ Engl J, Rettenbacher M, Fleischhacker WW, Ebenbichler CF (2007). "Atypical antipsychotic drugs directly impair insulin action in adipocytes: effects on glucose transport, lipogenesis, and antilipolysis.". Neuropsychopharmacology. Nov;32(11):2431-2; author reply 2433-4. 32 (11): 2431–2.
  31. ^ Fulbright, April R.; Breedlove, K. T. (2006). "Complete Resolution of Olanzapine-Induced Diabetic Ketoacidosis" (abstract). Journal of Pharmacy Practice (Thousand Oaks, CA: SAGE Publications) 19 (4): 255–258. doi:10.1177/0897190006294180. http://jpp.sagepub.com/cgi/content/abstract/19/4/255. Retrieved 2007-12-02. "Olanzapine has been associated with diabetic ketoacidosis and also with weight gain, lipid abnormalities, and the development of type 2 diabetes."
  32. ^ Chiu CC, Chen CH, Chen BY, Yu SH, Lu ML (August 2010). "The time-dependent change of insulin secretion in schizophrenic patients treated with olanzapine". Prog. Neuropsychopharmacol. Biol. Psychiatry 34 (6): 866–70. doi:10.1016/j.pnpbp.2010.04.003. PMID 20394794.
  33. ^ Sacher J, Mossaheb N, Spindelegger C, Klein N, Geiss-Granadia T, Sauermann R, Lackner E, Joukhadar C, Müller M, Kasper S., J; Mossaheb, N; Spindelegger, C; Klein, N; Geiss-Granadia, T; Sauermann, R; Lackner, E; Joukhadar, C et al (2008). "Effects of olanzapine and ziprasidone on glucose tolerance in healthy volunteers.". Neuropsychopharmacology 33 (7): 1633–41. doi:10.1038/sj.npp.1301541. PMID 17712347.
  34. ^ Sowell, Margaret; et al. (August 8, 2003). "Evaluation of Insulin Sensitivity in Healthy Volunteers Treated with Olanzapine, Risperidone, or Placebo: A Prospective, Randomised Study Using the Two-Step Hyperinsulinemic, Euglycemic Clamp". Journal of Clinical Endocrinology & Metabolism (The Endocrine Society) 88 (12): 5875–5880. doi:10.1210/jc.2002-021884. PMID 14671184. http://jcem.endojournals.org/cgi/content/full/88/12/5875. Retrieved 2007-12-02. "In summary, this study did not demonstrate significant changes in insulin sensitivity in healthy subjects after 3 wk of treatment with olanzapine or risperidone."
  35. ^ Albaugh VL; Vary TC; Ilkayeva O; Wener BR; Maresca KP; Joyal JL; Breazeale S; Elich TD et al (2010). "Atypical Antipsychotics Rapidly and Inappropriately Switch Peripheral Fuel Utilization to Lipids, Impairing Metabolic Flexibility in Rodents". Schizophrenia Bulletin 38 (1): 153–66. doi:10.1093/schbul/sbq053. PMID 20494946.
  36. ^ Albaugh VL; Judson JG; She P; Lang CH; Maresca KP; Joyal JL; Lynch CJ (2010). "Olanzapine promotes fat accumulation in male rats by decreasing physical activity, repartitioning energy and increasing adipose tissue lipogenesis while impairing lipolysis". Molecular Psychiatry 16 (5): 569–581. doi:10.1038/mp.2010.33. . PMID 20308992. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2892549.
  37. ^ Weston-Green, KL; Huang, Deng (March 16PLoS One. 2012;7(3):e33548. Epub 2012 Mar 16.). "Alterations to melanocortinergic, GABAergic and cannabinoid neurotransmission associated with olanzapine-induced weight gain". PLoS One 7 (3): e33548. PMID 22438946. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0033548.
