From the Guidelines
Zyprexa (olanzapine) should not be routinely used to treat delirium in critically ill adults, as the current evidence does not support its effectiveness in reducing delirium duration, mechanical ventilation, ICU length of stay, or mortality. According to the clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU 1, the use of antipsychotics, including atypical antipsychotics like olanzapine, is not recommended for the treatment of delirium due to low-quality evidence.
The guidelines suggest that non-pharmacological interventions should be prioritized, including early mobilization, sleep promotion, orientation protocols, and addressing underlying causes of delirium. If pharmacologic agents are considered, the benefits and risks should be carefully weighed, and the treatment should be individualized based on the patient's specific needs and circumstances.
Some key points to consider when evaluating the use of Zyprexa in ICU delirium include:
- The lack of evidence supporting the use of antipsychotics in reducing delirium duration or improving patient outcomes 1
- The potential risks and side effects associated with antipsychotic use, including metabolic effects, sedation, and increased risk of stroke and mortality in elderly patients
- The importance of addressing underlying causes of delirium and implementing non-pharmacological interventions to promote patient recovery and reduce the risk of long-term cognitive impairment.
In general, the treatment of delirium in critically ill adults should focus on identifying and addressing the underlying causes, promoting patient comfort and safety, and minimizing the use of pharmacologic agents whenever possible.
From the Research
Zyprexa in ICU Delirium
- Zyprexa, also known as olanzapine, is an antipsychotic medication that has been used in the management of delirium in the intensive care unit (ICU) 2.
- However, recent studies suggest that antipsychotics, including olanzapine, may not be effective in preventing or treating delirium in critically ill patients 3, 4.
- In fact, one study found that olanzapine was associated with greater odds of continued delirium and increased hazard of in-hospital mortality 2.
- The Society of Critical Care Medicine (SCCM) guidelines suggest against the routine use of antipsychotics, including olanzapine, for delirium in critically ill adults 3.
- Nonpharmacologic interventions, such as the ABCDEF bundle, are recommended as the cornerstone of delirium management in the ICU 3, 4.
- Other pharmacologic interventions, such as dexmedetomidine, are being investigated as potential treatments for delirium in the ICU 4, 5.
- The use of antipsychotics, including olanzapine, should be approached with caution and carefully considered on a case-by-case basis 2.