Olanzapine is an atypical antipsychotic that is given frequently in the ED for many of the same symptoms that are seen in patients who are experiencing opioid withdrawal, however its use in this toxidrome has never been studied. Widely used in Australasia and therefore a fairly common presentation to the emergency department. This study will be a randomized control trial where patients will be randomized to receive intramuscular olanzapine or oral clonidine as the first intervention given for treatment of opiate withdrawal.

At this time the provider may order the patient to have a peripheral IV placed and IV fluids administered at their discretion. The summed score for the complete scale can be used to help clinicians determine the stage or severity of opiate withdrawal and assess the level of physical dependence on opioids. The summed score for the complete scale can be used to help clinicians determine the stage or severity of opiate withdrawal and assess the level of physical dependence on opioids.

You may gain weight or have high cholesterol and triglycerides (types of fat) while taking olanzapine, especially if you are a teenager.
Olanzapine is a second generation atypical antipsychotic. When these patients are identified, the RA will approach the CITI trained ED provider who will obtain written informed consent. Initial power analysis and sample size calculations delineated that the investigators would need 35 patients per arm to detect a 50% difference in the need for rescue medication at 1 hour between the two study medications.Opiate withdrawal scale score for all patients who received medication by one hourThe Clinical Opiate Withdrawal Scale (COWS) is an 11-item scale, ranging from 0 to 48 (5- 12 = mild; 13-24 = moderate; 25-36 = moderately severe; more than 36 = severe withdrawal).This tool can be used to reproducibly rate common signs and symptoms of opiate withdrawal and monitor these symptoms over time. Patients who present with opioid withdrawal display symptoms such as agitation, anxiety, myalgias, abdominal pain, diarrhea, nausea, and vomiting. At 30 minutes, additional medications or interventions may be prescribed at the discretion of the ED provider for symptom control, including crossover of the study medications. Poisonings - Acute Guidelines for Initial Management Poisonings - Antihistamines / antihistamine-decongestant poisoning Poisonings - Tricyclic antidepressant poisoning Throughout the patient's ED stay, the research associate will be monitoring for adverse complications such as allergic reaction, dystonia, akathisia, respiratory complications, or hypotension.The investigators will conduct preliminary data analysis after the first 25 and 50 patients are enrolled, respectively. Olanzapine is an atypical antipsychotic that is given frequently in the ED for many of the same symptoms that are seen in patients who are experiencing opioid withdrawal, however its use in this toxidrome has never been studied. COVID-19 is an emerging, rapidly evolving situation. Allergies will also be verified by the provider who is completing the consent.Study protocol: If the patient consents to enroll in the study, the research associate will randomize the patient to receive olanzapine or clonidine as the first treatment intervention. : “Blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone.” This refers to pupillary dilation and impaired lens accommodation, delusions, hallucinations or delirium, … Subtle and not-so-subtle toxicity. The medical provider will also obtain information regarding the patients opioid use history (what type of opioid used, chronicity of use, date and time of last use). Home Toxicology Library Toxicants Olanzapine is a second generation atypical antipsychotic. The 11 items on the scale include scores rate the following symptoms: pulse rate, GI upset, sweating, tremor, restlessness, yawning, pupil size, anxiety, bone or joint aches, gooseflesh skin, runny nose. You may need frequent blood tests. The ED provider will then order that medication for the patient and will it be administered by nursing staff. The research associate will record which other medications/interventions were ordered, the indication for these interventions, and times administered.Symptoms will be re-assessed by the research associate using the COWS at 60 minutes, 120 minutes post administration of the initial treatment intervention, as well as at 4 hours post administration (approximately time of discharge from the emergency depatment). Students often learn the adverse effects of anticholinergics from a mnemonic, e.g. Olanzapine like queitiapine has a … This causes an anticholinergic effect (muscarinic receptors) in overdose and drowsiness (histamine receptor blockade).Dr Neil Long BMBS FACEM FRCEM FRCPC.

At these same time marks, sedation of the patient will be assessed using the overt agitation severity scale (OASS).
Loves the misery of alpine climbing and working in austere environments. Allergies to either medication will be screened for in Epic by the research associates. After the study medication administration, patients will be observed for clinical improvement. Funtabulously Frivolous Friday Five 322