Olanzapine for Sedation of Agitated Patients in the Emergency Department

Olanzapine (Zyprexa) is a second-generation antipsychotic that blocks D₂ dopamine receptors and others. It is FDA approved for intramuscular (IM) use only, but anecdotal information suggests increasing intravenous (IV) use for agitated emergency department (ED) patients, especially in light of the droperidol black box warning and shortage. To evaluate its safety and efficacy, investigators reviewed medical records for 784 patients who received parenteral olanzapine at a single ED.

Of the 295 patients who received IV olanzapine, most (79%) received a 5-mg initial dose, and of the 489 patients who received IM olanzapine, most (93%) received 10 mg. Adverse effects were infrequent after both IV and IM administration, with rates of respiratory su…