PostInjection Delirium/Sedation Syndrome in Patie

Authors: Daniel Luedecke Daniel Schöttle Anne Karow Martin Lambert Dieter Naber

Publish Date: 2014/11/26

Volume: 29, Issue: 1, Pages: 41-46

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Abstract

Secondgeneration antipsychotics SGAs are a mainstay in the treatment of patients with schizophrenia However continuity in intake of the prescribed medication has been one of the greatest challenges in these patients One option to improve medication adherence is to prescribe depot or longacting injectable formulations LAIs of antipsychotics Following risperidone several other SGAs have been introduced as LAIs Olanzapine pamoate paliperidone palmitate and aripiprazole are the newgeneration LAIs which are available for 2 to 4week intervals of application in many countries The literature shows a clear advantage of these drugs over placebo regarding symptom reduction and relapse prevention LAIs show a similar safety profile to oral formulations of the relevant drug with the exception of olanzapine pamoate which can lead to rare cases of postinjection delirium/sedation syndrome PDSS PDSS is characterized by heavy sedation possibly including coma and/or delirium after injection During PDSS events patients show higher plasma concentrations of olanzapine leading to the assumption that unintended partial intravascular injection or blood vessel injury during the injection is causative of PDSS Therefore a riskmanagement plan proposing an observation period of 3 h was introduced In August 2013 a new proposal by the European Medicines Agency terminated the requirement to accompany these patients to their next destination although this requirement remains in place according to US FDA recommendationsThere was no funding used to assist with the preparation of the manuscript D Luedecke has no conflicts of interest to declare D Schöttle has received honoraria from Astra Zeneca Otsuka Pharma and Janssen Cilag A Karow has received honoraria from Eli Lilly M Lambert received honoraria from AstraZeneca BristolMyers Squibb Eli Lilly Janssen Cilag Lundbeck Otsuka Pharma Roche Germany and Sanofi Aventis D Naber was a member of an advisory board of Eli Lilly and received honoraria from this company

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