Interactions médicamenteuses

Zyprexa IM et benzodiazepines parentérales

Cardiovascular - Hypotension and Syncope
As with other drugs that have high alpha-1 adrenergic receptor blocking activity, ZYPREXA may induce orthostatic hypotension, tachycardia, dizziness, and sometimes syncope, especially at the initiation of treatment. In a clinical trial database of 2500 patients treated with oral ZYPREXA, syncope was reported in 0.6% (15/2500). The risk of orthostatic hypotension and syncope may be minimized by initiating therapy with 5 mg QD (see Dosage and Administration). A more gradual titration to the target dose should be considered if hypotension occurs.
Hypotension and/or syncope associated with bradycardia has been observed infrequently with ZYPREXA IntraMuscular.
Patients receiving intramuscular olanzapine should be closely observed for hypotension including postural hypotension, bradyarrhythmia and/or hypoventilation, particularly for the first 2 to 4 hours following injection. Patients should remain recumbent if dizzy or drowsy after injection until examination indicates that they are not experiencing hypotension including postural hypotension, bradyarrhythmia and/or hypoventilation.
Caution is necessary in patients who receive intramuscular olanzapine with other drugs having effects that can induce hypotension, bradycardia, respiratory or central nervous system depression. Concomitant administration of intramuscular olanzapine and parenteral benzodiazepine and/or other drugs with CNS depressant activity has been associated with post-marketing reports of serious adverse events, including fatalities and is therefore not recommended. If the patient is considered to need parenteral benzodiazepine treatment, this should not be given until at least one hour after IM olanzapine administration. If the patient has received parenteral benzodiazepine, IM olanzapine administration should only be considered after careful evaluation of clinical status and the patient should be closely monitored for excessive sedation and cardiorespiratory depression.

Conclusions

  • Supériorité du zyprexa IM vs haldol IM en aigu?
  • Arguments économiques du fait que le haldol 5mg IM coute 1,16$ et le zyprexa IM 10mg 13$
  • Ne pouvant pas utiliser de benzodiazépines parentéraux de façon concomitante me semble assez contraignant chez la population à qui on veut utiliser le produit.