Journal of Pain and Symptom Management
Volume 40, Issue 5 , Pages 774-782 , November 2010

Subcutaneous Olanzapine for Hyperactive or Mixed Delirium in Patients with Advanced Cancer: A Preliminary Study

  • Ahmed Elsayem, MD

      Affiliations

    • The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
    • Corresponding Author InformationAddress correspondence to: Ahmed Elsayem, MD, Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Unit 1414, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
    • ,
  • Shirley H. Bush, MBBS

      Affiliations

    • The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
    • ,
  • Mark F. Munsell, MD

      Affiliations

    • The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
    • ,
  • Eardie Curry III, MD

      Affiliations

    • University Medical Center at Brackenridge, Austin, Texas, USA
    • ,
  • Bianca B. Calderon, PharmD

      Affiliations

    • The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
    • ,
  • Timotheos Paraskevopoulos, RN

      Affiliations

    • The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
    • ,
  • Nada Fadul, MD

      Affiliations

    • The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
    • ,
  • Eduardo Bruera, MD

      Affiliations

    • The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA

,Accepted 24 February 2010.

References 

  1. Bruera E, Franco JJ, Maltoni M, Watanabe S, Suarez-Almazor M. Changing pattern of agitated impaired mental status in patients with advanced cancer: association with cognitive monitoring, hydration, and opioid rotation. J Pain Symptom Manage. 1995;10:287–291
  2. Morita T, Hirai K, Sakaguchi Y, et al. Family-perceived distress from delirium-related symptoms of terminally ill cancer patients. Psychosomatics. 2004;45:107–113
  3. O’Malley G, Leonard M, Meagher D, et al. The delirium experience: a review. J Psychosom Res. 2008;65:223–228
  4. Michaud L, Bula C, Berney A, et al. Delirium: guidelines for general hospitals. J Psychosom Res. 2007;62:371–383
  5. Tesar GE, Murray GB, Cassem NH. Use of high-dose intravenous haloperidol in the treatment of agitated cardiac patients. J Clin Psychopharmacol. 1985;5:344–347
  6. Elsayem A, Curry E, Boohene J, et al. Use of palliative sedation for intractable symptoms in the palliative care unit of a comprehensive cancer center. Support Care Cancer. 2009;17:53–59
  7. Fainsinger RL, Landman W, Hoskings M, Bruera E. Sedation for uncontrolled symptoms in a South African hospice. J Pain Symptom Manage. 1998;16:145–152
  8. Boettger S, Breitbart W. Atypical antipsychotics in the management of delirium: a review of the empirical literature. Palliat Support Care. 2005;3:227–237
  9. Rea RS, Battistone S, Fong JJ, et al. Atypical antipsychotics versus haloperidol for treatment of delirium in acutely ill patients. Pharmacotherapy. 2007;27:588–594
  10. Lonergan E, Britton AM, Luxenberg J. Antipsychotics for delirium. Cochrane Database Syst Rev. 2007;(2):CD005594
  11. Kim KS, Pae CU, Chae JH, et al. An open pilot trial of olanzapine for delirium in the Korean population. Psychiatry Clin Neurosci. 2001;55:515–519
  12. Breitbart W, Tremblay A, Bibson C. An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients. Psychosomatics. 2002;43:175–182
  13. Kapur S, Kipursky RB, Remington G, et al. 5-HT2 and D2 receptor occupancy of olanzapine in schizophrenia: a PET investigation. Am J Psychiatry. 1998;155:921–928
  14. Beasley CM, Tollefson G, Tran P, et al. Olanzapine versus placebo and haloperidol: acute phase results of the North American double-blind olanzapine trial. Neuropsychopharmacology. 1996;14:111–123
  15. Zyprexa. [package insert] Indianapolis, IN: Eli Lilly and Company; 1997, 2008;
