Adverse Effects and Laboratory Parameters of High-Dose Olanzapine vs. Clozapine in Treatment-Resistant Schizophrenia

Deanna L. Kelly, Robert R. Conley, Charles M. Richardson, Carol A. Tamminga, William T. Carpenter

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Patients with treatment-resistant schizophrenia pose a major challenge to caregivers since only clozapine is documented as having superior efficacy in this population. Although olanzapine is similar to clozapine in structure and receptor profile, it has not been proven to have superior efficacy for this patient group. Nonetheless, olanzapine is being increasingly used in higher doses as clinicians attempt to find a more effective and tolerable therapy for refractory patients. Furthermore, there are little data comparing olanzapine and clozapine in this population. Thirteen patients participated in a randomized double-blind 16-week crossover study of clozapine therapy (450 mg/day) compared to high doses of olanzapine (50 mg/day). No patients on olanzapine responded while 20% responded to clozapine treatment. Olanzapine patients tended to experience higher rates of anticholinergic effects such as dry mouth (80 vs. 20%) and blurry vision (40 vs. 0%). Clozapine-treated patients had higher rates of sialorrhea (80 vs. 10%), sweating (50 vs. 10%), dyspepsia (70 vs. 30%), and lethargy (90 vs. 60%). Neither treatment was associated with significant akathisia. Liver enzyme elevation and lipids were higher with clozapine treatment. Mean weight gain in the initial 8 weeks was 3. 4 kg for olanzapine and 1.2 kg for clozapine. High doses of olanzapine during 8 weeks of treatment did not increase lipids and liver enzymes like clozapine did. Olanzapine at 50 mg/day may be associated with more anticholinergic effects and weight gain than clozapine.

Original languageEnglish (US)
Pages (from-to)181-186
Number of pages6
JournalAnnals of Clinical Psychiatry
Volume15
Issue number3-4
DOIs
StatePublished - Sep 2003

Fingerprint

olanzapine
Clozapine
Schizophrenia
Therapeutics
Cholinergic Antagonists
Weight Gain
Sialorrhea
Lipids
Psychomotor Agitation
Lethargy
Sweating
Dyspepsia
Liver
Enzymes

Keywords

  • Clozapine
  • Olanzapine
  • Schizophrenia
  • Side effects
  • Treatment-resistant

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Adverse Effects and Laboratory Parameters of High-Dose Olanzapine vs. Clozapine in Treatment-Resistant Schizophrenia. / Kelly, Deanna L.; Conley, Robert R.; Richardson, Charles M.; Tamminga, Carol A.; Carpenter, William T.

In: Annals of Clinical Psychiatry, Vol. 15, No. 3-4, 09.2003, p. 181-186.

Research output: Contribution to journalArticle

Kelly, Deanna L. ; Conley, Robert R. ; Richardson, Charles M. ; Tamminga, Carol A. ; Carpenter, William T. / Adverse Effects and Laboratory Parameters of High-Dose Olanzapine vs. Clozapine in Treatment-Resistant Schizophrenia. In: Annals of Clinical Psychiatry. 2003 ; Vol. 15, No. 3-4. pp. 181-186.
@article{a1ba5c6ef5ad4be2af22d2a9ac51d049,
title = "Adverse Effects and Laboratory Parameters of High-Dose Olanzapine vs. Clozapine in Treatment-Resistant Schizophrenia",
abstract = "Patients with treatment-resistant schizophrenia pose a major challenge to caregivers since only clozapine is documented as having superior efficacy in this population. Although olanzapine is similar to clozapine in structure and receptor profile, it has not been proven to have superior efficacy for this patient group. Nonetheless, olanzapine is being increasingly used in higher doses as clinicians attempt to find a more effective and tolerable therapy for refractory patients. Furthermore, there are little data comparing olanzapine and clozapine in this population. Thirteen patients participated in a randomized double-blind 16-week crossover study of clozapine therapy (450 mg/day) compared to high doses of olanzapine (50 mg/day). No patients on olanzapine responded while 20{\%} responded to clozapine treatment. Olanzapine patients tended to experience higher rates of anticholinergic effects such as dry mouth (80 vs. 20{\%}) and blurry vision (40 vs. 0{\%}). Clozapine-treated patients had higher rates of sialorrhea (80 vs. 10{\%}), sweating (50 vs. 10{\%}), dyspepsia (70 vs. 30{\%}), and lethargy (90 vs. 60{\%}). Neither treatment was associated with significant akathisia. Liver enzyme elevation and lipids were higher with clozapine treatment. Mean weight gain in the initial 8 weeks was 3. 4 kg for olanzapine and 1.2 kg for clozapine. High doses of olanzapine during 8 weeks of treatment did not increase lipids and liver enzymes like clozapine did. Olanzapine at 50 mg/day may be associated with more anticholinergic effects and weight gain than clozapine.",
keywords = "Clozapine, Olanzapine, Schizophrenia, Side effects, Treatment-resistant",
author = "Kelly, {Deanna L.} and Conley, {Robert R.} and Richardson, {Charles M.} and Tamminga, {Carol A.} and Carpenter, {William T.}",
year = "2003",
month = "9",
doi = "10.1023/B:ACLI.0000008171.90644.f8",
language = "English (US)",
volume = "15",
pages = "181--186",
journal = "Annals of Clinical Psychiatry",
issn = "1040-1237",
publisher = "Dowden Health Media,Inc",
number = "3-4",

