Olanzapine- and Clozapine-induced Stuttering

Drug-induced stuttering has been described in association with several drugs, in particular antidepressants and low-potency neuroleptics. Here we describe a case series of stuttering induced by the atypical neuroleptics olanzapine and clozapine.

Patients receiving neuroleptic treatment were carefully screened for stuttering as a possible side effect. We have studied all patients in the outpatient department (800 per year) as well as most inpatients (1300 per year) within 3 years.

Seven cases of drug-induced stuttering were observed. Six patients suffered from stuttering in association with olanzapine treatment, and one received clozapine. Stuttering arose on average 2-21 days after initiation of treatment and ceased 2-5 days after discontinuation. Most patients suffered from additional diseases, such as brain pathology due to cortical atrophy or celiac disease, or received concomitant medication (i. e. intrathecal morphine pump).

Our case series suggests that the atypical neuroleptic olanzapine can induce stuttering in the absence of a history of stuttering without accompanying akathisia or general decline of function. It appears that preexisting brain pathology or concomitant antidepressant medication might predispose some patients to this side effect.

References

• 1 Bhana N, Foster R H, Olney R, Plosker G L. Olanzapine: an updated review of its use in the management of schizophrenia.  Drugs. 2001;  61 111-161
• 2 Brady J P. Drug-induced stuttering: a review of the literature.  J Clin Psychopharmacol. 1998;  18 50-54
• 3 Burns D, Brady J P, Kuruvilla K. The acute effect of haloperidol and apomorphine on the severity of stuttering.  Biol Psychiat. 1978;  13 255-264
• 4 Burns M J. The pharmacology and toxicology of atypical antipsychotic agents.  J Toxicol Clin Toxicol. 2001;  39 1-14
• 5 Ebeling T A, Compton A D, Albright D W. Clozapine-induced stuttering.  Am J Psychiat. 1997;  154 1473
• 6 Eschweiler G W, Bartels M, Langle G, Wild B, Gaertner I, Nickola M. Heart-rate variability (HRV) in the ECG trace of routine EEGs: fast monitoring for the anticholinergic effects of clozapine and olanzapine?.  Pharmacopsychiatry. 2002;  35(3) 96-100
• 7 Friedman E H. Fluoxetine and stuttering.  J Clin Psychiat. 1990;  51 310-311
• 8 Gaile S, Noviasky J A. Speech disturbance and marked decrease in function seen in several older patients on olanzapine.  J Am Geriat Soc. 1998;  46 1330-1331
• 9 Horacek J. Novel antipsychotics and extrapyramidal side effects. Theory and reality.  Pharmacopsychiatry. 2000;  33 24-42
• 10 Kent R D. Research on speech motor control and its disorders: a review and prospective.  J Commun Disord. 2000;  33 391-427
• 11 Lee H J, Lee H S, Kim L, Lee M S, Suh K Y, Kwak D I. A case of risperidone-induced stuttering.  J Clin Psychopharmacol. 2001;  21 115-116
• 12 Maguire G A, Riley G D, Franklin D L, Gottschalk L A. Risperidone for the treatment of stuttering.  J Clin Psychopharmacol. 2000;  20 479-482
• 13 Marsalek M. Tardive drug-induced extrapyramidal syndromes. Pharmacopsychiatry 2000: 14-33
• 14 Menkes D B, Ungvari G S. Adult-onset stuttering as a presenting feature of schizophrenia: restoration of fluency with trifluoperazine.  J Nerv Ment Dis. 1993;  181 64-65
• 15 Thomas P, Lalaux N, Vaiva G, Goudemand M. Dose-dependent stuttering and dystonia in a patient taking clozapine.  Am J Psychiat. 1994;  151 1096