Olanzapine with Dehydroepiandrosterone Interaction Details
Brand Names Associated with Olanzapine
- Olanzapine
- Symbyax® (as a combination product containing Fluoxetine, Olanzapine )
- Zyprexa®
- Zyprexa® Zydis
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 03, 2023
Interaction Effect
Reduced effectiveness of olanzapine
Interaction Summary
Dehydroepiandrosterone (DHEA) levels within the normal range of 100 to 400 microgram/deciliter (mcg/dL) are conducive for optimal treatment of patients with psychosis. In case reports, patients have been resistant to antipsychotics when DHEA levels were elevated . Patients being treated with olanzapine should avoid DHEA supplementation.
Severity
Moderate
Onset
Delayed
Evidence
Theoretical
How To Manage Interaction
Avoid concomitant use of dehydroepiandrosterone (DHEA) and olanzapine. If DHEA is elevated, treatment with dexamethasone 1 mg orally per day may be used to normalize DHEA levels.
Mechanism Of Interaction
Elevated dehydroepiandrosterone (DHEA) blood levels may reduce responsiveness to olanzapine
Literature Reports
A) A 24-year-old female diagnosed with schizophrenia was resistant to daily doses of haloperidol 20 milligrams (mg), fluphenazine 40 mg, lithium carbonate 1200 mg, and lithium carbonate 900 mg plus thioridazine 300 mg. The patient appeared Cushinoid with moon face, acne, facial hair, abdominal hair, and a 40 pound weight gain in the previous 8 months. Dehydroepiandrosterone (DHEA) measured as part of an endocrine panel was 725 micrograms/deciliter (mcg/dL) (normal: 100 to 400 mcg/dL). Dexamethasone 1 mg orally at bedtime resulted in substantial improvement within one week. The patient appeared calmer, more alert with improved psychotic symptoms and ability to concentrate. At two weeks, a repeated DHEA level was within normal range (328 mcg/dL). The author concluded that elevated DHEA levels were associated with severe psychosis resistant to conventional antipsychotic therapy .
B) A 13-year-old male decompensated with a subsequent two-year period of emotional problems accompanied by heavy use of LSD, hashish, barbiturates, and alcohol. His mental status included bizarre, disorganized, delusional thinking, auditory and visual hallucinations, paranoia, lack of attention to personal hygiene, agitation, and combativeness. He was diagnosed with chronic paranoid schizophrenia; schizophrenia, chronic undifferentiated type, and schizoaffective disorder, excited type. He was resistant to daily doses of trifluoperazine 40 mg, chlorpromazine 400 mg, and imipramine 100 mg. He was also resistant to combination therapy with chlorpromazine 400 mg with thiothixene 80 mg, thioridazine 1000 mg, perphenazine 48 mg with lithium carbonate 1200 mg, clonazepam 4 mg, and carbamazepine 1200 mg daily. Baseline DHEA level exceeded 900 mcg/dL. A seven-day suppression test with dexamethasone 1 mg orally at bedtime resulted in a normal DHEA level of 200 mcg/dL. By day 5, psychosis improved and the patient was well-oriented, conversational, and was making good eye contact. Once dexamethasone was discontinued, rapid decompensation and florid psychosis ensued despite "substantial amounts of psychotropic medications". DHEA increased to 536 mcg/dL. The author concluded that elevated DHEA levels were associated with florid psychosis resistant to conventional antipsychotic therapy .
Olanzapine Overview
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Olanzapine is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used to treat bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods) in adults and teenagers 13 years of age and older. Olanzapine is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.