}

TY - JOUR

T1 - Adverse Effects and Laboratory Parameters of High-Dose Olanzapine vs. Clozapine in Treatment-Resistant Schizophrenia

AU - Kelly, Deanna L.

AU - Conley, Robert R.

AU - Richardson, Charles M.

AU - Tamminga, Carol A.

AU - Carpenter, William T.

PY - 2003/9

Y1 - 2003/9

N2 - Patients with treatment-resistant schizophrenia pose a major challenge to caregivers since only clozapine is documented as having superior efficacy in this population. Although olanzapine is similar to clozapine in structure and receptor profile, it has not been proven to have superior efficacy for this patient group. Nonetheless, olanzapine is being increasingly used in higher doses as clinicians attempt to find a more effective and tolerable therapy for refractory patients. Furthermore, there are little data comparing olanzapine and clozapine in this population. Thirteen patients participated in a randomized double-blind 16-week crossover study of clozapine therapy (450 mg/day) compared to high doses of olanzapine (50 mg/day). No patients on olanzapine responded while 20% responded to clozapine treatment. Olanzapine patients tended to experience higher rates of anticholinergic effects such as dry mouth (80 vs. 20%) and blurry vision (40 vs. 0%). Clozapine-treated patients had higher rates of sialorrhea (80 vs. 10%), sweating (50 vs. 10%), dyspepsia (70 vs. 30%), and lethargy (90 vs. 60%). Neither treatment was associated with significant akathisia. Liver enzyme elevation and lipids were higher with clozapine treatment. Mean weight gain in the initial 8 weeks was 3. 4 kg for olanzapine and 1.2 kg for clozapine. High doses of olanzapine during 8 weeks of treatment did not increase lipids and liver enzymes like clozapine did. Olanzapine at 50 mg/day may be associated with more anticholinergic effects and weight gain than clozapine.

AB - Patients with treatment-resistant schizophrenia pose a major challenge to caregivers since only clozapine is documented as having superior efficacy in this population. Although olanzapine is similar to clozapine in structure and receptor profile, it has not been proven to have superior efficacy for this patient group. Nonetheless, olanzapine is being increasingly used in higher doses as clinicians attempt to find a more effective and tolerable therapy for refractory patients. Furthermore, there are little data comparing olanzapine and clozapine in this population. Thirteen patients participated in a randomized double-blind 16-week crossover study of clozapine therapy (450 mg/day) compared to high doses of olanzapine (50 mg/day). No patients on olanzapine responded while 20% responded to clozapine treatment. Olanzapine patients tended to experience higher rates of anticholinergic effects such as dry mouth (80 vs. 20%) and blurry vision (40 vs. 0%). Clozapine-treated patients had higher rates of sialorrhea (80 vs. 10%), sweating (50 vs. 10%), dyspepsia (70 vs. 30%), and lethargy (90 vs. 60%). Neither treatment was associated with significant akathisia. Liver enzyme elevation and lipids were higher with clozapine treatment. Mean weight gain in the initial 8 weeks was 3. 4 kg for olanzapine and 1.2 kg for clozapine. High doses of olanzapine during 8 weeks of treatment did not increase lipids and liver enzymes like clozapine did. Olanzapine at 50 mg/day may be associated with more anticholinergic effects and weight gain than clozapine.

KW - Clozapine

KW - Olanzapine

KW - Schizophrenia

KW - Side effects

KW - Treatment-resistant

UR - http://www.scopus.com/inward/record.url?scp=0842327252&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0842327252&partnerID=8YFLogxK

U2 - 10.1023/B:ACLI.0000008171.90644.f8

DO - 10.1023/B:ACLI.0000008171.90644.f8

M3 - Article

C2 - 14971863

AN - SCOPUS:0842327252

VL - 15

SP - 181

EP - 186

JO - Annals of Clinical Psychiatry

JF - Annals of Clinical Psychiatry

SN - 1040-1237

IS - 3-4

ER -