Recurrent Hyperammonemia Associated With Olanzapine

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To the Editors
Olanzapine is a commonly prescribed antipsychotic, which has Food and Drug Administration–approved labeling for the treatment of acute manic episodes of bipolar disorder and schizophrenia.1,2 Common adverse effects include somnolence, dizziness, weight gain, transient and asymptomatic elevation of hepatic transaminase levels, constipation, and postural hypotension.3 Hyperammonemia is a rare but dangerous adverse event that can lead to impaired consciousness, lethargy, coma, and death.4 Common early symptoms include appetite loss, nausea, insomnia, agitation, and personality changes.5 Medications associated with hyperammonemia include either valproic acid only6 or combined with aripiprazole,7 risperidone,8 and quetiapine.9 We could not find other reports of olanzapine-related hyperammonemia. We report a case of hyperammonemia consisting of agitation and aggressiveness associated with the use of olanzapine.
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