High Initial Dosing of Olanzapine for Stabilization of Acute Agitation: A Retrospective Case Series

Abstract

Background:

There are several possible dosing strategies for the use of atypical antipsychotics for acute agitation, such as the rapid initial dose escalation protocol (olanzapine) or starting at the maximum recommended dose (aripiprazole). There can be challenges to dose escalation as compared with “loading” patients with an atypical antipsychotic.

Objective:

To describe an effective loading dose protocol for olanzapine used to enhance control of acute psychotic and manic symptoms.

Methods:

A retrospective case series was constructed from the records of inpatients treated on an acute psychiatry unit. Records from 8 patients who were diagnosed with bipolar disorder or schizophrenia and who received an initial dose of olanzapine 40 mg for 2 days, 30 mg for 2 days, and 20 mg for 2 days were retrieved and examined. Scores on the Brief Psychiatric Rating Scale (BPRS) and the Young Mania Rating Scale (YMRS) were assigned retrospectively on the basis of chart review.

Results:

The dosing regimen was associated with average reductions of 9.2 points per day on the BPRS and 9.1 points per day on the YMRS over the first 4 days of treatment. None of the patients in this series experienced serious adverse events, and the only adverse effect observed was mild sedation.

Conclusions:

High initial dose olanzapine, used in a scheduled loading dose regimen, was associated with rapid reduction of psychotic and manic symptoms. Our conclusions are limited by the small sample size, the lack of random assignment, and the retrospective approach. The results of this series suggest the need for additional studies of the efficacy and safety of this olanzapine loading dose protocol.