Salveo ODT Overdosage

Very common symptoms reported for olanzapine overdose include tachycardia, agitation/aggressiveness, dysarthria, various extrapyramidal symptoms and reduced level of consciousness ranging from sedation to coma. Other significant symptoms of overdose include delirium, convulsion, possible NMS, respiratory depression/arrest, aspiration, hypertension or hypotension, cardiac arrhythmias (e.g., supraventricular tachycardia), and cardiopulmonary arrest. Fatal outcomes have been reported for acute overdoses as low as 450 mg of olanzapine administered orally. However, survival has also been reported following acute overdose of 2,000 mg.
Induction of emesis is not recommended. Standard procedures for the management of overdose may be given. The possibility of multiple drug involvement should also be considered.
During acute overdose, airway should be established and maintained. Adequate oxygenation and ventilation, which may include intubation, should also be ensured. The use of activated charcoal for overdose should be considered because concomitant use of activated charcoal was shown to reduce the oral bioavailability of olanzapine by 50% to 60%. In patients who are not fully conscious or who have impaired gag reflex, consideration should be given to administering activated charcoal via a nasogastric tube, once the airway is protected. Olanzapine is not substantially removed by hemodialysis.
There is no specific antidote to olanzapine overdosage. Thus, symptomatic treatment and monitoring of vital organ function should be done according to clinical presentation, including treatment of hypotension and circulatory collapse, and support of respiratory function. Appropriate measures such as Trendelenburg's position, intravenous fluids and/or sympathomimetic agents (e.g., norepinephrine, phenylephrine) should be given to treat hypotension and circulatory collapse. Epinephrine, dopamine or other sympathomimetic agents with beta-agonist activity should not be used since beta stimulation may worsen hypotension in the setting of α-blockade induced by olanzapine, Tachycardia associated with olanzapine overdose does not usually require specific therapy. Cardiovascular monitoring should be considered to detect possible atrial and ventricular arrhythmias and conduction disturbances. Sodium bicarbonate may be helpful in the presence of QRS interval prolongation. Benzodiazepines followed by barbiturates may be used in the initial treatment of seizures after olanzapine overdosage, if necessary. Acute extrapyramidal reactions should be treated with anticholinergic drugs (e.g., diphenhydramine, benztropine).
Toxic effects from intoxication with atypical antipsychotics are usually resolved within 12 to 48 hours following acute overdosage, although it has taken up to six days in some cases. Close medical supervision and monitoring should continue until the patient recovers.