{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:57:20Z","timestamp":1792112240038,"version":"4.4.0"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2015,12,31]],"date-time":"2015-12-31T00:00:00Z","timestamp":1451520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Olanzapine is an atypical antipsychotic with similar pharmacologic properties to droperidol. Due to the current droperidol shortage, the authors\u2019 clinical practice has been to substitute olanzapine for droperidol in many situations. At this time, olanzapine is U.S. Food and Drug Administration approved for oral and intramuscular (<jats:styled-content style=\"fixed-case\">IM<\/jats:styled-content>) use only, but due to its increased utility, intravenous (<jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>) olanzapine was recently approved for use in the study emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The authors sought to review the use and safety of <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> olanzapine in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> patient population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective review of consecutive patients receiving <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> olanzapine between January 1, 2014, and July 1, 2014, was conducted. Data were collected via an electronic medical record review. The study was deemed exempt from informed consent by our institutional review board.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 713 patients received <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> olanzapine during the study period. The median age was 38 years (range\u00a0= 18 to 85 years), and 313 patients were male (43.9%). Primary indications for <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> olanzapine administration included acute agitation (<jats:italic>n\u00a0=<\/jats:italic>\u00a0245, 34.4%), abdominal pain (<jats:italic>n\u00a0=<\/jats:italic>\u00a0165, 23.1%), headache (<jats:italic>n\u00a0=<\/jats:italic>\u00a0121, 17.0%), nausea and vomiting (<jats:italic>n\u00a0=<\/jats:italic>\u00a0107, 15.0%), pain (other; <jats:italic>n\u00a0=<\/jats:italic>\u00a060, 8.4%), and unknown (<jats:italic>n\u00a0=<\/jats:italic>\u00a015, 2.1%). <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> dosing varied: 1.25 mg (<jats:italic>n\u00a0=<\/jats:italic>\u00a020, 2.8%), 2.5 mg (<jats:italic>n\u00a0=<\/jats:italic>\u00a0185, 25.9%), 5 mg (<jats:italic>n\u00a0=<\/jats:italic>\u00a0507, 71.1%), and 10 mg (<jats:italic>n\u00a0=<\/jats:italic>\u00a01, 0.1%). Forty\u2010nine patients required a second dose of olanzapine (22 <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>, 26 <jats:styled-content style=\"fixed-case\">IM<\/jats:styled-content>, one oral). The maximum total dose of olanzapine was 20 mg. Ninety\u2010eight patients required a total of 146 doses of additional sedatives during their <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> course. Other sedative medications included ketamine (<jats:italic>n\u00a0=<\/jats:italic>\u00a017, 2.4%), haloperidol (<jats:italic>n\u00a0=<\/jats:italic>\u00a048, 6.7%), and benzodiazepines (<jats:italic>n\u00a0=<\/jats:italic>\u00a081, 11.4%). Hypoxia was noted in 74 patients (10.4%). Major respiratory complications, including airway stimulation or repositioning maneuvers and intubation, occurred in 15 patients (2.1%). After consensus review, one intubation was classified as \u201clikely related\u201d to olanzapine administration, and two were classified as \u201cpossibly related\u201d to olanzapine. Akathisia likely occurred in four patients (0.6%), and no allergic reactions were identified. Electrocardiograms (<jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>s) were performed in 322 patients. A total of 251 patients had an <jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content> performed before olanzapine administration (median <jats:styled-content style=\"fixed-case\">QT<\/jats:styled-content>c\u00a0= 404 ms), and 88 patients had an <jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content> performed after olanzapine administration (median <jats:styled-content style=\"fixed-case\">QT<\/jats:styled-content>c\u00a0= 415 ms). Acute alcohol and drug intoxication was common, 118 (16.5%) patients were positive for ethanol, and seven of 23 drug screens were positive for sympathomimetics. Thirty\u2010four of 284 admissions (4.5%) were to intermediate or intensive care unit beds. No patients died while in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> and no cases of sudden cardiac death were noted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this large retrospective review, <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> olanzapine appears to be a safe in the management of a variety of <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> indications. Hypoxia was common, but serious airway compromise was rare.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.12842","type":"journal-article","created":{"date-parts":[[2015,12,31]],"date-time":"2015-12-31T15:52:46Z","timestamp":1451577166000},"page":"29-35","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["A Large Retrospective Cohort of Patients Receiving Intravenous Olanzapine in the Emergency Department"],"prefix":"10.1111","volume":"23","author":[{"given":"Marc L.","family":"Martel","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Hennepin County Medical Center Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren R.","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Hennepin County Medical Center Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Rivard","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Hennepin County Medical Center Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon B.","family":"Cole","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Hennepin County Medical Center Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,12,31]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"1003","volume-title":"Goldfrank's Toxicologic Emergencies","author":"Juurlink DN.","year":"2011"},{"key":"e_1_2_7_3_1","unstructured":"Eli Lilly and Company.Package insert olanzapine. 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