Complications From Olanzapine in a Mentally Healthy Patient
Mr. A, a 36-year-old man with chronic seasonal allergies, was given a prescription for cetirizine, 10 mg b.i.d., to be taken on an as-needed basis for his allergy symptoms. As the result of a retail pharmacy error, he received olanzapine at the same dosage. He took olanzapine for 2 years, refilling the prescription automatically outside his primary pharmacy. He had no preexisting illnesses other than seasonal allergies and sickle cell trait. He had no history of mental illness.During treatment, Mr. A’s weight increased 45 lb. Associated with this weight gain, he developed hyperlipidemia, hypertension, and sleep apnea, requiring treatment. His total cholesterol level increased from 258 to 274 mg/dl, and his triglyceride level increased from 87 to 152 mg/dl, requiring treatment with simvastatin, 10 mg/day. His diastolic blood pressure increased from 79 to 98 mm Hg requiring treatment with combination irbesartan/hydrochlorothiazide at 150 mg/day and 12.5 mg/day, respectively, and amlodipine, 10 mg/day. A formal sleep study revealed severe obstructive sleep apnea requiring treatment with continuous positive airway pressure.The error was discovered 2 years later when Mr. A’s primary care provider declined to write a prescription for his “allergy” medication, at which time the olanzapine was stopped.
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