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What Causes Excessive Sleepiness While On Olanzapine?

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Posted on Mon, 16 Nov 2015
Question: Hello sir.if u remember I had consulted u regarding my 20 year old son in XXXXXXX He was diagnosed as drug induced psychosis(marijuana) in January 2015 and was started on olanzapine 5mg to which he responded well.in may 2015 he started sleeping excessively often not getting up till late afternoon.otherwise he was fine.you advised us to reduce the dose of olanzapine to 2.5 mg in XXXXXXX as his increased sleep hours were interfering with his daily routine. So the dose was reduced to 2.5mg after consulting my son's consultant.the sleep pattern improved after some days..rest all remained fine.so till now he has taken olanzapine 5mg for 5 months and then 2.5 mg for 4 months and 15 days..he is completely fine(as it appears to us from his daily behaviour although if we ask him if he has any problem he closes up.)he is now studying well for approximately 10 hours a day.he regularly attends his civil services coaching class 3.5 hours a day with religious punctualityand sincerity.he interacts with all relatives who come to our house with confidence and politeness.he has weekly interaction with his friends however he is more focused towards passing upsc .he reads the newspaper,editorials daily and watches both educative television programs as well as entertainment program of his choice during his off time.He has chosen this path on his own without any pressure from our side and his academic performance in test series is much above our expectations and very promising.he is a happy 20 year old with a goal in life towards which he is working..the main concern for this consult is that we do not want any relapse and that the excellent results achieved should remain.in light of the above mentioned facts please advise how long the treatment has to be continued and when can be safely stopped. is there any chance of relapse after discontinuing therapy..he is off marijuana since last October .Sir do u have record of our previous conversation or do u need me to send u the whole information again.he most probably abused marijuana for approximately 7-8 months in 2014 after he was first exposed to it in university.in October 2014 we shifted him back home.
doctor
Answered by Dr. Dr. Chintan Solanki (1 hour later)
Brief Answer:
medicine should be continued until his exams are over

Detailed Answer:
Dear XXXXXXX

Thanks for contacting me again. Yes I have record of previous communication and I read it again before answering your current query.

You again have narrated history well. It is good that your son is on fine track and going well in his studies. I mentioned in our previous discussion that medicine should be continued for at least 3 months after complete improvement. Here I would like to give you two options if I were his treating doctor.

1. Olanzapine 2.5 mg is very low dose and no significant side effects will be there even if he continues for long. As he is preparing for highly competitive exams and doing well I would not like to disturb (though chances are rare that after stopping the medicines he would have any problem) at all by stopping the medicines though he is completely improved and 3 months have passed. Better to continue until his all exams are over. Later on you can reduce to 2.5 mg half tablet for a month and then stop.

2. Here again I would not like to stop the medicine. But I would suggest taking half tablet of 2.5 mg if he is completely fine since 3 months. He can continue this half tablet until exams are over and then can completely stop the medicine. By chance (I think less than 0.1% chance) if he feels any discomfort for more than 3 days after reducing to half tablet he can again take full tablet.

I would like to stop the medicines in similar cases in general when person is stable by reducing the dose half but I just do not want to take very rare risk in his case as he is preparing for higher studies.

Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dr. Chintan Solanki (3 days later)
Sir thanks for ur valuable consult.I have a few queries.firstly that he is eligible to appear for upsc in 2017 Dec.that's 2years from today.so what should be my approach considering this.but these years are very crucial to his preparation.he however would be giving a dummy attempt next year.is it advisable to continue the meds for this long..do I need to get any investigations done to look for some side effects of the drug..secondly if I taper his dose what kind of problem can occur and u mentioned that if he has any problem for more than three days I should again hike the dose.do u mean that after reducing the dose if he faces any of the old symptoms for more three consecutive days or more than three random days...what is the maximum and minimum time after dose reduction when reversal or aggravation of situation can occur.can failure lead to a relapse although we are very supportive and motivate him and regularly counsel him for any such eventuality
doctor
Answered by Dr. Dr. Chintan Solanki (16 hours later)
Brief Answer:
I think medicine can be stopped gradually

Detailed Answer:
Hi XXXXXXX

Thanks for clarification about his exam timing. Sorry for delayed response.

Olanzapine at 2.5 mg does not cause any significant side effects.

One just needs to measure weight every month and fasting blood sugar every 6 months.

After reduction of dose he may feel discomfort in form sleep disturbance, low mood, fatigue and lack of concentration. Chances of the same are less than 10%. And these symptoms gradually reduce on their own in 2 days. If he feels symptoms for more than 3 days with same potency we can restart the previous dose and can reduce dose later on.

His diagnosis is almost confirmed that it is drug induced psychosis. After stopping the medicines rare chances that he may have any problem.

If I were his treating doctor I would like to reduce dose to half tablet of 2.5 mg after a month. And this dose can be stopped after 2 months. During this reduction I think there will be no problem. I have suggested continuing medicines in first answer as I thought exams are there within 6 months.

However now I feel that there is lot of time and he can adjust very easily without medicines.
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2407 Questions

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What Causes Excessive Sleepiness While On Olanzapine?

Brief Answer: medicine should be continued until his exams are over Detailed Answer: Dear XXXXXXX Thanks for contacting me again. Yes I have record of previous communication and I read it again before answering your current query. You again have narrated history well. It is good that your son is on fine track and going well in his studies. I mentioned in our previous discussion that medicine should be continued for at least 3 months after complete improvement. Here I would like to give you two options if I were his treating doctor. 1. Olanzapine 2.5 mg is very low dose and no significant side effects will be there even if he continues for long. As he is preparing for highly competitive exams and doing well I would not like to disturb (though chances are rare that after stopping the medicines he would have any problem) at all by stopping the medicines though he is completely improved and 3 months have passed. Better to continue until his all exams are over. Later on you can reduce to 2.5 mg half tablet for a month and then stop. 2. Here again I would not like to stop the medicine. But I would suggest taking half tablet of 2.5 mg if he is completely fine since 3 months. He can continue this half tablet until exams are over and then can completely stop the medicine. By chance (I think less than 0.1% chance) if he feels any discomfort for more than 3 days after reducing to half tablet he can again take full tablet. I would like to stop the medicines in similar cases in general when person is stable by reducing the dose half but I just do not want to take very rare risk in his case as he is preparing for higher studies. Hope I have answered your query, I will be happy to help further. Regards, Dr.Chintan Solanki.