Olanzapine in the treatment of hallucinosis in idiopathic parkinson’s disease: a cautionary note
- University of Sheffield, Department of Clinical Neurology, N Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK
- Professor Harvey J Sagar, University of Sheffield, Department of Clinical Neurology, N Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
- Received 27 October 1997
- Revised 7 April 1998
- Accepted 16 April 1998
Abstract
BACKGROUND Hallucinosis is a dopaminergic dose limiting complication of the treatment of idiopathic Parkinson’s disease. Typical neuroleptic medications cannot be used for suppressing hallucinosis because the extrapyramidal side effects worsen parkinsonian motor control. Olanzapine is a novel atypical antipsychotic drug with few reported extrapyramidal side effects which may be more suitable for controlling hallucinosis in these patients.
METHODS Olanzapine was given to five patients with idiopathic Parkinson’s disease and the dosage was titrated until a clinically meaningful reduction in hallucinosis was achieved. The commercially available 5 mg, 7.5 mg and 10 mg tablets were used.
RESULTS After an initial 9 days of treatment, hallucinosis frequency was significantly reduced, an effect which was maintained with continued treatment. However, during this early phase of treatment, parkinsonian motor disability increased, which resulted in two of the patients discontinuing medication.
CONCLUSIONS Olanzapine is effective in the suppression of hallucinosis in patients with idiopathic Parkinson’s disease but the currently available dose increments may result in an unacceptable exacerbation of motor disability.
