DEPARTMENT OF:-

Clinical pharmacy

ASSIGNMENT ONE ON:-

Drug informatics

ASSIGNMENT TITLE:-
DI Consult on olanzapine

Submitted by:-

Sintayehu DEMISSEW
ID-NO
1011/07
SUBMITTED TO:-
ABEBE ZELEKE (BSC)

DATE: - 25/SEP/2018
 The use of olanzapine for the management of anorexia nervosa
Is olanzapine used for the management of anorexia nervosa?
Anorexia nervosa is a psychiatric disorder characterized by an unrealistic fear of weight
gain, self- starvation. And conspicuous distortion of body image. The individual is obsessed with
becoming increasingly thinner and limits food intake to the point where health is compromised.
The disorder may be fatal. It is relatively common among young women. While the overall
incidence rate remained stable over the past decades, there has been an increase in the high risk-
group of 15-19 year old girls. Anorexia nervosa is estimated to occur in 0.9% to 4.3% of women
and 0.2% to 0.3% of men in western countries at some point in their life. About 0.4% of young
females are affected in a given year and it is estimated to occur three to ten times less commonly
in males. Rates in most of the developing world are unclear; often it begins during the teen years
or young adulthood.
Olanzapine (originally branded zyprexa) is an antipsychotic medication used to treat schizophrenia
and bipolar disorder. It is usually classed with the typical antipsychotics. The newer generation of
antipsychotics. Olanzapine is believed to work by antagonizing the dopamine D2 receptor and
antagonizes the 5-HT2A receptor. The first line psychiatric treatment for schizophrenia is
antipsychotic medication; olanzapine is one such medication. Olanzapine appears to be effective
in reducing symptoms of schizophrenia, treating acute exacerbations, and treating early-onset
schizophrenia and also effective and safe in controlling symptoms as well as stimulate appetite
and weight gain in gastro parses.
The general principles of treatment of eating disorders are to take an interdisciplinary approach.
Behavior therapy (BT), cognitive analytic therapy(CAT), cognitive behavior therapy(CBT)(it is a
standard treatment of anorexia nervosa), interpersonal psychotherapy(IPT), family therapy and
family innervations , psychodynamic psychotherapy and pharmacological treatment (anti-
psychotic, anti-depressant, anti-emetic) but none of the medicines available have been shown to
be very effective on their own in the treatment of anorexia nervosa. The APA guidelines state that
psychotropic medications should not be used as the sole or primary treatment for anorexia nervosa,
but they can be considered for the prevention of relapse in weight restored patients or to treat
depression or obsessive compulsive disorder. Family-based treatment (FBT) has been shown to be
more successful than individual therapy for adolescents with anorexia nervosa, cognitive-
behavioral therapy (CBT) is a psycho-social intervention that aims to improve mental health. CBT
focuses on challenging and changing unhelpful cognitive distortions (e.g. thoughts, beliefs, and
attitudes) and behaviors, improving emotional regulation, and the development of personal coping
strategies that target solving current problems but pharmacological treatment associated with an
increase in appetite can be a normal physiological response that occurs, for example, in children
and adolescents during periods of growth or following strenuous activity or excessive caloric
demand. In some cases, an increase in appetite can be a sign of an abnormal condition, such as
some endocrinology conditions, including diabetes, hyperthyroidism, and graves’ disease.
Increased appetite may also be seen in certain emotional or psychiatric conditions, as well as a
response to stress, anxiety, or depression. Episodes of hypoglycemia can cause excessive hunger
as well. Certain prescription drugs can also increase appetite. It is important to take in to account
the context and any related emotional or physical factors when determining whether one has an
abnormally increased appetite. Polyphagia is the medical term for excessive eating and also
associate with weight gain can result from an increase in body fluid, muscle mass, or fat. An
increase in body fluid can come from medications, fluid and salt retention, intravenous fluid
infusion, kidney or heart failure.
The review team conducted a new systematic search for RCTS of outpatient psychological
treatments used for the initiation of treatment during the first or later episodes of anorexia nervosa.
Eleven small RCTS were identified providing data on 459 participants ranging in age from
adolescents to young adults. Olanzapine does will be in keeping with the investigators current
clinical practice, with flex doses ranging from 1.25mg to 10.0mg daily(the majority of patients are
treated with 2.5mg or 5.0mg at bedtime); does adjustments made based on individual need and
tolerability. Participants will remain in the study for 12 weeks; those who initially decline
olanzapine treatment may change their minds and take olanzapine up until week 9 of the trial. The
investigators hypothesize that olanzapine will be effective and safe in controlling symptoms as
well as stimulate appetite and weight gain in gastro paresis. The investigators also hypothesize that
olanzapine will stimulate gastric motility; finally, the investigators hypothesize that olanzapine
will modulate the secretion of ghrelin in gastro paresis. This pilot study may provide further
information on the efficacy and safety of olanzapine in gastro paresis which could be utilized in a
larger randomized, prospective study in the future. Ghrelin is a hormone produced by the gut that
stimulates appetite and has also been shown to have beneficial effect on gastro paresis. Anorexia
nervosa (AN) is a disorder of unknown etiology that predominantly occurs in women as specified
in the 4th ed. Of the diagnostic and statically manual of mental disorders (DSM-IV; American
Psychiatric Association, 1994). This illness is characterized by restricted eating, the relentless
pursuit of thinness, and obsessive fears of being fat.
Summary; anorexia nervosa is an eating disorder characterized by the inability to maintain a
minimally normal weight, a devastating fear of weight gain, relentless dietary habits that prevent
weight gain, and a disturbance in the way in which body weight and shape are perceived the
individual is obsessed with becoming increasingly thinner and limits food intake to the point where
health is compromised as a result the general principles of treatment of eating disorders are to take
an interdisciplinary approach which combine staff and more focus on psychotherapy like; behavior
therapy (BT) , cognitive analytic therapy(CAT), cognitive behavior therapy(CBT) (it is a standard
treatment of anorexia nervosa), interpersonal psychotherapy(IPT), family therapy and family
innervations , psychodynamic psychotherapy and pharmacological treatment. Certain prescription
drugs can also increase appetite; it is believed to work by antagonizing the dopamine D2 receptor
and antagonizes the 5-HT2A receptor. Olanzapine is a safe and efficient drug for prevention of
CINV. But in most episodes can cause excessive hunger as well as hypoglycemia and also increase
weight and lead to metabolic disorder.
Reference
1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders
(4th ed.). Washington, DC:
Author.
2. Bissada H, Tasca GA, Barber AM, Bradwejn J:Olnzapine in the treatment of low body weight and
obsessive thinking in women with anorexia nervosa: a randomized, double-blind, placebo-
controlled trial. Am J Psychiatry. 2008; 165:1281-8.
3. Jump up to : a b c Drugs.com international listings for Olanzapine page accessed August 4,2015
4. Son GE, et al, Time trends in the incidence of eating disorders; a primary care study in the
Netherlands. Int J Eat Disord. 2006;39(7):565-9.doi:10.1002/eat.20316.[Pub Med] [Cross Ref]