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Psychocutaneous Disorders
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Kristen Russomanno, Vesna M. Petronic-Rosic
Second-generation antipsychotics (e.g., risperidone, olanzapine) have become the first-line treatment for delusions of parasitosis, and atypical antipsychotics have also been used successfully. In small case reports and case series, risperidone and olanzapine have shown to be effective and well tolerated. Risperidone is typically initiated at a dose of 0.25 or 0.5 mg/day and can be titrated up to 6 mg/day. Patients may require between 2–4 mg/day for symptom benefit, and at least partial response may be achieved within a few weeks to months of treatment. Initiation of olanzapine at a dose of 5 mg/day, titrated up to as high as 20 mg/day may be effective within 1–3 months. Severe side effects of second-generation antipsychotics include extrapyramidal symptoms, hyperprolactinemia, neuroleptic malignant syndrome, tardive dyskinesia, agranulocytosis, and metabolic syndrome. Baseline bloodwork and close monitoring are recommended.
Immunosuppressants, rheumatic and gastrointestinal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Olanzapine has also been assessed through open studies. Symptomatic improvement in 15 children between the ages of 6 and 13, at doses of 2.5 to 10 mg/day, was reported [38]. Similarly, negative and positive symptoms of 16 adolescents (12 to 17 years of age) in Findling’s study [39] were improved by doses of 2.5 to 20 mg/day, with weight gain and sedation as the two main side effects.
Antipsychotics: pharmacology
Published in Kathy J Aitchison, Karena Meehan, Robin M Murray, First Episode Psychosis, 2021
Kathy J Aitchison, Karena Meehan, Robin M Murray
To some extent the rule regarding potency and side-effects for typicals given above holds for atypicals: clozapine is a low-potency, high milligram compound which has significant sedative and anticholinergic effects but little or no EPS. Risperidone is a high-potency, low milligram drug which has few sedative and anticholinergic effects and at doses of less than 4 mg leads to a reduction in baseline levels of EPS in drug-naive first episode cases.116 However, olanzapine breaks the rule in that it is used in low milligram dosage but has a significant sedative and anticholinergic effect.
Olanzapine-samidorphan combination tablets for the treatment of schizophrenia and bipolar I disorder - what is it, and will it be used?
Published in Expert Review of Neurotherapeutics, 2022
Justin Faden, Ryan Serdenes, Leslie Citrome
Antipsychotic medications are foundational for the treatment of schizophrenia. Olanzapine has long been established as one of the most efficacious pharmacologic options, with proven efficacy in first-episode psychosis, acute exacerbations of schizophrenia, and maintenance therapy [14]. Meta-analyses consistently rank olanzapine amongst the most effective antipsychotic medications [8,9,13,86,87]. Effectiveness studies further support the utilization of olanzapine, demonstrating longer times to all-cause treatment discontinuation [9,13,29;88]. However, olanzapine has drawbacks, which limit its utilization, and many providers do not consider it to be a first-line option for the treatment of schizophrenia. Olanzapine consistently ranks as one of the worst metabolic offenders relative to other antipsychotic medication alternatives, with higher incidences of weight gain, increases in waist circumference, and metabolic laboratory abnormalities (e.g. cholesterol, blood glucose, and triglycerides). These tolerability issues are cause for concern because cardiometabolic disease is the greatest cause of death in those with schizophrenia, and can be exacerbated by weight gain [4,89]. Additionally, an increase in waist circumference ≥5 cm, independent of weight gain, has been associated with an increased mortality risk [90,91]. Moreover, weight gain can damage self-esteem and limit treatment adherence, which is already low in many individuals with schizophrenia, and is one of the major determinants of non-adherence in patients with bipolar disorder [92,93].
Managing bipolar disorder during pregnancy and the postpartum period: a critical review of current practice
Published in Expert Review of Neurotherapeutics, 2020
Verinder Sharma, Priya Sharma, Sapna Sharma
Lithium is the most studied drug in the prevention of bipolar mood and psychotic episodes in the postpartum period. In contrast, there is a paucity of data on lamotrigine and atypical neuroleptics. In one study, olanzapine used alone or in combination with other psychotropic drugs was effective in the prevention of postpartum mood episodes [64]. A single-blind nonrandomized trial of valproate in women with bipolar disorder did not find the medication was significantly more effective than clinical monitoring alone for the prevention of postpartum episodes [65]. A meta-analysis by Wesseloo et al. found that women without drug treatment during pregnancy had a postpartum relapse rate of 66% compared with 23% for women with prophylaxis [66]. There was no differential in the relapse risk between women with bipolar I and II disorders; however, a study from the United Kingdom found a higher risk of relapse in women with bipolar I disorder compared with bipolar II disorder [8].
Cigarette smoking and heavy coffee consumption affecting response to olanzapine: The role of genetic polymorphism
Published in The World Journal of Biological Psychiatry, 2020
Natasa Djordjevic, Branimir Radmanovic, Jelena Cukic, Dejan Baskic, Slavica Djukic-Dejanovic, Dragan Milovanovic, Eleni Aklillu
Olanzapine is an atypical antipsychotic agent that serves as a first-line treatment of schizophrenia (Halfdanarson et al. 2017). Yet, it seems that patients do not respond to this therapy equally, most probably due to significant inter-individual variation in achieved drug plasma concentrations (Skogh et al. 2002; Batail et al. 2014). In humans, the metabolism and clearance of olanzapine, as the main sources of the observed variability, predominantly depend on CYP1A2 activity, with contribution of highly polymorphic CYP2D6 (Ring et al. 1996). CYP1A2 could be induced by cigarette smoking and heavy coffee consumption (Djordjevic et al. 2008), which explains their effect on olanzapine pharmacokinetics. Yet, CYP1A2 inducibility seems to be genotype dependent (Sachse et al. 1999; Djordjevic et al. 2010; Djordjevic et al. 2016), thus the significance of cigarette smoking and heavy coffee consumption for response to therapy in olanzapine-treated patients might differ according to CYP1A2 genetic background.