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With haloperidol, intravenous use is associated with fewer extrapyramidal side effects compared to oral administration. If the same relative forum consultation in extrapyramidal symptoms forum consultation true of IV olanzapine compared to oral olanzapine, it would suggest that IV olanzapine should have a very low rate of extrapyramidal symptoms.

One large study of IV olanzapine reported a 0. Some concerns have been raised about over-sedation due from the combination of IM olanzapine with benzodiazepines. However, the RCT by Chan 2013 discussed above reported no increase in adverse effects forum consultation 109 patients receiving IV olanzapine plus midazolam, compared to patients receiving placebo forum consultation midazolam. There was actually a trend towards increased desaturation in the placebo group, likely due to higher doses of midazolam required in the placebo group.

IV olanzapine may be safer than IM olanzapine, because IV olanzapine works faster, allowing hemorrhagic stroke to be titrated accurately. Alternatively, agitated patients who johnson adventure IM olanzapine may continue to receive several doses of benzodiazepine, before the olanzapine has taken effect.

Thus, titrated doses of IV olanzapine may reduce the total dose administered. Martel 2015 reported a retrospective cohort study examining side effects experienced by 713 patients who received IV olanzapine in the emergency department. The only safety concern raised in this article were three intubations potentially related to olanzapine (adjacent box). These intubations might have been required regardless of the choice of antipsychotic.

Overall this study is reassuring, since it represents a large pragmatic description of olanzapine use in acutely ill patients that failed to reveal any unexpected problems. Olanzapine is currently off-patent, but forum consultation may remain somewhat more expensive than haloperidol conjunctivitis. However, haloperidol is associated with costs of obtaining EKGs and more frequent treatment of extrapyramidal reactions (e.

Additionally, although TdP is rare, the cost of treating a single forum consultation can be enormous.

Formal pharmacoeconomic analyses show forum consultation the primary determinant of the cost of managing an agitated patient is time: anything which prolongs forum consultation ED or ICU length of stay is expensive (e. This makes it unwise to choose a cheaper drug that may occasionally prolong length of stay.

Is IV olanzapine ready for prime time. IV olanzapine is newer, so it is possible that additional side effects may emerge over time. However, we already know that there are significant forum consultation with IV haloperidol. IV haloperidol can cause TdP. Patients receiving this should be monitored with serial EKGs to minimize their risk. However, in practice it may be impossible to obtain an EKG in forum consultation agitated patient.

Thus, compliance with recommended QT monitoring for IV haloperidol is extremely poor (Warnier 2015). This represents a systemic source of risk to our patients. The switch to olanzapine might be justifiable solely on the basis that we could spend less time checking EKGs and debating the damn QTc.

Humans have forum consultation limited capacity to make decisions and pay attention to details. As discussed by Scott Weingart in the John Hinds Memorial Lecture, making too forum consultation decisions (even minor decisions) leads to decision fatigue. Eliminating unnecessary decisions and interruptions could free up physicians and nurses to pay attention to more important problems.

Ultimately, weighing the known versus forum consultation unknown is a matter of judgment. Hennepin County Hospital) have forum consultation broadly adopted IV olanzapine.

Another approach forum consultation be to selectively use IV olanzapine for patients at higher risk of harm from haloperidol (e. For agitation, a reasonable dose appears to be 2. Note that IV olanzapine appears to be roughly twice as powerful as haloperidol (e. As with any sedative, forum consultation lower doses and increasing the time interval between doses will reduce the risk of over-sedation. Akathisia is 3-5 times less common with olanzapine compared to haloperidol (Tollefson 1997, Kishi 2015).

Therefore, using IV olanzapine in the case described above might have avoided this complication entirely.



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