High-dose olanzapine for treatment-refractory schizophrenia

To date there is no common or adequate therapeutic strategy for treatment of refractory schizophrenic patients. Increasing antipsychotics' doses in treatment-resistant schizophrenic patients is the most common intervention used by clinicians. Olanzapine is an atypical antipsychotic, which in a number of double-blind, placebo-controlled studies has been found to be more effective than haloperidol for the treatment of positive and negative symptoms of schizophrenia. During the last few years there have been several reports of successful results in prescribing olanzapine at dosages of more than 25 mg/day for treatment-resistant schizophrenic and schizoaffective patients. This report presents the results from the treatment of three resistant schizophrenic patients treated successfully with high dosages of olanzapine (35, 40, and 60 mg/day). None of the patients had any side effects, including abnormal laboratory levels and weight gain. The results and literature data suggest that in clinical practice some schizophrenic patients resistant to conventional neuroleptic treatment and not responding to olanzapine at recommended dosages as high as 20 mg/day may respond to higher dosages such as 40 or 60 mg/day, and these dosages are well tolerated. Further prospective clinical studies are needed.