  38. ^ Weston-Green, KL; Huang, Lian, Deng (Oct 6, 2011). "Effects of olanzapine on muscarinic M3 receptor binding density in the brain relates to weight gain, plasma insulin and metabolic hormone levels". European Neuropsychopharmacology. PMID 21982116. http://www.sciencedirect.com/science/article/pii/S0924977X11002185.
  39. ^ Carey, Benedict (September 20, 2005). "Little Difference Found in Schizophrenia Drugs". New York Times (The New York Times Company). http://www.nytimes.com/2005/09/20/health/psychology/20drug.html. Retrieved 2007-12-03.
  40. ^ de Haan L, van Amelsvoort T, Rosien K, Linszen D (2004). "Weight loss after switching from conventional olanzapine tablets to orally disintegrating olanzapine tablets". Psychopharmacology (Berl) 175 (3): 389–90. doi:10.1007/s00213-004-1951-2. PMID 15322727.
  41. ^ Dorph-Petersen KA, Pierri JN, Perel JM, Sun Z, Sampson AR, Lewis DA (September 2005). "The influence of chronic exposure to antipsychotic medications on brain size before and after tissue fixation: a comparison of haloperidol and olanzapine in macaque monkeys". Neuropsychopharmacology 30 (9): 1649–61. doi:10.1038/sj.npp.1300710. PMID 15756305.
  42. ^ Konopaske GT, Dorph-Petersen KA, Sweet RA, Pierri JN, Zhang W, Sampson AR, Lewis DA (April 2008). "Effect of chronic antipsychotic exposure on astrocyte and oligodendrocyte numbers in macaque monkeys". Biol. Psychiatry 63 (8): 759–65. doi:10.1016/j.biopsych.2007.08.018. . PMID 17945195. http://linkinghub.elsevier.com/retrieve/pii/S0006-3223(07)00847-5.
  43. ^ Giovanni Brambilla, Francesca Mattioli, Antonietta Martelli (June 2009). "Genotoxic and carcinogenic effects of antipsychotics and antidepressants". Toxicology 261 (3): 77–88. doi:10.1016/j.tox.2009.04.056. PMID 19410629. http://linkinghub.elsevier.com/retrieve/pii/S0300-483X(09)00232-7.
  44. ^ Group, BMJ, ed. (March 2009). "4.2.1". British National Formulary (57 ed.). United Kingdom: Royal Pharmaceutical Society of Great Britain. p. 192. ISBN 0260-535X. "Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse."
  45. ^ Kim, DR.; Staab, JP. (May 2005). "Quetiapine discontinuation syndrome". Am J Psychiatry 162 (5): 1020. doi:10.1176/appi.ajp.162.5.1020. PMID 15863814. http://ajp.psychiatryonline.org/cgi/content/full/162/5/1020.
  46. ^ Michaelides, C.; Thakore-James, M.; Durso, R. (Jun 2005). "Reversible withdrawal dyskinesia associated with quetiapine". Mov Disord 20 (6): 769–70. doi:10.1002/mds.20427. PMID 15747370.
  47. ^ Chouinard, G.; Jones, BD. (Jan 1980). "Neuroleptic-induced supersensitivity psychosis: clinical and pharmacologic characteristics". Am J Psychiatry 137 (1): 16–21. PMID 6101522. http://ajp.psychiatryonline.org/article.aspx?articleid=157922.
  48. ^ Miller, R.; Chouinard, G. (Nov 1993). "Loss of striatal cholinergic neurons as a basis for tardive and L-dopa-induced dyskinesias, neuroleptic-induced supersensitivity psychosis and refractory schizophrenia". Biol Psychiatry 34 (10): 713–38. PMID 7904833. http://www.biologicalpsychiatryjournal.com/article/0006-3223(93)90044-E/abstract.
  49. ^ Chouinard, G.; Jones, BD.; Annable, L. (Nov 1978). "Neuroleptic-induced supersensitivity psychosis". Am J Psychiatry 135 (11): 1409–10. PMID 30291. http://ajp.psychiatryonline.org/article.aspx?articleid=156959.
