A current review of olanzapine's safety in the geriatric patient: from pre-clinical pharmacology to clinical data

OBJECTIVE

Olanzapine (OLZ) is unique among currently available antipsychotic medications in its antagonism of a range of receptor systems including dopamine, norepinephrine, serotonin, acetylcholine, and histamine. Olanzapine's mechanistic complexity provides a broad efficacy profile in patients with schizophrenia and acute, pure or mixed mania. Patients experience symptomatic relief of mania, anxiety, hallucinations, delusions, and agitation/aggression and reduced depressive, negative, and some cognitive symptoms. This paper will review the safety profile of OLZ, focusing on the elderly, where data are available.

METHOD

Preclinical and clinical studies of OLZ are reviewed, with emphasis on its possible effects on the cholinergic system and the histamine H(1) receptor. Weight change and related metabolic considerations, cardiac and cardiovascular safety, and motor function during treatment with OLZ are also reviewed.

RESULTS AND CONCLUSION

In vitro receptor characterization methods, when done using physiologically relevant conditions allow accurate prediction of the relatively low rate of anticholinergic-like adverse events, extrapyramidal symptoms, and cardiovascular adverse events during treatment with OLZ. Currently available clinical data suggest olanzapine is predictably safe in treating adult patients of any age with schizophrenia and acute bipolar mania, as well as in treatment of patients with some types of neurodegenerative disorders.

[Nonpuerperal mastitis--a disease with increasing clinical relevance?]

During the last few years, a relative increase in the number of patients with non-puerperal mastitis was recorded. From 1980 to 1983, 51 patients were treated who were suffering from an abacterially or bacterially complicated nonpuerperal inflammation of the breast tissue. The present paper reports on patients' history, clinical symptoms, and the development of this form of mastitis during different methods of treatment. The importance of pre-existing lesions of the breast tissue and of hormonal data for the pathogenesis is discussed. The authors conclude that the administration of prolactin inhibiting drugs is an effective therapy. This treatment results in lower rates of abscesses. Long-term therapy with bromocryptine can prevent recurrence of this disease.