Olanzapine and Benzodiazepine Safe in Agitated ED Patients

TOPLINE: 

Rates of cardiorespiratory depression are not significantly different between patients with severe agitation treated with olanzapine alone and those receiving a combination of olanzapine and a benzodiazepine.

METHODOLOGY:

• Researchers assessed 693 patients with severe agitation in an emergency department who received intramuscular or intravenous olanzapine coadministered with either a second parenteral dose of olanzapine (n = 549) or a benzodiazepine (n = 144) within 60 minutes of each other between January 2017 and May 2019.
• The primary outcome was tracheal intubation.
• The secondary outcomes included hypoxemia (oxygen saturation less than 90%), hypotension (systolic blood pressure less than 90 mmHg), and death during hospitalization.

TAKEAWAY:

• No significant difference in tracheal intubation rates was found between the olanzapine-only group and the olanzapine plus benzodiazepine group (3.8% vs 3.5%; difference, 0.3%; 95% CI, −3.0% to 3.7%).
• Respiratory depression was the reason for tracheal intubation in 10 out of 21 patients in the olanzapine-only group and 4 out of 5 patients in the olanzapine plus benzodiazepine group.
• The occurrence rate of hypotension was 9% in both groups.
• Among patients with a detectable alcohol concentration, 3.6% were intubated following two doses of olanzapine, and 6.4% received olanzapine plus a benzodiazepine.

IN PRACTICE:

"Our data suggest that if olanzapine monotherapy is not effective in this instance, rescue therapy with parenteral benzodiazepines is safe even if coadministered within 60 minutes," wrote the authors of the study.

SOURCE:

The study was led by Jon B. Cole, MD, Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota. It was published online on June 15, 2024, in the Annals of Emergency Medicine.

LIMITATIONS: 

The single-center retrospective design was a limitation of the study. The patient population in the two treatment groups may have varied. A potential drug-drug interaction was not fully addressed by the researchers.

DISCLOSURES:

This work did not receive any funding. The authors have stated that no relevant conflicts of interest exist.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.