  16. Meehan K, Wang H, David S, et al. Comparison of rapidly acting intramuscular olanzapine, lorazepam, and placebo: a double-blind, randomized study in acutely agitated patients with dementia. Neuropsychopharmacology. 2002;26:494–504
  17. Jones B, Taylor CC, Meehan K. The efficacy of rapid-acting intramuscular formulation of olanzapine for positive symptoms. J Clin Psychiatry. 2001;62(Suppl 2):22–24
  18. Wright P, Birkett M, David SR, et al. Double-blind, placebo-controlled comparison of intramuscular olanzapine and intramuscular haloperidol in the treatment of acute agitation in schizophrenia. Am J Psychiatry. 2001;158:1149–1151
  19. Breier A, Meehan K, Birkett M, et al. A double-blind, placebo-controlled dose response comparison of intramuscular olanzapine and haloperidol in the treatment of acute agitation in schizophrenia. Arch Gen Psychiatry. 2002;59:441–448
  20. Meehan K, Zhang F, David S, et al. A double-blind, randomized comparison of the efficacy and safety of intramuscular injections of olanzapine, lorazepam, or placebo in treating acutely agitated patients diagnosed with bipolar mania. J Clin Psychopharmacol. 2001;21:389–397
  21. Kim JJ, Lim HK, Pae CU, et al. P.3.c.036 Comparison of intramuscular olanzapine and haloperidol for the treatment of delirium. Eur Neuropsychopharmacol. 2008;18(Suppl 4):S424–S425
  22. Cockshott WP, Thompson GT, Howlett LJ, et al. Intramuscular or intralipomatous injection?. N Engl J Med. 1982;307:356–358
  23. Chan VO, Colville J, Persaud T, et al. Intramuscular injections into the buttocks: are they truly intramuscular?. Eur J Radiol. 2006;58:480–484
  24. Fainsinger R, MacEachern T, Miller MJ, et al. The use of hypodermoclysis for rehydration in terminally ill cancer patients. J Pain Symptom Manage. 1994;9:298–302
  25. Bruera E, Brennels C, MacDonald NR. Continuous SC infusion of narcotics for the treatment of cancer pain: an update. Cancer Treat Rep. 1987;71:953–958
  26. Walker P, Watanabe S, Lawlor P, et al. Subcutaneous clodronate: a study evaluating efficacy in hypercalcemia of malignancy and local toxicity. Ann Oncol. 1997;8:915–916
  27. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. text revision 4th ed.. Washington, DC: American Psychiatric Association; 2000;
  28. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198
  29. Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166:1338–1344
  30. Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003;289:2983–2991
  31. National Cancer Institute . Common terminology criteria for adverse events, version 3.0. NIH publication No. 03-5410 Bethesda, MD: National Cancer Institute; 2003;
  32. Prettyman J. Subcutaneous or intramuscular? Confronting a parenteral administration dilemma. Medsurg Nurs. 2005;14:93–98
  33. Alldredge BK. Seizure risk associated with psychotropic drugs: clinical and pharmacokinetic considerations. Neurology. 1999;53(Suppl 2):S68–S85
  34. Alper K, Schwartz KA, Kolts RL, et al. Seizure incidence in psychopharmacological clinical trials: an analysis of Food and Drug Administration (FDA) summary basis of approval reports. Biol Psychiatry. 2007;62:345–354
  35. Etienne L, Wittebole X, Liolios A, et al. Polyuria after olanzapine overdose. [letter] Am J Psychiatry. 2004;161:1130
  36. Morita T, Tei Y, Shishido H, et al. Olanzapine-induced delirium in a terminally ill cancer patient. J Pain Symptom Manage. 2004;28:102–103
  37. Lawlor PG, Watanabe S, Walker P, Bruera E. Re: Memorial Delirium Assessment Scale and commentary. [letter] J Pain Symptom Manage. 1998;5:73–75

PII: S0885-3924(10)00460-4

doi: 10.1016/j.jpainsymman.2010.02.017

Journal of Pain and Symptom Management
Volume 40, Issue 5 , Pages 774-782 , November 2010

Article Tools

* Image Usage & Resolution