Olanzapine plus carbamazepine v. carbamazepine alone in treating manic episodes

Mauricio Tohen, Charles L. Bowden, Anatoly B. Smulevich, Richard Bergstrom, Tonya Quinlan, Olawale Osuntokun, Wei V. Wang, Heather S. Oliff, Ferenc Martenyi, Ludmila A. Kryzhanovskaya, Waldemar Greil

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Background: Combinations of olanzapine and carbamazepine are often used in clinical practice in the management of mania. Aims: To assess the efficacy and safety of olanzapine plus carbamazepine in mixed and manic bipolar episodes. Method: Randomised, double-blind, 6-week trial of olanzapine (10-30 mg/day) plus carbamazepine (400-1200 mg/day; n=58) v. placebo plus carbamazepine (n=60) followed by open-label, 20-week olanzapine (10-30 mg/day) plus carbamazepine (400-1200 mg/day, n=86), with change in manic symptoms as main outcome measure. Safety and pharmacokinetics were also evaluated. Results: There were no significant differences (baseline to endpoint) in efficacy measures between treatment groups, but at 6 weeks triglyceride levels were significantly higher (P=0.008) and potentially clinically significant weight gain (≥7%) occurred more frequently (24.6% v. 3.4%, P=0.002) in the combined olanzapine and carbamazepine group. Carbamazepine reduced olanzapine concentrations but olanzapine had no effect on carbamazepine concentrations. Conclusions: The combination of olanzapine and carbamazepine did not have superior efficacy to carbamazepine alone. The increases in weight and triglycerides observed during combination treatment are a matter of concern. Declaration of interest: Study sponsor: Eli Lilly & Company (employees: M.T., R.B., T.Q., O.O., W.W., F.M. and L.K.). Full declaration in Acknowledgements.

Original languageEnglish (US)
Pages (from-to)135-143
Number of pages9
JournalBritish Journal of Psychiatry
Volume192
Issue number2
DOIs
StatePublished - Feb 2008

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olanzapine
Carbamazepine
Triglycerides
Safety
Practice Management

ASJC Scopus subject areas

  • Neuroscience(all)
  • Psychiatry and Mental health

Cite this

Tohen, M., Bowden, C. L., Smulevich, A. B., Bergstrom, R., Quinlan, T., Osuntokun, O., ... Greil, W. (2008). Olanzapine plus carbamazepine v. carbamazepine alone in treating manic episodes. British Journal of Psychiatry, 192(2), 135-143. https://doi.org/10.1192/bjp.bp.107.041301

Olanzapine plus carbamazepine v. carbamazepine alone in treating manic episodes. / Tohen, Mauricio; Bowden, Charles L.; Smulevich, Anatoly B.; Bergstrom, Richard; Quinlan, Tonya; Osuntokun, Olawale; Wang, Wei V.; Oliff, Heather S.; Martenyi, Ferenc; Kryzhanovskaya, Ludmila A.; Greil, Waldemar.

In: British Journal of Psychiatry, Vol. 192, No. 2, 02.2008, p. 135-143.

Research output: Contribution to journalArticle

Tohen, M, Bowden, CL, Smulevich, AB, Bergstrom, R, Quinlan, T, Osuntokun, O, Wang, WV, Oliff, HS, Martenyi, F, Kryzhanovskaya, LA & Greil, W 2008, 'Olanzapine plus carbamazepine v. carbamazepine alone in treating manic episodes', British Journal of Psychiatry, vol. 192, no. 2, pp. 135-143. https://doi.org/10.1192/bjp.bp.107.041301
Tohen M, Bowden CL, Smulevich AB, Bergstrom R, Quinlan T, Osuntokun O et al. Olanzapine plus carbamazepine v. carbamazepine alone in treating manic episodes. British Journal of Psychiatry. 2008 Feb;192(2):135-143. https://doi.org/10.1192/bjp.bp.107.041301
Tohen, Mauricio ; Bowden, Charles L. ; Smulevich, Anatoly B. ; Bergstrom, Richard ; Quinlan, Tonya ; Osuntokun, Olawale ; Wang, Wei V. ; Oliff, Heather S. ; Martenyi, Ferenc ; Kryzhanovskaya, Ludmila A. ; Greil, Waldemar. / Olanzapine plus carbamazepine v. carbamazepine alone in treating manic episodes. In: British Journal of Psychiatry. 2008 ; Vol. 192, No. 2. pp. 135-143.
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abstract = "Background: Combinations of olanzapine and carbamazepine are often used in clinical practice in the management of mania. Aims: To assess the efficacy and safety of olanzapine plus carbamazepine in mixed and manic bipolar episodes. Method: Randomised, double-blind, 6-week trial of olanzapine (10-30 mg/day) plus carbamazepine (400-1200 mg/day; n=58) v. placebo plus carbamazepine (n=60) followed by open-label, 20-week olanzapine (10-30 mg/day) plus carbamazepine (400-1200 mg/day, n=86), with change in manic symptoms as main outcome measure. Safety and pharmacokinetics were also evaluated. Results: There were no significant differences (baseline to endpoint) in efficacy measures between treatment groups, but at 6 weeks triglyceride levels were significantly higher (P=0.008) and potentially clinically significant weight gain (≥7{\%}) occurred more frequently (24.6{\%} v. 3.4{\%}, P=0.002) in the combined olanzapine and carbamazepine group. Carbamazepine reduced olanzapine concentrations but olanzapine had no effect on carbamazepine concentrations. Conclusions: The combination of olanzapine and carbamazepine did not have superior efficacy to carbamazepine alone. The increases in weight and triglycerides observed during combination treatment are a matter of concern. Declaration of interest: Study sponsor: Eli Lilly & Company (employees: M.T., R.B., T.Q., O.O., W.W., F.M. and L.K.). Full declaration in Acknowledgements.",
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AU - Osuntokun, Olawale

AU - Wang, Wei V.

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