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Altered mental status from olanzapine overdose treated with physostigmine
M Weizberg1, M Su, J L Mazzola
1Department of Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital, Brooklyn, NY 11203, USA.
Clinical Toxicology (Philadelphia, Pa.)
|June 6, 2006
Summary
Physostigmine may help reverse delirium from olanzapine overdose. Two patients with olanzapine overdose experienced improved mental status after physostigmine administration, though its overall utility requires further study.
Area of Science:
- Pharmacology
- Toxicology
- Emergency Medicine
Background:
- Olanzapine is a common antipsychotic for schizophrenia.
- Physostigmine is an acetylcholinesterase inhibitor.
- Previous studies suggest physostigmine can reverse olanzapine-induced anticholinergic effects.
Observation:
- Two cases of olanzapine overdose presenting with delirium and anticholinergic symptoms are described.
- Case 1: A 25-year-old male ingested 300 mg olanzapine, showing agitation and delirium. Intravenous physostigmine administration led to a clear sensorium and normal mentation.
- Case 2: A 20-year-old female ingested 600 mg olanzapine, presenting obtunded. Intravenous physostigmine temporarily improved her mental status, with full recovery by day 3.
Findings:
- Physostigmine administration resulted in transient or complete reversal of mental status changes in both patients with olanzapine overdose.
- Olanzapine was confirmed in urine via HPLC in Case 1.
- High serum olanzapine concentration (1230 ng/mL) was noted in Case 2.
Implications:
- Physostigmine may be a potential treatment for olanzapine-induced delirium and anticholinergic toxicity.
- Further research is needed to establish the safety and efficacy of physostigmine as an antidote for olanzapine overdose.
- These cases highlight the importance of recognizing and managing severe olanzapine toxicity.
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