Psychopharmacology and Psychiatry Updates Pushing the Boundaries: Exploring High-Dose Antipsychotics
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Dec 27, 2024 
Oliver Freudenreich, a Boston-based psychiatrist and expert at the Psychopharmacology Institute, dives into the intriguing world of high-dose olanzapine as a potential alternative for treatment-resistant schizophrenia. The conversation highlights the challenges and risks associated with doses exceeding FDA limits. Oliver compares high-dose olanzapine to clozapine, discussing its efficacy based on a systematic review of various studies. They stress the necessity for patient-centered care, emphasizing informed discussions about long-term side effects like metabolism and weight gain.
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Olanzapine Dose-Response Unclear
- Olanzapine's FDA-approved max dose of 20 mg may not be the peak of its effectiveness.
- The dose-response curve for olanzapine is unclear, suggesting potential benefits at higher doses.
High-Dose Olanzapine vs Clozapine
- Some trials show high-dose olanzapine is not inferior to clozapine for treatment-resistant schizophrenia.
- However, evidence is weak and clozapine remains the gold standard.
Use High-Dose Olanzapine Carefully
- Consider a high-dose olanzapine trial in patients who reject clozapine or cannot be monitored.
- Watch for and proactively manage olanzapine's serious metabolic side effects regardless of dose.