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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by SaM on October 22, 1998, at 2:43:33
Has anyone experienced side effects on olanzapine such as white blood count drop or NMS. Would appreciate any dialogue in this area.Sam
Posted by cathyF on December 2, 2000, at 19:21:37
In reply to Olanzapine and side effects, posted by SaM on October 22, 1998, at 2:43:33
>
> Has anyone experienced side effects on olanzapine such as white blood count drop or NMS. Would appreciate any dialogue in this area.
> SamSomeone that I know has suffered serious heart problems after taking Olanzapine for approx.3 weeks------What happened to you when you took it?
Is there anyone else out there who has suffered serious side effects after taking it....everyone thinks it's a safe medicine.
Posted by Deborah on December 3, 2000, at 3:42:19
In reply to Re: Olanzapine and side effects, posted by cathyF on December 2, 2000, at 19:21:37
Hi cathyF
My Mum developed Neuroleptic Malignant Syndrome after being switched from Risperidone to Olanzapine. The NMS developed about three weeks into the Olanzapine (I think) and Mum was hospitalised for several weeks while recovering. I found Sam's post when I first found this site, but despite posting to him I haven't seen any posts from him, which is a shame as I would have like to compare notes with him.
I guess it could have been the change of drugs that caused Mum to become so ill, perhaps this syndrome was developing on the Risperidone, then when the drugs were changed it just continued to develop. I think it was the Olanzapine though, Mum is in her 70's and our older folk should be on much reduced doses than younger people are - well I have read that anyway.
Do you, or a family member have any experiences such as these, I am very interested in learning as much as I can about this drug and the effects that people notice.
Best wishes,
Deb R.
> >
> > Has anyone experienced side effects on olanzapine such as white blood count drop or NMS. Would appreciate any dialogue in this area.
> > Sam
>
> Someone that I know has suffered serious heart problems after taking Olanzapine for approx.3 weeks------What happened to you when you took it?
> Is there anyone else out there who has suffered serious side effects after taking it....everyone thinks it's a safe medicine.
Posted by KarenK on December 3, 2000, at 11:47:18
In reply to Re: Olanzapine and side effects, posted by Deborah on December 3, 2000, at 3:42:19
Hi Deb R,
My son took olanzapine for a few months this year and the only side effect he had was tremendous weight gain. He gained about 70lbs in 2 months so he had to discontinue it.
So sorry to hear about your mother.
Love,
Karen> Hi cathyF
>
> My Mum developed Neuroleptic Malignant Syndrome after being switched from Risperidone to Olanzapine. The NMS developed about three weeks into the Olanzapine (I think) and Mum was hospitalised for several weeks while recovering. I found Sam's post when I first found this site, but despite posting to him I haven't seen any posts from him, which is a shame as I would have like to compare notes with him.
>
> I guess it could have been the change of drugs that caused Mum to become so ill, perhaps this syndrome was developing on the Risperidone, then when the drugs were changed it just continued to develop. I think it was the Olanzapine though, Mum is in her 70's and our older folk should be on much reduced doses than younger people are - well I have read that anyway.
>
> Do you, or a family member have any experiences such as these, I am very interested in learning as much as I can about this drug and the effects that people notice.
>
> Best wishes,
> Deb R.
> > >
> > > Has anyone experienced side effects on olanzapine such as white blood count drop or NMS. Would appreciate any dialogue in this area.
> > > Sam
> >
> > Someone that I know has suffered serious heart problems after taking Olanzapine for approx.3 weeks------What happened to you when you took it?
> > Is there anyone else out there who has suffered serious side effects after taking it....everyone thinks it's a safe medicine.
Posted by Sunnely on December 3, 2000, at 23:20:12
In reply to Re: Olanzapine and side effects, posted by cathyF on December 2, 2000, at 19:21:37
> >
> > Has anyone experienced side effects on olanzapine such as white blood count drop or NMS. Would appreciate any dialogue in this area.
> > Sam++++++++++++++++++++++
Virtually all antipsychotics, traditional and atypical, have been reported to cause NMS (neuroleptic malignant syndrome), a serious and potentially fatal adverse effect of these meds.
Posted by SLS on December 4, 2000, at 6:45:28
In reply to Re: Olanzapine and side effects, posted by Sunnely on December 3, 2000, at 23:20:12
> > >
> > > Has anyone experienced side effects on olanzapine such as white blood count drop or NMS. Would appreciate any dialogue in this area.
