The Benefits of Olanzapine in Palliating Symptoms
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Palliative and Supportive Care (MP Davis, Section Editor)
The Benefits of Olanzapine in Palliating Symptoms Mellar P. Davis1,* Gareth J. Sanger2 Address *,1 Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA Email: [email protected] 2 Blizard Institute and National Bowel Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Palliative and Supportive Care Keywords Olanzapine I Nausea I Vomiting I Appetite I Advanced cancer I Substance abuse
Opinion Statement Olanzapine has become a major drug in the management of chemotherapy-induced nausea and vomiting as a prophylactic agent. In addition, a recent randomized trial has demonstrated its benefits in treating nausea and vomiting associated with advanced cancer. The added benefit to olanzapine is that it also stimulates appetite. As a result, since it treats multiple symptoms associated with advanced cancer, it is likely to become the antiemetic of choice in palliative care at least in the USA. The added benefit of treating insomnia and the avoidance of benzodiazepines should place olanzapine in at the top of the list of drugs to use for patients who do complain of insomnia. There is no good evidence that it potentiates the respiratory depression of opioids unlike benzodiazepines. The evidence is weak that olanzapine in as an adjuvant analgesic. Hopefully, future trials will explore this in greater depth. The benefits of adding olanzapine to potent opioids are that it may reduce craving, drug cues, and opioid misuse. Other symptoms like anxiety and depression may be addressed by the addition of olanzapine to standard antidepressants.
Introduction Patients with cancer, particularly with advanced cancer, have a multitude of symptoms which may not be volunteered without asking [1]. These include anorexia, insomnia, nausea, vomiting, pain, constipation, and other symptoms. The prevalence of nausea and
vomiting in advanced cancer ranges from 20 to 30%; 42% of these patients have nausea and/ or vomiting without a known ethology [2, 3]. Patients tend to minimize nausea and vomiting, and physicians may underestimate its presence [3]. Further, these terms are
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sometimes combined in the literature and often in trials and in the minds of treating clinicians but should be assessed separately. Thus, although nausea and vomiting are strongly associated, they are recognized in different areas of the brain and have different sensitivities to different treatments [4•]. In addition, anorexia and weight loss are two of the most common symptoms and signs of advanced cancer which have prognostic importance [5•]. Pain is experienced in 50–60% of patients with advanced cancer. Approximately 15% of patients have problems sleeping or have clinical insomnia [6]. Finally, substance abuse in patients with cancer occurs in a higher preva
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