Safety of Intravenous Olanzapine in a General Hospital Population

This study's goal was to assess the safety of intravenous (IV) olanzapine for general hospital inpatients.

Data were collected through retrospective chart review for any patient who received at least one dose of intravenous olanzapine between January 2013 and December 2022. Primary outcomes were vital sign abnormalities (blood pressure, heart rate, respiratory rate, and oxygen saturation) in the 4 hours following each administration of IV olanzapine. Secondary outcomes were intubation or death following a dose of IV olanzapine. This study was approved by the Institutional Review Board.

Three hundred four unique inpatients were found who had received at least one dose of IV olanzapine, and a total of 1214 administrations of IV olanzapine were identified. Doses ranged from 1 to 20 mg, with 5 mg being the most common. Agitation was the most common indication when one was provided (66% of doses). Of doses, 95% were associated with a simultaneous order for at least one class of potentially confounding medications (antihypertensives, other antipsychotics, opioids, or benzodiazepines). Of IV olanzapine doses, 7.41% were associated with at least one vital sign-related adverse drug effect (ADE) and 15.23% of doses above 5 mg were associated with an ADE.

IV olanzapine appears reasonably safe in single or repeated doses for patients hospitalized in the general hospital. Doses above 5 mg appear to have a significantly higher risk of ADEs. Future trials will be important to better clarify the safety and effectiveness of IV olanzapine.