There are very rare reports of development Hyperglycemia and / or decompensation of diabetes mellitus, sometimes accompanied by the development of ketoacidosis or ketoacidotic coma, including there are reports of several fatal cases.In some cases, there was a previous decompensation of weight gain, which could become a predisposing factor. In patients with diabetes mellitus and risk factors for the development of this disease, regular clinical monitoring and monitoring of blood glucose levels are recommended.
When the level of lipids changes, correction of therapy is required.
With a sharp discontinuation of admission olanzapine very rarely (less than 0.01%), the following symptoms may develop: sweating, insomnia, tremor, anxiety, nausea, or vomiting. With the withdrawal of the drug, a gradual dose reduction is recommended. Anticholinergic activity. Since clinical experience with olanzapine in people with concomitant diseases is limited, the drug should be used with caution in patients with prostatic hyperplasia, paralytic intestinal obstruction.
Experience with olanzapine in patients with psychoses in Parkinson's disease caused by dopaminomimetic drugs. Olanzapine It is not recommended for the treatment of psychoses in Parkinson's disease caused by dopaminomimetic treatment. The symptoms of parkinsonism and hallucinations increase. Wherein olanzapine on the effectiveness of psychosis treatment did not exceed the placebo.
Olanzapine is not indicated for the treatment of psychoses and / or behavioral disorders in dementia, due to increased mortality and increased risk of cerebrovascular disorders (stroke, transient ischemic attacks). The increase in mortality does not depend on the dose of olanzapine or the duration of therapy. Risk factors predisposing to increased mortality include: age over 65 years, dysphagia, sedation, malnutrition and dehydration, lung diseases (eg, pneumonia, including aspiration), simultaneous reception of benzodiazepines. However, the increased incidence of death in olanzapine compared with placebo did not depend on these risk factors.
With antipsychotic therapy, the improvement in the clinical state of the patient occurs in the period from several days to several weeks. During this period, the patient needs careful observation.
Dysfunction of the liver. At the beginning of therapy, an asymptomatic increase in liver transaminases (ALT and ACT) is possible. In patients with initially elevated levels of ACT and / or ALT, with hepatic insufficiency and conditions,potentially limiting the functionality of the liver, as well as those taking hepatotoxic drugs, caution should be exercised in prescribing olanzapine. When ALT and / or ACT are increased against the background of drug therapy, it is recommended that medical supervision of the patient and, possibly, a reduction in the dose of the drug be recommended. When diagnosing hepatitis (including hepatocellular, cholestatic or mixed) olanzapine necessary cancel.
Hematologic changes. The drug should be used with caution in patients with leukopenia and / or neutropenia any genesis, myelosuppression drug origin, as well as the background radiation or chemotherapy, due to concomitant diseases in patients with myeloproliferative or hypereosinophilic states of diseases. Neutropenia has often been noted with the simultaneous use of olanzapine and valproic acid (see the "Side effect" section).
Malignant neuroleptic syndrome (CNS). ZNS is a potentially life-threatening condition associated with antipsychotic medication (neuroleptics), incl. olanzapine.Clinical manifestations of ZNS: fever, rigidity of muscles, impaired consciousness, vegetative disorders (unstable pulse or labile blood pressure, tachycardia, increased sweating, arrhythmias). Additional symptoms of CNS: elevation of CK, myoglobinuria (against rhabdomyolysis) and acute renal failure. With the development of symptoms of the ZNS, as well as an increase in body temperature for no apparent reason, it is necessary to cancel all neuroleptics, including. olanzapine.
Convulsive Syndrome. Olanzapine should be cautiously prescribed to patients with a history of seizures or the presence of factors that reduce the threshold of convulsive readiness. On the background of taking olanzapine, seizures were rarely recorded.
Late dyskinesia. The therapy with olanzapine was accompanied by a significantly lower incidence of late dyskinesia, in comparison with haloperidol. The risk of developing tardive dyskinesia increases with increasing duration of treatment. When there are signs of this condition in the patient receiving olanzapine, you should cancel the drug or reduce its dose. Symptoms of dyskinesia may temporarily increase after the drug is discontinued.
Total activity against the central nervous system. Care should be taken when using other drugs of central action and alcohol.
Cerebrovascular adverse events, including stroke in elderly patients with dementia. In elderly people, postural arterial hypotension is not often observed. Patients over 65 years of age are advised to periodically monitor blood pressure (BP). Olanzapine should be administered with caution to patients with an established increase in the QTc interval, especially the elderly, with a congenital syndrome of prolonged QT interval, congestive heart failure, myocardial hypertrophy, hypokalemia, and hypomagnesemia.
When taking olanzapine very rarely (less than 0.01%) recorded cases of venous thromboembolism. The causal relationship between olanzapine therapy and vein thrombosis has not been established. Since patients with schizophrenia often have acquired risk factors for venous thrombosis, all possible other factors (eg, immobilization) should be identified and preventive measures taken. Zalasta® tablets contain lactose. The drug should not be taken to patients with rare hereditary problems of galactose intolerance,deficiency of lactase Lappa or impaired absorption of glucose-galactose.