title: Olanzapine as alternative therapy for patients with haloperidol-induced extrapyramidal symptoms: results of a multicenter, collaborative trial in Latin America.
abstract: Conventional antipsychotic agents can induce extrapyramidal symptoms (EPS) that may be alleviated by switching patients to novel agents such as olanzapine. Patients with schizophrenia and related disorders (ICD-10) who were taking haloperidol (N = 94; mean dose = 12.7 mg/day) and had EPS (Simpson-Angus Scale [SAS] > 3) were directly switched to 6 weeks of open-label olanzapine treatment (mean dose = 11.4 mg/day). There were significant mean improvements (p <0.001 for all measurements) from baseline to endpoint on the SAS (-9.69+/-5.33; percentage change, 87.2%), the Barnes Akathisia Scale (-1.00+/-1.19; percentage change, 82.5%), and the Abnormal Involuntary Movement Scale (-1.48+/-2.89; percentage change, 81.1%), and anticholinergic use decreased from 47.9% to 12.8% (mean baseline to endpoint change: -1.52+/-1.91-mg equivalents of benztropine; p < 0.001). Significant mean baseline to endpoint improvements (p < 0.001 for all measurements) were observed on the Positive and Negative Syndrome Scale (PANSS; -25.28+/-18.67; percentage change, 30.3%), the PANSS-extracted Brief Psychiatric Rating Scale (0-6 scale, -13.41+/-10.16; percentage change, 54.4%), and the Clinical Global Impressions Severity scale (-1.16+/-1.19; percentage change, 26.4%). Spontaneously reported treatment- emergent adverse events with a greater than 5% incidence were somnolence (16.0%), increased appetite (14.9%), weight gain (11.7%), headache (8.5%), anxiety (7.4%), dizziness (6.4%), and insomnia (5.3%). Criteria for a successful switch were met by 90.5% of patients. Psychotic symptom exacerbation was experienced by 30.9% of patients at any time during the study and by 11.7% of patients at endpoint. Results suggest that a direct switch to olanzapine is a therapeutic option when patients with haloperidol-induced EPS are unable to tolerate a more gradual switch.
authors.affiliation: Santa Casa de Misericórdia, Rio de Janeiro, Brazil.
authors.forename: J A
authors.initials: JA
authors.lastname: Costa e Silva
authors.forename: N
authors.initials: N
authors.lastname: Alvarez
authors.forename: G
authors.initials: G
authors.lastname: Mazzotti
authors.forename: W F
authors.initials: WF
authors.lastname: Gattaz
authors.forename: J
authors.initials: J
authors.lastname: Ospina
authors.forename: V
authors.initials: V
authors.lastname: Larach
authors.forename: S
authors.initials: S
authors.lastname: Starkstein
authors.forename: D
authors.initials: D
authors.lastname: Oliva
authors.forename: L
authors.initials: L
authors.lastname: Cousins
authors.forename: M
authors.initials: M
authors.lastname: Tohen
authors.forename: C C
authors.initials: CC
authors.lastname: Taylor
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.forename: P V
authors.initials: PV
authors.lastname: Tran
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001569:Benzodiazepines; D004409:Dyskinesia, Drug-Induced / Q000453:epidemiology*; D005260:Female; D006220:Haloperidol / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D007843:Latin America; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D010890:Pirenzepine / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D010890:Pirenzepine; D006220:Haloperidol; D000077152:Olanzapine