  50. ^ Seeman, P.; Weinshenker, D.; Quiron, R.; Srivastava, LK.; Bhardwaj, SK.; Grandy, DK.; Premont, RT.; Sotnikova, TD. et al (Mar 2005). "Dopamine supersensitivity correlates with D2High states, implying many paths to psychosis". Proc Natl Acad Sci U S A 102 (9): 3513–8. doi:10.1073/pnas.0409766102. . PMID 15716360. http://www.pnas.org/content/102/9/3513.full.pdf+html.
  51. ^ Moncrieff, J. (Jul 2006). "Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse". Acta Psychiatr Scand 114 (1): 3–13. doi:10.1111/j.1600-0447.2006.00787.x. PMID 16774655. http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2006.00787.x/abstract.
  52. ^ a b "Symbyax (Olanzapine and fluoxetine) drug overdose and contraindication information". RxList: The Internet Drug Index. WebMD. 2007. http://www.rxlist.com/cgi/generic/symbyax_od.htm. Retrieved 2007-12-03.
  53. ^ Bymaster FP, Calligaro DO, Falcone JF, Marsh RD, Moore NA, Tye NC, Seeman P, Wong DT. (1996). "Radioreceptor binding profile of the atypical antipsychotic olanzapine.". Neuropsychopharmacology. 14 (2): 87–96. doi:10.1016/0893-133X(94)00129-N. PMID 8822531.
  54. ^ Johnson, DE; Yamazaki, Ward, Schmidt et al. (2005). "Inhibitory Effects of Antipsychotics on Carbachol-Enhanced Insulin Secretion From Perifused Rat Islets: Role of Muscarinic Antagonism in Antipsychotic-Induced Diabetes and Hyperglycemia". Diabetes 54 (5): 1552–1558. doi:10.2337/diabetes.54.5.1552. http://diabetes.diabetesjournals.org/cgi/content/abstract/54/5/1552.
  55. ^ Silvestre, JS; Prous (2005). "Research on adverse drug events. I. Muscarinic M3 receptor binding affinity could predict the risk of antipsychotics to induce type 2 diabetes". Methods and Findings in Experimental and Clinical Pharmacology 27 (5): 289–304. http://www.ncbi.nlm.nih.gov/pubmed/16082416.
  56. ^ [1]
  57. ^ Definition of Olanzapine - National Cancer Institute
  58. ^ http://www.askdrjones.com/medication-best-meds/part-six-medication-and-weight-control/
  59. ^ The New York Times December 17, 2006
  60. ^ a b c U:\Cases\Civil L-Z\In re Zyprexa\Documents Leak\Injunction Memo & Order\FINAL INJUNCTION MEMO 2.13.07.wpd
  61. ^ EFF.org
  62. ^ a b Eli Lilly was Concerned by Zyprexa Side-Effects from 1998, The Times (London), January 23, 2007
  63. ^ NYtimes.com Mother Wonders if Psychosis Drug Helped Kill Son, New York Times, January 4, 2007
  64. ^ NYtimes.com Lilly to Pay Up to $500 Million to Settle Claims. The New York Times, January 4, 2007
  65. ^ Press Releases: January, 2007 | Electronic Frontier Foundation
  66. ^ MSN.com Lilly settles Zyprexa suit for $1.42 billion. The Associated Press, January 15, 2009
  67. ^ Cronin Fisk, Martha, Lopatto, Elizabeth and Feeley, Jef (June 1, 2009). "Lilly Sold Drug for Dementia Knowing It Didn’t Help, Files Show". Bloomberg L.P.. http://www.bloomberg.com/apps/news?pid=20601109&sid=aTLcF3zT1Pdo. Retrieved 2009-09-03.
  68. ^ Berenson, Alex (December 18, 2006). "Drug Files Show Maker Promoted Unapproved Use". The New York Times. http://www.nytimes.com/2006/12/18/business/18drug.ht. Retrieved 2009-09-03.
  69. ^ Frontal21.ZDF.de, Tödliche Nebenwirkungen? - Umstrittenes Medikament bringt satte Gewinne
  70. ^ YouTube.com, Zyprexa - Umstrittenes Medikament bringt satte Gewinne
  71. ^ US 5229382

