
- Mechanism
- Dopamine receptor inhibition
- Serotonin, histamine, a2, norepinephrine receptor inhibition
Drug | Onset (IM) | Onset (IV) |
Olanzapine 5-10 mg | 15-30 min | ?? (1-2 min) |
Ziprasidone 10-20 mg | 15-45 min | — |
- Effects
- Reduces psychotic symptoms
- Minimal EPS due to multi-receptor binding and intrinsic anticholinergic effect
- Adverse Effects
- Less akathisia, QTc prolongation
- Few short-term adverse effects
- Controversies
- Better than first-generation antipsychotics?
- Similar onset of action, less need for benzodiazepine/anticholinergic
- Better than first-generation antipsychotics?
Kishi 2015
- IM olanzapine
- Noninferior/superior to haloperidol
- Less anticholinergic use and less AEs
Miner 2018
- IM olanzapine
- No additional medications needed at 1 hour in > 80% of cases
Klein 2019
- IM olanzapine and IM droperidol
- Less need for rescue sedation compared with haloperidol
- Increased cases of intubation in the olanzapine group
- Controversies
- Intravenous administration of medication labeled for intramuscular use?
Chan 2013
- IV olanzapine + midazolam
- Compared with droperidol + midazolam or midazolam alone
- Olanzapine and droperidol groups comparable for sedation, QTc, AEs
- Less airway AEs than midazolam alone
Martel 2015
- IV olanzapine
- Review of 713 patients who received IV olanzapine
- 0.6% akathisia, 0% dystonia
- 3 patients intubated…but what would have happened with standard of care?