Olanzapine in ED patients: differential effects on oxygenation in patients with alcohol intoxication.
BACKGROUND
Agitation has significant consequences for patients and staff. When verbal techniques fail, expert guidelines recommend the use of second-generation antipsychotics (SGAs). Perhaps out of familiarity with haloperidol and benzodiazepines, emergency department (ED) clinicians often pair SGAs with benzodiazepines as well. Use of SGAs such as olanzapine in alcohol-intoxicated (ETOH+) patients or with benzodiazepines is not well studied and may be associated with vital sign abnormalities.


METHODS
This is a structured chart review of all patient visits who received either oral or intramuscular (i.m.) olanzapine in an academic ED from 2004 to 2010 and who had systolic blood pressure, heart rate, and oxygen saturation documented before medication administration and within 4 hours afterwards.


RESULTS
Four hundred eighty-two patient visits received olanzapine; 275 patient visits (225 oral, 50 i.m.) had vital signs documented. Neither route of administration, concurrent benzodiazepines, nor ingestion of ETOH were associated with significant decreases in systolic BP or heart rate (P = ns for all comparisons). Decreases in oxygen saturations, however, were significantly larger in ETOH+ patients who received i.m. olanzapine or i.m. olanzapine + benzodiazepines. Route of administration, concurrent benzodiazepines, nor ingestion of ETOH was associated with significant decreases in systolic blood pressure or heart rate (p = ns for all comparisons). Decreases in oxygen saturations, however, were significantly larger in ETOH+ patients who received i.m. olanzapine or i.m. olanzapine + benzodiazepines.


CONCLUSIONS
Oral olanzapine was not associated with significant vital sign changes in ED patients. Intramuscular olanzapine also was not associated with vital sign changes in ETOH- patients. In ETOH+ patients, i.m. olanzapine was associated with significant oxygen desaturations. In ETOH+ ED patients, oral olanzapine (with or without benzodiazepines) or haloperidol may be safer choices. ETOH+ patients may have differential effects with the use of i.m. SGAs such as olanzapine and should be studied separately in drug trials.
Department of Emergency Medicine, UC San Diego Health System, San Diego, CA 92103, USA. mpwilso1@gmail.com
Michael P
MP
Wilson
Nita
N
Chen
Gary M
GM
Vilke
Edward M
EM
Castillo
Kai S
KS
MacDonald
Arpi
A
Minassian
D000284:Administration, Oral; D000328:Adult; D000435:Alcoholic Intoxication / Q000188:drug therapy*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004347:Drug Interactions; D004636:Emergency Service, Hospital; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007273:Injections, Intramuscular; D008297:Male; D000077152:Olanzapine; D010100:Oxygen / Q000097:blood*; D011595:Psychomotor Agitation / Q000188:drug therapy; D012189:Retrospective Studies
D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D000077152:Olanzapine; D010100:Oxygen