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Olanzapine overdose mimicking opioid intoxication
G F O'Malley1, S Seifert, K Heard
1Rocky Mountain Poison and Drug Center, Denver, CO, USA. geraldo@pol.net
Abstract:
We report significant central nervous system depression and the previously unreported phenomenon of pupillary constriction after acute overdose of olanzapine (Zyprexa) in 4 patients. Phase 2 trials describe a typically benign course in overdose, and published abstracts note a wide spectrum of clinical effects with supratherapeutic ingestion of olanzapine. Our patients demonstrated profound central nervous system depression, and 2 required advanced airway support. All 4 patients recovered with supportive care. Olanzapine should be added to opioid and alpha(2)-adrenergic agonist intoxication in the differential diagnosis of the patient with depressed mental status and miosis.
Insights
Acute overdose of olanzapine (Zyprexa) can cause severe central nervous system depression and pupillary constriction. This finding is crucial for diagnosing patients with altered mental status and miosis.
Area of Science:
- Pharmacology
- Toxicology
- Emergency Medicine
Background:
- Published literature suggests a generally benign course for olanzapine overdose.
- Supratherapeutic ingestion of olanzapine can lead to a wide range of clinical effects.
Purpose of the Study:
- To report the previously undocumented phenomenon of pupillary constriction in acute olanzapine overdose.
- To highlight the potential for severe central nervous system depression in olanzapine overdose.
Main Methods:
- Case series of 4 patients presenting with acute olanzapine overdose.
- Clinical observation and supportive care management.
Main Results:
- All 4 patients experienced significant central nervous system depression.
- Two patients required advanced airway support.
- A previously unreported finding of pupillary constriction was observed in all patients.
Conclusions:
- Olanzapine overdose can cause profound CNS depression and miosis.
- Olanzapine should be considered in the differential diagnosis for patients with depressed mental status and miosis.
- All patients recovered with supportive care, indicating the importance of prompt medical intervention.