Olanzapine in ED patients: differential effects on oxygenation in patients with alcohol intoxication

• Published in: The American journal of emergency medicine 2012-09, Vol.30 (7), p.1196-1201
• Main Authors: Wilson, Michael P., MD, PhD, Chen, Nita, BA, Vilke, Gary M., MD, Castillo, Edward M., PhD, MPH, MacDonald, Kai S., MD, Minassian, Arpi, PhD
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adult; Alcohol use; Alcoholic Intoxication - drug therapy; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antipsychotic Agents - administration & dosage; Antipsychotic Agents - adverse effects; Antipsychotic Agents - therapeutic use; Antipsychotics; Benzodiazepines - administration & dosage; Benzodiazepines - adverse effects; Benzodiazepines - therapeutic use; Biological and medical sciences; Blood pressure; Blood Pressure - drug effects; Clinical death. Palliative care. Organ gift and preservation; Drug dosages; Drug Interactions; Emergency; Emergency medical care; Emergency Service, Hospital; Female; Heart rate; Heart Rate - drug effects; Humans; Hypnotics and Sedatives - therapeutic use; Ingestion; Injections, Intramuscular; Intensive care medicine; Male; Medical sciences; Oxygen; Oxygen - blood; Oxygenation; Psychomotor Agitation - drug therapy; Psychotropic drugs; Retrospective Studies; Review boards; Signs; Vital signs
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2012.03.013

Abstract Introduction Agitation has significant consequences for patients and staff. When verbal techniques fail, expert guidelines recommend the use of second-generation antipsychotics (SGAs). Perhaps out of familiarity with haloperidol and benzodiazepines, emergency department (ED) clinicians often pair SGAs with benzodiazepines as well. Use of SGAs such as olanzapine in alcohol-intoxicated (ETOH+) patients or with benzodiazepines is not well studied and may be associated with vital sign abnormalities. Methods This is a structured chart review of all patient visits who received either oral or intramuscular (IM) olanzapine in an academic ED from 2004 to 2010 and who had systolic blood pressure, heart rate, and oxygen saturation documented before medication administration and within 4 hours afterwards. Results Four hundred eighty-two patient visits received olanzapine; 275 patient visits (225 oral, 50 IM) had vital signs documented. Neither route of administration, concurrent benzodiazepines, nor ingestion of ETOH were associated with significant decreases in systolic BP or heart rate ( P = ns for all comparisons). Decreases in oxygen saturations, however, were significantly larger in ETOH+ patients who received IM olanzapine or IM olanzapine + benzodiazepines. Route of administration, concurrent benzodiazepines, nor ingestion of ETOH was associated with significant decreases in systolic blood pressure or heart rate ( p = ns for all comparisons). Decreases in oxygen saturations, however, were significantly larger in ETOH+ patients who received IM olanzapine or IM olanzapine + benzodiazepines. Conclusions Oral olanzapine was not associated with significant vital sign changes in ED patients. Intramuscular olanzapine also was not associated with vital sign changes in ETOH− patients. In ETOH+ patients, IM olanzapine was associated with significant oxygen desaturations. In ETOH+ ED patients, oral olanzapine (with or without benzodiazepines) or haloperidol may be safer choices. ETOH+ patients may have differential effects with the use of IM SGAs such as olanzapine and should be studied separately in drug trials.