Treatment of glossodynia with olanzapine

The authors present a case of a 73-year-old white male with a 6-month history of glossodynia, unresponsive to clotrimazole troches, cevimeline, triamcinolone dental paste, paroxetine, and lorazepam. The patient had restriction of social activities because of the pain. Because of the presence of dysphoria and anticipatory anxiety secondary to glossodynia, the patient was started on olanzapine. Improvements of pain symptoms were noted within 3 days with full resolution of symptoms at 1- and 3-month follow-ups. The patient's psychiatric symptoms improved with a decrease in pain.

JDD ARTICLE EVALUATION:

Glossodynia, or burning tongue syndrome, may be associated with fungal disorders, B-12 deficiency, dentures, and spicy foods. Olanzapine, Zyprexa[R], is an anti-psychotic and anti-manic medication that has never been documented to be used in glossodynia. It is not by any means a first-line therapy for this condition but we should consider it after all other etiologies, fungal and other, are ruled out. The medication belongs to the thienobenzodiazepine class of anti-psychotics that work on dopaminergic, serotonergic, muscarinic and adrenergic receptors and perhaps glossodynia is multifactorial in nature and a multireceptor disorder that requires a multidisciplinary approach. All in all, before starting olanzapine we must rule-out other etiologies and then perhaps we can refer to psychiatrist.

Gick CL, et al. J Am Acad Dermatol. 2004; 51(3):463-5.