Psychiatria polska · 2025
Olanzapine in the treatment of schizophrenia in adolescents - mechanisms of action and therapeutic efficacy.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
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Nowak Wiktoria, Korba Paulina, Kinalska Natalia, Kubik Julia, Lizoń Anna, Krzyściak Wirginia
Аннотация
BACKGROUND: Olanzapine is widely used for schizophrenia and bipolar I disorder, yet its role in adolescents remains debated due to metabolic risks.
OBJECTIVE: To review mechanisms, efficacy, safety, pharmacokinetics, and guideline positions of olanzapine in youth, with comparison to adults.
METHODS: Narrative synthesis of randomized trials, open-label studies, meta-analyses, and major guidelines (APA, NICE, Canadian), with focused appraisal of pediatric data.
RESULTS: Olanzapine's multi-receptor antagonism (D₂, 5-HT₂A/2C, H₁, muscarinic, α₁) underpins robust antipsychotic effects. In adolescents, short-term RCTs show significant improvement in PANSS/BPRS-C and YMRS versus placebo; efficacy is broadly comparable to risperidone and aripiprazole. Pharmacokinetics are similar to adults, though exposure is ~27-34% higher in youth. Adverse effects-especially weight gain, dyslipidemia, hyperprolactinemia, and glycemic abnormalities-are more pronounced in adolescents. Guidelines endorse olanzapine as an option for schizophrenia and as first-line for acute mania; OFC is recommended for bipolar depression by most but not NICE. LAI olanzapine is not approved <18 years.
CONCLUSIONS: Olanzapine is effective in adolescent psychosis and mania but carries substantial metabolic liability. Given no clear efficacy advantage over other SGAs, it is best positioned as a second-line agent in youth, with preference for monotherapy, cautious dosing, and stringent metabolic monitoring. Evidence for benefits on negative and cognitive symptoms in adolescents remains limited.
OBJECTIVE: To review mechanisms, efficacy, safety, pharmacokinetics, and guideline positions of olanzapine in youth, with comparison to adults.
METHODS: Narrative synthesis of randomized trials, open-label studies, meta-analyses, and major guidelines (APA, NICE, Canadian), with focused appraisal of pediatric data.
RESULTS: Olanzapine's multi-receptor antagonism (D₂, 5-HT₂A/2C, H₁, muscarinic, α₁) underpins robust antipsychotic effects. In adolescents, short-term RCTs show significant improvement in PANSS/BPRS-C and YMRS versus placebo; efficacy is broadly comparable to risperidone and aripiprazole. Pharmacokinetics are similar to adults, though exposure is ~27-34% higher in youth. Adverse effects-especially weight gain, dyslipidemia, hyperprolactinemia, and glycemic abnormalities-are more pronounced in adolescents. Guidelines endorse olanzapine as an option for schizophrenia and as first-line for acute mania; OFC is recommended for bipolar depression by most but not NICE. LAI olanzapine is not approved <18 years.
CONCLUSIONS: Olanzapine is effective in adolescent psychosis and mania but carries substantial metabolic liability. Given no clear efficacy advantage over other SGAs, it is best positioned as a second-line agent in youth, with preference for monotherapy, cautious dosing, and stringent metabolic monitoring. Evidence for benefits on negative and cognitive symptoms in adolescents remains limited.