External links

Manufacturer site

Consumer information

Controversy

Antipsychotics (neuroleptics) (N05A)
Typical Benzamides: Levosulpiride • Nemonapride • Sulpiride • Sultopride • Tiapride • Veralipride; Butyrophenones: Azaperone • Benperidol • Bromperidol • Droperidol • Fluanisone • Haloperidol • Lenperone • Moperone • Pipamperone • Spiperone • Timiperone • Trifluperidol; Diphenylbutylpiperidines: Clopimozide • Fluspirilene • Penfluridol • Pimozide; Phenothiazines: Acepromazine • Acetophenazine • Butaperazine • Carphenazine • Chloracizine • Chlorproethazine • Chlorpromazine • Cyamemazine • Dixyrazine • Fluacizine • Fluphenazine • Levomepromazine/Methotrimeprazine • Mesoridazine • Perazine • Pericyazine • Perphenazine • Piperacetazine • Pipotiazine • Prochlorperazine • Promazine • Promethazine • Propiomazine • Sulforidazine • Thiethylperazine • Thiopropazate • Thioproperazine • Thioridazine • Trifluoperazine • Triflupromazine; Thioxanthenes: Chlorprothixene • Clopenthixol • Flupentixol • Thiothixene • Zuclopenthixol; Tricyclics: Amoxapine • Butaclamol • Fluotracen • Loxapine • Trimipramine; Others: Prothipendyl
Atypical Benzamides: Amisulpride • Remoxipride; Butyrophenones: Cinuperone • Setoperone; Benzo(iso)oxazole piperidines: Iloperidone • Ocaperidone • Paliperidone • Risperidone; Benzo(iso)thiazole piperazines: Lurasidone • Perospirone • Revospirone • Tiospirone • Ziprasidone; Diphenylbutylpiperazines: Amperozide; Phenylpiperazines: Aripiprazole • Bifeprunox • Elopiprazole • Umespirone; Tricyclics: Asenapine • Carpipramine • Clocapramine • Clorotepine • Clotiapine • Clozapine • Fluperlapine • Gevotroline • Metitepine • Mosapramine • NDMC • Olanzapine • Piquindone • Quetiapine • Tenilapine • Zotepine; Others: Blonanserin • Cariprazine • Molindone • Pimavanserin • Roxindole • Sarizotan • Sertindole • Spiramide
Others Azacyclonol • Cannabidiol • D-Cycloserine • Lithium • Mazapertine§ • Mifepristone • Oxypertine • Reserpine • Rimcazole • Secretin • Talnetant • Tetrabenazine • Vabicaserin

