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Due to individual variability in response to antipsychotics, it may be prudent to continue the existing regimen if ongoing treatment is deemed necessary during breast-feeding, however, alternate medications for consideration include atypical agents such as olanzapine or quetiapine.

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MAIN RESULTSTwenty trials are includedAttrition from olanzapine versus placebo studies was so greatolanzapine61placebo73by six weeksRR 0.85 CI 07-0.98NNT 8 CI 5-40that interpretation of results is problematicOlanzapine appeared superior to placebo at six weeks for the outcome ofno important clinical responseRR 0.88 CI 0.8-0.98NNT 8 CI 5-27but trial data regarding negative symptoms are equivocal for this comparisonDizziness and dry mouth were more common in the olanzapine-treated groupandalthough not statistically significantthe olanzapine group gained more weightData from several small trials are incompletebutfor the short term outcome ofno important clinical responseolanzapine seem as effective as typical antipsychoticsn=2778RR 0.9 CI 0.76-1.06Brief Psychiatric Rating ScaleBPRSdata tended to be equivocal but Positive and Negative Syndrome ScalePANSSrating of total score and negative and positive symptom sub-scores favoured olanzapineWith high attrition in both groupsolanzapine36typical drug49by 6 weeksn=2738RR 0.85 CI 0.66-1.1olanzapine83typical drug90by 1 yearn=2738RR 0.9 CI 086-1.02the assumptions included in all continuous data are considerableParticipants us online pharmacy medicines. allocated olanzapine experienced fewer extrapyramidal side effects than people given haloperidolWeight change data for the short term are not conclusiven=2455WMD 0.8kg CI0.6-2.2but the three to 12 month results suggest an average gain of four kilogramsn=233WMD 4 CI 0.3-7.8It is difficult to distinguish between olanzapine and other atypical drugsalthough it may cause fewer extrapyramidal side effects than risperidonen=339RR 0.6 CI 0.4-0.9NNH 8 CI 4-29Olanzapine did cause more weight gain than its comparators but current data are not statistically significant3-12 monthsn=535WMD 2.2kg CI0.6-5One studyn=180found no clear differences between olanzapine and clozapine for people with treatment-resistant illness.

AgitationOverallthere was no difference in the incidence of discontinuation due to adverse reactions0.4for intramuscular olanzapine for injection vs 0for placebo

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