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Olanzapine

What is olanzapine?

The treatment of bipolar disorder is complex due to the presence of varying configurations of symptoms in patients. The primary treatments for bipolar disorder are pharmacological, and often involve antipsychotic drugs such as the second-generation antipsychotic, olanzapine.

What is the evidence for olanzapine as treatment for bipolar disorder?

Symptoms

Moderate to high quality evidence suggests significant, small to medium-sized effects of greater improvement in depression symptoms and better response to treatment with olanzapine than with placebo. Olanzapine + fluoxetine resulted in greater improvement in depression symptoms and response than olanzapine alone.

Moderate to high quality evidence suggests small to medium-sized effects of greater improvement in acute mania symptoms with olanzapine than with placebo, particularly for people with more severe symptoms at the start of treatment. Moderate quality evidence suggests greater improvement in acute mania symptoms with olanzapine than with lithium topiramate or lamotrigine, although there was greater improvement in mania symptoms with tamoxefin than with olanzapine.

Moderate to low quality evidence suggests intramuscular olanzapine was more effective at reducing agitation than placebo or lorazepam.

Relapse

Moderate to high quality evidence suggests a medium-sized effect of fewer relapses with olanzapine than with placebo. There were small effects of fewer relapses (any) with olanzapine compared to lamotrigine, paliperidone and imipramine.

Side effects

Moderate quality evidence suggests more weight gain with olanzapine than with lurasidone. Olanzapine was more likely to elevate prolactin levels than placebo. Moderate to low quality evidence suggests olanzapine may be more likely to elevate prolactin levels than risperidone, and less likely to elevate prolactin levels than valproate. There was less all-cause discontinuation with olanzapine than with placebo, cariprazine, lithium, carbamazepine, asenapine, verapamil, lamotrigine, licarbazepine and topiramate. There were no differences between olanzapine and placebo in rates of switching to mania.

November 2021

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Last updated at: 1:54 pm, 1st December 2021
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