> > > Sam
>
> ++++++++++++++++++++++
>
> Virtually all antipsychotics, traditional and atypical, have been reported to cause NMS (neuroleptic malignant syndrome), a serious and potentially fatal adverse effect of these meds.
Hi Sunnely,Is there a cross-sensitivity to NMS? To what degree?
- Scott
Posted by Sunnely on December 4, 2000, at 19:46:08
In reply to Re: Olanzapine and side effects » Sunnely, posted by SLS on December 4, 2000, at 6:45:28
> Is there a cross-sensitivity to NMS? To what degree?
>
>
> - Scott+++++++++++++++++++
Hi Scott,
Although the exact mechanism of NMS remains unclear, it does not appear to involve a hypersensitivity reaction. There have been reports of patients who developed NMS from one phenothiazine antipsychotic and were successfully re-challenged with another phenothiazine antipsychotic. Also, there have been reports of patients who developed NMS from one medication and were re-challenged successfully, although with extreme caution, with the very same antipsychotic drug that caused it.
It has been postulated that NMS is due to the central (nervous system) dopaminergic blockade leading to an an acute state of dopamine deficiency. Therefore, any drug with the ability to block dopamine receptors such as the antipsychotics, is also capable of causing NMS. So, every time one is prescribed an antipsychotic drug, there is always the risk for NMS, but of course, this does not always occur. A number of contributing factors play some role in its development. Another possible scenario for NMS to occur is when an antiparkinsonian drug is abruptly discontinued. So, patients with Parkinson's disease and on antiparkinson drug, may be at risk for NMS if the antiparkinson is abruptly discontinued. This action leads to a state of acute dopamine deficiency.
Other drugs (not antipsychotics) have also been reported to cause NMS such as lithium, anti-emetics (Compazine, Torecan, Tigan, Reglan), antidepressants (tricyclic antidepressants, MAOIs, and yes, SSRIs).
The risk of NMS on someone taking an antipsychotic drug becomes higher if certain factors are also involved. These factors include but not limited to: 1) starting the antipsychotic drug at high dose; 2) rapidly increasing the dose; 3) dehydration; 4) agitation; 5) affective disorders (bipolar disorder, depression) higher than schizophrenia; 6) presence of organic brain syndromes (e.g., dementia, history of brain injury); 7) concurrent use of lithium. Younger males seem to be affected more than females. There is no consistent evidence that one antipsychotic drug or class is more or less likely to produce NMS.
NMS usually does not occur overnight. It was suggested that about 70% of NMS cases follow a spectrum of events. Usually, the premonitory signs are confusion, mutism, and catatonia. There may be accompanying muscle rigidity or tremor (EPS). So, if someone on antipsychotic drug develops these symptoms, especially the combination of mutism or catatonia and EPS, THINK NMS and stop the antipsychotic immediately. If the antipsychotic drug is stopped immediately and with suppportive care, you can almost always prevent the NMS from developing into a full-blown stage, when it becomes more serious and increased risk of fatality.
The 4 cardinal clinical features of a full-blown NMS are: 1) Hyperthermia (markedly elevated body temperature, 104 F or higher); 2) Muscular rigidity (e.g., "lead-pipe" rigidity; patient can't move, can't talk, can't swallow); 3) Autonomic instability (e.g., blood pressure fluctuating, rapid pulse, rapid respiration, profuse sweating, incontinence); and 4) Altered consciousness (e.g., confusion, agitation, mute, frightened facial expression, lethargic, stuporous, delirious). Although not diagnostic of NMS, in one study, 92% of patients who developed NMS had elevated levels of CPK (creatine phosphokinase). CPK is a muscle enzyme and a sensitive marker of muscle injury (e.g. marked muscular rigidity). Death from NMS is usually due to acute kidney failure or aspiration pneumonia.
Posted by SLS on December 4, 2000, at 22:05:33
In reply to Re: Olanzapine and side effects » SLS, posted by Sunnely on December 4, 2000, at 19:46:08
Sunnely - Thank you for contributing another one of your thoroughly informative replies.
There is an obvious similarity in the presentation of NMS with serotonin syndrome. How are they differentially diagnosed?
Thanks again.
