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Rapid Tranquilization With Olanzapine in Acute Psychosis: A Case Series

James L. Karagianis, MD, FRCP(C); Ian C. Dawe, MHSc, MD, FRCP(C); Aruna Thakur, MD, FRCP(C); Simon Bégin, MD, FRCP(C); Joel Raskin, MD, FRCP(C); and Suraja M. Roychowdhury, PhD, for the Acute Setting Agitation Program (ASAP) Study Group

Published: February 1, 2001

Article Abstract

Acute, high-dose loading strategies (rapid neuroleptization) with the first-generation antipsychotics administered orally or parenterally, alone or combined with benzodiazepines, have been a commonly used treatment paradigm for controlling acutely agitated psychotic patients. The rationale was to achieve high plasma levels of drug within a shorter time period, resulting in rapid symptom mitigation. However, studies have shown that rapid neuroleptization with first-generation antipsychotics is associated with a greater incidence of side effects. To our knowledge, loading strategies with second-generation antipsychotics have not been investigated, primarily owing to a need for dose titration. Olanzapine, a second-generation antipsychotic, is well tolerated in doses ranging from 5 to 20 mg. The objective of this report was to determine experience with the use of up to 20 mg of an oral loading dose of olanzapine administered within 4 hours in the treatment of patients early in an acute psychotic phase of their illness. In the reported case series of 57 patients, olanzapine initiated at 15 to 20 mg/day was a safe and effective medication for rapidly calming the agitation of acutely agitated psychotic patients (rapid tranquilization). Furthermore, dose reduction over 2 to 3 weeks was achieved in a number of patients without appreciable loss of efficacy.

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