: PSO/PSI

(, , , , , , ), /,

proc(/), drug(/////)
Benzodiazepine derivatives
1,4-Benzodiazepines
1,5-Benzodiazepines
2,3-Benzodiazepines *
Triazolobenzodiazepines
Imidazobenzodiazepines
Oxazolobenzodiazepines
Thienodiazepines
Pyridodiazepines
Pyrazolodiazepines
Pyrrolodiazepines
Tetrahydroisoquinobenzodiazepines
Benzodiazepine prodrugs
* atypical activity profile (not GABAA receptor ligands)
Cholinergics
Receptor ligands
mAChR
nAChR
Reuptake inhibitors
Plasmalemmal
CHT Inhibitors
Vesicular
VAChT Inhibitors
Enzyme inhibitors
Anabolism
ChAT inhibitors
  • 1-(-Benzoylethyl)pyridinium
  • 2-(α-Naphthoyl)ethyltrimethylammonium
  • 3-Chloro-4-stillbazole
  • 4-(1-Naphthylvinyl)pyridine
  • Acetylseco hemicholinium-3
  • Acryloylcholine
  • AF64A
  • B115
  • BETA
  • CM-54,903
  • N,N-Dimethylaminoethylacrylate
  • N,N-Dimethylaminoethylchloroacetate
Catabolism
AChE inhibitors
BChE inhibitors
  • Cymserine * Many of the acetylcholinesterase inhibitors listed above act as butyrylcholinesterase inhibitors.
Others
Precursors
Cofactors
Others
Dopaminergics
Receptor ligands
Agonists
Antagonists
Reuptake inhibitors
Plasmalemmal
DAT inhibitors
Vesicular
VMAT inhibitors
Releasing agents
Allosteric modulators
  • Quinazolinamines: SoRI-9804
  • SoRI-20040
  • SoRI-20041
Enzyme inhibitors
Anabolism
PAH inhibitors
TH inhibitors
AAAD/DDC inhibitors
Catabolism
MAO inhibitors
COMT inhibitors
DBH inhibitors
Others
Precursors
Cofactors
Others
List of dopaminergic drugs
Histaminergics
Receptor ligands
H1
H2
H3
H4
Reuptake inhibitors
Vesicular
VMAT inhibitors
Enzyme inhibitors
Anabolism
HDC inhibitors
Catabolism
HNMT inhibitors
DAO inhibitors
Others
Precursors
Cofactors
Serotonergics
5-HT1 receptor ligands
5-HT1A
5-HT1B
5-HT1D
5-HT1E
5-HT1F
5-HT2 receptor ligands
5-HT2A
5-HT2B
5-HT2C
5-HT3
5-HT4
5-HT5A
5-HT6
5-HT7
Reuptake inhibitors
SERT
VMAT
Releasing agents
Enzyme inhibitors
Anabolism
TPH
AAAD
Catabolism
MAO
Others
Precursors
Cofactors
Others
Piperazines
Simple piperazines (no additional rings) 1-Cyclohexylpiperazine • Aminoethylpiperazine • Diethylcarbamazine • HEPPS • Midafotel • Piperazine • PIPES
Phenylpiperazines Acaprazine • Antrafenine • Aripiprazole • Batoprazine • Bifeprunox • BRL-15,572 • Ciprofloxacin • CSP-2503 • Dapiprazole • DCPP • DMPP • Diphenylpiperazine • Dropropizine • EGIS-12,233 • Elopiprazole • Eltoprazine • Enpiprazole • Ensaculin • Etoperidone • Flesinoxan • Flibanserin • Fluprazine • Itraconazole • Ketoconazole • Levodropropizine • Lorpiprazole • mCPP • Mefway • MeOPP • Mepiprazole • Naftopidil • Naphthylpiperazine • Nefazodone • Niaprazine • Oxypertine • Pardoprunox • pCPP • pFPP • Posaconazole • PRX-00023 • S-14,506 • S-14,671 • S-15,535 • SB-258,585 • SB-271,046 • SB-357,134 • SB-399,885 • Sonepiprazole • TFMPP • Tolpiprazole • Trazodone • Urapidil • Vesnarinone • Vilazodone • WAY-100,135 • WAY-100,635
Benzylpiperazines 2C-B-BZP • Befuraline • Bifeprunox • Buclizine • BZP • Chlorbenzoxamine • DBZP • Fipexide • Imatinib • MBZP • MDBZP • Meclozine • Piberaline • Piribedil • Trimetazidine • Vesnarinone
Diphenylalkylpiperazines (benzhydrylalkylpiperazines) Almitrine • Amperozide • BRL-15,572 • Buclizine • BW373U86 • Cetirizine • Chlorbenzoxamine • Chlorcyclizine • Cinnarizine • Clocinizine • Cyclizine • DBL-583 • Diphenylmethylpiperazine • Dotarizine • DPI-221 • DPI-287 • DPI-3290 • GBR-12,783 • GBR-12,935 • GBR-13,069 • GBR-13,098 • GBR-13,119 • Hydroxyzine • Lidoflazine • Manidipine • Meclozine • Oxatomide • SNC-80 • Vanoxerine
Pyrimidinylpiperazines Buspirone • Dasatinib • Eptapirone • Gepirone • Ipsapirone • Piribedil • Prazitone • Pyrimidinylpiperazine • Revospirone • Tandospirone • Tirilazad • Trimazosin • Umespirone • Zalospirone
Pyridinylpiperazines Atevirdine • Azaperone • Pyridinylpiperazine
Benzo(iso)thiazolyl piperazines Lurasidone • Perospirone • Revospirone • Tiospirone • Ziprasidone
Tricyclics (piperazine attached via side chain) Amoxapine • Clopenthixol • Clorotepine • Clozapine • Cyanothepin • Doclothepin • Docloxythepin • Flupentixol • Fluphenazine • Isofloxythepin • Loxapine • Meperathiepin • Metitepine • Octomethothepin • Olanzapine • Opipramol • Oxyclothepin • Oxyprothepin • Peradithiepin • Perathiepin • Perazine • Perphenazine • Pirenzepine • Prochlorperazine • Thiethylperazine • Thiothixene • Trifluoperazine • Trifluthepin • Zuclopenthixol
Others 6-Nitroquipazine • Azimilide • Cinepazet • Cyclohexylpiperazine • Hexocyclium • Indinavir • JNJ-7777120 • Lodenafil • Mirodenafil • PB-28 • Quipazine • Ranolazine • SA-4503 • Sildenafil • Tadalafil • Vardenafil • VUF-6002 • Zipeprol
Tricyclics
Classes
Antidepressants
Antihistamines
Antipsychotics
Others

Categories:

 

The above information uses material from Wikipedia and is licensed under the GNU Free Documentation License.
Some facts may not have been fully verified for accuracy. [Disclaimers]
This page was last archived by our server on Sun Apr 29 13:55:23 2012.
Displaying this page or its contents does not use any Wikimedia Foundation's resources.
The owners of this site proudly support the Wikimedia Foundation.

More Information Results for "Olanzapine"
[Hide]▼
'Olanzapine' Images
[Hide]▲