- Scott> The 4 cardinal clinical features of a full-blown NMS are: 1) Hyperthermia (markedly elevated body temperature, 104 F or higher); 2) Muscular rigidity (e.g., "lead-pipe" rigidity; patient can't move, can't talk, can't swallow); 3) Autonomic instability (e.g., blood pressure fluctuating, rapid pulse, rapid respiration, profuse sweating, incontinence); and 4) Altered consciousness (e.g., confusion, agitation, mute, frightened facial expression, lethargic, stuporous, delirious). Although not diagnostic of NMS, in one study, 92% of patients who developed NMS had elevated levels of CPK (creatine phosphokinase). CPK is a muscle enzyme and a sensitive marker of muscle injury (e.g. marked muscular rigidity). Death from NMS is usually due to acute kidney failure or aspiration pneumonia.
Posted by Deborah on December 4, 2000, at 22:48:16
In reply to Re: Olanzapine and side effects » SLS, posted by Sunnely on December 4, 2000, at 19:46:08
Dear Sunnely,
I really appreciate the post where you explained more about NMS - it is very informative and easy to read. My Mum has fully recovered and is now on a much lower dose of Olanzapine which seems to be working well for her most of the time.
You are a wonderful contributor here and I thank you sincerely.
Best wishes,
Deb.
Posted by Sunnely on December 5, 2000, at 19:53:34
In reply to Re: Olanzapine and side effects » Sunnely, posted by SLS on December 4, 2000, at 22:05:33
> Sunnely - Thank you for contributing another one of your thoroughly informative replies.
>
> There is an obvious similarity in the presentation of NMS with serotonin syndrome. How are they differentially diagnosed?
>
> Thanks again.++++++++++++++++++++++++
Hi Scott,
Indeed, neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) have significant similarity in clinical features.
The following are general differences between the two:
1) DRUGS INVOLVED:
NMS - neuroleptics (aka antipsychotics); SS - serotonergic drugs (especially in combination)2) CAUSE(S) OR MECHANISM(S) PROPOSED:
NMS - central (brain) dopamine deficiency; SS - Activation of 5HT1A receptors; enhancement of overall 5HT neurotransmission.3) ONSET:
NMS - full syndrome usually 3-9 days of start of antipsychotic (but can occur anytime); SS - usually within hours4) RIGIDITY:
NMS - more; SS - less5) AUTONOMIC DYSFUNCTION (e.g., fluctuating BP, profuse sweating, rapid pulse, breathing, etc.):
NMS - more; SS - less6) HYPERREFLEXIA, RESTLESSNESS, UNSTEADY GAIT, MYOCLONUS:
NMS - less; SS - more7) AVERAGE DURATIION:
NMS - longer (especially if depot antipsychotics are involved); SS - shorter8) MORTALITY:
NMS - higher; SS - lowerNo diagnostic or laboratory tests to confirm diagnosis of SS or NMS. CPK level is usually elevated in both.
Aside from serotonin syndrome, other conditions that can be mistaken for NMS include: 1) Malignant Hyperthermia (during general anesthesia), 2) Lethal Catatonia, 3) Central Anticholinergic Toxicity (e.g., tricyclic antidepressant overdose), 4) Neuroleptic-related Heatstroke (especially during heat wave).
Posted by cathyF on January 27, 2001, at 17:06:32
In reply to Re: Olanzapine and side effects, posted by Deborah on December 3, 2000, at 3:42:19
Hello Debbie
I didn't think anyone would respond to my message!
Someone that I know also developed problems around 3 weeks after starting Olanzapine...it has caused permanent damage to his heart and he almost died.Did your Mum have symptoms like this. Best wishes. Cathy F > Hi cathyF
>
> My Mum developed Neuroleptic Malignant Syndrome after being switched from Risperidone to Olanzapine. The NMS developed about three weeks into the Olanzapine (I think) and Mum was hospitalised for several weeks while recovering. I found Sam's post when I first found this site, but despite posting to him I haven't seen any posts from him, which is a shame as I would have like to compare notes with him.
>
> I guess it could have been the change of drugs that caused Mum to become so ill, perhaps this syndrome was developing on the Risperidone, then when the drugs were changed it just continued to develop. I think it was the Olanzapine though, Mum is in her 70's and our older folk should be on much reduced doses than younger people are - well I have read that anyway.
>
> Do you, or a family member have any experiences such as these, I am very interested in learning as much as I can about this drug and the effects that people notice.
>
> Best wishes,
> Deb R.
