Professional Documents
Culture Documents
OPEN ACCESS
270 J.-M. Batail et al. / Open Journal of Psychiatry 2 (2012) 269-271
receptor occupancy ranges from 50% to 90% [3,17,18]. [8] Kumra, S., Kranzler, H., Gerbino-Rosen, G., Kester, H.M.,
At these doses, the relationship between dopamine D2 De Thomas, C., Kafantaris, V., Correll, C.U. and Kane,
J.M. (2008) Clozapine and high dose olanzapine in re-
occupancy and both dose and plasma level seems to be
fractory early-onset schizophrenia: A 12-week random-
represented by a hyperbolic saturation curve [3]. The ized and double-blind comparison. Biological Psychiatry,
psychopharmacological mechanism of the therapeutic 63, 524-529. doi:10.1016/j.biopsych.2007.04.043
response at very high doses remains unclear. Are other [9] Meltzer, H., Bobo, W., Roy, A., Jayathilake, K., Chen, Y.,
cerebral targets saturated at such high doses? Are recep- Ertugrul, A., Anil Yagcioglu, A.E. and Small, J.G. (2008)
tors other than dopamine D2/D3 involved? A randomized, double-blind comparison of clozapine and
In conclusion, very-high-dose olanzapine seems to be high dose olanzapine in treatment-resistant patients with
a good alternative in treatment-resistant schizophrenia. schizophrenia. The Journal of Clinical Psychiatry, 69, 274-
Its use at such high doses needs to be closely monitored, 285. doi:10.4088/JCP.v69n0214
due to poor data on its clinical and biological tolerance. [10] Baldacchino, A.M., Stubbs, J.H. and Nevison-Andrews,
Most studies suggest that the dose range is correlated D. (1998) The use of olanzapine in non-compliant or
treatment-resistant clozapine populations in hospital. Phar-
with improvements in organization (lower doses) and maceutical Journal, 260, 207-209.
positive symptoms (higher doses). Nevertheless, more
[11] Dursun, S., Gardner, D., Bird, D. and Flinn, J. (1999) Olan-
data are needed to confirm its relative efficacy at higher
zapine for patients with treatment-resistant schizophrenia:
doses for different symptom dimensions, compared with A naturalistic case-series outcome study. Canadian Jour-
clozapine, in treatment-resistant schizophrenia. This could nal of Psychiatry, 44, 701-704.
be achieved by conducting randomized double-blind trials [12] Martin, J., Gomez, J.C., Garcia-Bernardo, E., Cuesta, M.,
with larger samples of participants. Furthermore, clinical Alvarez, E. and Gurpegui, M. (Spanish Group for the
data need to be correlated with imaging data in order to Study of Olanzapine in Treatment-Refractory Schizophre-
investigate a potential correlation between clinical im- nia Spain) (1997) Olanzapine in treatment-refractory
provement and the D2/D3 occupancy profile at such very schizophrenia: Results of an open label study. Journal of
high doses. Clinical Psychiatry, 58, 479-483.
doi:10.4088/JCP.v58n1103
[13] Rodriguez-Perez, V., Lopez, A., Blanco, C., Pena, C.,
REFERENCES Lopez, A., Gomez, Y., Ferreiro, M.J., Rego, C., Lopez,
A., Cudeiro, F., Alvarez, V., Prieto, R. and Ciudad, A.
[1] Bitter, I., Dossenbach, M., Brook, S., Feldman, P.D., (2002) Olanzapine for the treatment of chronic refractory
Metcalfe, S., Gagiano, C.A., Fredi, J., Bartko, G., Janka, schizophrenia: A 12-month follow-up naturalistic study.
Z., Banki, C.M., Kovacs, G. and Breier, A. (2004) Olan- Progress in Neuropsycholopharmacology and Biological
zapine versus clozapine in treatment-resistant or treatment- Psychiatry, 26, 1055-1062.
intolerant schizophrenia. Progress in Neuropsycholophar-
[14] Perry, P.J., Lund, B.C., Sanger, T. and Beasley, C. (2001)
macology and Biological Psychiatry, 28, 173-180.
Olanzapine plasma concentrations and clinical response:
[2] Mcilwain, M., Harrison, J., Wheeler, A.J. and Russell, B. Acute phase results of the North American Olanzapine
R. (2011) Pharmacotherapy for treatment-resistant schizo- Trial. Journal of Clinical Psychopharmacology, 21, 14-
phrenia. Neuropsychiatric Disease and Treatment, 7, 135- 20. doi:10.1097/00004714-200102000-00004
149.
[15] Mauri, M.C., et al. (2005) Clinical outcome and olanzap-
[3] Kapur, S., Zipursky, R.B., Remington, G., Jones, C., Da- ine plasma levels in acute schizophrenia. European Psy-
Silva, J., Wilson, A.A. and Houle, S. (1998) 5-HT2 and D2 chiatry, 20, 55-60. doi:10.1016/j.eurpsy.2004.09.009
receptor occupancy of olanzapine in schizophrenia: A
[16] Lane, H.-Y., et al. (2002) Effects of olanzapine plasma
PET investigation. American Journal of Psychiatry, 155,
concentrations on depressive symptoms in schizophrenia:
921-928. A pilot study. Journal of Clinical Psychopharmacology,
[4] Callaghan, J.T., Bergstrom, R., Ptak, L.R., and Beasley, 22, 530-532. doi:10.1097/00004714-200210000-00019
C.M. (1999) Olanzapine: Pharmacokinetic and pharmacody- [17] Raedler, T.J., Knable, M.B., Lafargue, T., Urbina, R.A.,
namic profile. Clinical Pharmacokinetics, 37, 177-193. Egan, M.F., Pickar, D. and Weinberger, D.R. (1999) In
doi:10.2165/00003088-199937030-00001 vivo determination of striatal dopamine D2 receptor oc-
[5] Sheitman, B., Lindgren, C., Early, J. and Sved, M. (1997) cupancy in patients treated with olanzapine. Psychiatry
High-dose olanzapine for treatment-refractory schizophre- Research: Neuroimaging Section, 90, 81-90.
nia. American Journal of Psychiatry, 154, 1626. doi:10.1016/S0925-4927(99)00010-4
[6] Quadri, S.F., Padala, P.R., Strunk, J.C. and Boust, S.J. [18] Moresco, R.M., Cavallaro, R., Messa, C., Bravi, D., Gob-
(2006) High-dose olanzapine orally disintegrating tablets bo, C., Galli, L., Lucignani, G., Colombo, C., Rizzo, G.,
for treatment-resistant psychosis. The Journal of Clinical Velona, I., Smeraldi, E. and Fazio, F. (2004) Cerebral D2
Psychiatry, 8, 244-245. and 5-HT2 receptor occupancy in schizophrenic patients
treated with olanzapine or clozapine. Journal of Psycho-
[7] Reich, J. (1999) Use of high-dose olanzapine in refrac-
pharmacology, 18, 355-365.
tory psychosis. American Journal of Psychiatry, 156,
661.