adieuolivaaw - When reading product monographs, such as that for Zyprexa (olanzapine), one has to realize that the drug companies are required to enter all the side effects that occurred to the participants of the clinical trials used to have that drug approved for use by Health Canada (or the FDA in the US), whether the studied drug caused the side effect or not. The chance of contracting tardive dyskinesia (TD) from Zyprexa is very remote. In fact, I am fairly certain that almost all case of TD reported from Zyprexa trials were a result of the Zyprexa unmasking TD that was originally caused by conventional antipsychotic (ie. Mellaril - thioridazine)use prior to the start of the Zyprexa.

The cause of a side effect from a medication is seldom a straight forward affair and many factors must be considered. I like to think of drug monographs as "lawyers documents, written by lawyers for lawyers". I find drug monographs to be of limited use in clinical practice and would much rather use results from evidence-based studies, such as those published by the Cochrane Review Group.

I once read an article a few years ago that explained the potential problems that occur when one reads drug monographs without understanding the context in which they are written. The article used a hypothetical drug monograph for purified water. The monograph listed cardiac arrythmias, convulsions, and death as side effects of water (one can drink too much water causing an electrolyte imbalance that can result in death from cardiac arrest). The article listed several terrible, life-threatening side effects without naming water as being the subject of the monograph. As the authors pointed out, anything used (eg. swallowed, rubbed onto the skin, injected, etc.) to elicit a medicinal effect must be considered a drug. When one increases water consumption when one has a head cold said water can be considered a drug. Increasing fluid intake when one has a cold helps to flush the viruses from the body by increasing urination.

A little knowledge can be a dangerous thing, especially when the information gained from that knowledge in not placed in its proper perspective. Medications need to be respected, not feared. Any information one gives about a medication must have a factual scientific basis and be as accurate as possible, within the current level of our understanding of pharmacology and physiology.

One more thing; drug reps are not allowed to give information on off-label use of medication that they are detailing unless there has been a study published in a peer-reviewed journal relating to the off-label use of the drug. Unless you are able to prove your claims (illegal actions by drug reps; your doctor conducting illegal, unapproved research) you could technically find yourself a defendant in a civil action. Please be careful that what you say is true and not speculation.

Thank you - Cam