> > >
> > > Has anyone experienced side effects on olanzapine such as white blood count drop or NMS. Would appreciate any dialogue in this area.
> > > Sam
> >
> > Someone that I know has suffered serious heart problems after taking Olanzapine for approx.3 weeks------What happened to you when you took it?
> > Is there anyone else out there who has suffered serious side effects after taking it....everyone thinks it's a safe medicine.
Posted by N_Oracle on August 26, 2001, at 21:41:13
In reply to Olanzapine and side effects, posted by SaM on October 22, 1998, at 2:43:33
My wife to be is now on it.
She has been on neuroleptics for the past 5 years and in the past has suffered from weight gain. Originally she was told that she was eating too much(but that is another story). Am I right in thinking that notn a lot is actually know about the side effects of this drug and that it is in effect experimental?Thankyou for being here...
I have been looking for someone who can understand my situation.Lots of Love...
RichPS. Couldn't get the email to work so here it is.
n_oracle@yahoo.co.uk
Posted by SalArmy4me on August 26, 2001, at 23:41:38
In reply to Olanzapine and side effects, posted by SaM on October 22, 1998, at 2:43:33
Muniz, Edmundo MD, PhD. Finding drug link to reaction. American Journal of Health-System Pharmacy. 56(15):1559, August 1, 1999:
"With respect to olanzapine and NMS, our analysis of the postmarketing data indicates that the overall clinical picture is reassuring. Two years after the drug was approved by FDA and after more than 2.1 million patient exposures, the reported rate of olanzapine-related NMS was less than 0.01%.
Many of the reports of NMS had at least one of the following problems:
- Failed to meet well-accepted diagnostic criteria, either from lack of necessary inclusion criteria (e.g., fever) or the presence of other exclusionary diagnoses (e.g., alcohol abuse or withdrawal, thyrotoxicosis, electrolyte imbalance),
- Involved preexisting risk factors (e.g., concomitant neuroleptic therapy, concomitant lithium therapy, history of NMS, organic brain disease, dehydration, withdrawal of an anticholinergic agent, elevated ambient body temperature), and
- Lacked sufficient information for a health care professional to make an adequate clinical assessment.
Information on NMS appears prominently in the warnings section of the olanzapine package insert and includes four paragraphs describing the clinical signs and treatment of NMS. The postmarketing data have not rendered this warning insufficient.
We thank Ms. Hammond for underscoring the importance of comprehensive ADR reporting in order to monitor adverse events and evaluate their significance. Lilly's comprehensive postmarketing "pharmacovigilance" program depends on these reports, as does our continuing commitment to maximizing the safe use of the company's products."
Edmundo Muniz, M.D., Ph.D., Director
Worldwide Pharmacovigilance and Epidemiology; Eli Lilly and Company; Lilly Corporate Center; Indianapolis, IN 46285
Posted by Cam W. on August 27, 2001, at 1:54:13
In reply to Re: Olanzapine and side effects Distressed, posted by N_Oracle on August 26, 2001, at 21:41:13
N - The weight gain with Zyprexa™ (olanzapine) is seen in approximately 70% of people taking the drug. The weight gain seems to level off after about 8 to 12 months.
Some of the weight gain seems to be related to increased carbohydrate craving, but other factors (leptin levels, baseline Body Mass Index [BMI], concentration of serotonin-2C receptors, antimuscarinic, or antihistaminergic effects etc.) also seem to be involved. To my knowledge, there has been no scientifically reproduceable conclusions as to the definitive mechanisms of Zyprexa-induced weight gain.
I hope that this is of some help. - Cam
Posted by Zo on August 27, 2001, at 13:58:13
In reply to Re: Olanzapine and side effects Distressed, posted by N_Oracle on August 26, 2001, at 21:41:13
The manufacturers of Axid, and over-the-counter anti-acid, (who also make Zyprexa/olanzapine, suggests 300mg. Axid twice a day will counter the weight gain in some people. It is also possible to pretreat with the Axid.
There is no question olanzapine causes serious weight gainm particularly in women but not only them. In my extensive searching on the web, I found gains of 50 to 80 lbs. were quite common. . .and I found everyone is looking for the solutionÑand no one has found one.
Risperdal (Geodon) has been widely touted as a substitute that does not cause weight gain. For myself, at least, it is not the same at all, wish it were.Good luck,
Zo
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