title: Anticholinergic differences among patients receiving standard clinical doses of olanzapine or clozapine.
abstract: This study evaluated anticholinergic effects among patients with schizophrenia, schizoaffective disorder, or bipolar I disorder who were receiving either olanzapine (N = 12) or clozapine (N = 12) at standard clinical doses in a naturalistic setting. Serum anticholinergic levels were determined in adult male and female subjects using a radioreceptor binding assay. The Udvalg for Kliniske Undersogelser Scale was used to evaluate anticholinergic side effects clinically, and the Mini-Mental State Examination provided a global cognitive measure. Patients had achieved target doses that were stable at the time at which blood samples were obtained, and no other concomitant medicine with known anticholinergic potential was allowed. Patients receiving olanzapine (average dose, 15 mg/day) had serum anticholinergic levels of 0.96 (+/-0.55) pmol/ atropine equivalents compared with levels of 5.47 (+/-3.33) pmol/atropine equivalents for those receiving clozapine (average dose, 444 mg/day) (p < 0.001). Rates of increased and decreased salivation were significantly more common among the clozapine- and olanzapine-treated patients, respectively, whereas constipation, urinary disturbances, and tachycardia/palpitations were significantly more common among clozapine-treated patients. Neither group showed any global cognitive deficits. Olanzapine-treated patients had serum anticholinergic levels that were less than one fifth those of the clozapine-treated patients. Furthermore, clinical evaluations confirmed that clozapine-treated patients experienced more frequent and severe anticholinergic side effects (except dry mouth). However, none of the patients in either group expressed any desire to discontinue these medications as a result of the anticholinergic side effects.
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pennsylvania 15213-2593, USA. chengappakn@msx.upmc.edu
authors.forename: K N
authors.initials: KN
authors.lastname: Chengappa
authors.forename: B G
authors.initials: BG
authors.lastname: Pollock
authors.forename: H
authors.initials: H
authors.lastname: Parepally
authors.forename: J
authors.initials: J
authors.lastname: Levine
authors.forename: M A
authors.initials: MA
authors.lastname: Kirshner
authors.forename: J S
authors.initials: JS
authors.lastname: Brar
authors.forename: R A
authors.initials: RA
authors.lastname: Zoretich
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001285:Atropine / Q000494:pharmacology; D001342:Autonomic Nervous System Diseases / Q000139:chemically induced; D001569:Benzodiazepines; D018680:Cholinergic Antagonists / Q000009:adverse effects* / Q000097:blood; D003024:Clozapine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000494:pharmacology; D000077152:Olanzapine; D010890:Pirenzepine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology; D011869:Radioligand Assay; D011976:Receptors, Muscarinic / Q000187:drug effects
chemical_list: D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists; D018727:Muscarinic Antagonists; D011976:Receptors, Muscarinic; D001569:Benzodiazepines; D010890:Pirenzepine; D001285:Atropine; D003024:Clozapine; D000077152:Olanzapine