Olanzapine(oh lan’ za peen)
Zyprexa, Zyprexa IntraMuscular, Zyprexa Relprevv, Zyprexa Zydis
PREGNANCY CATEGORY C
Drug Classes
Antipsychotic
Dopaminergic blocker
Therapeutic Actions
Mechanism of action not fully understood; blocks dopamine receptors in the brain, depresses the RAS; blocks serotonin receptor sites; anticholinergic, antihistaminic (H1), and alpha-adrenergic blocking activity may contribute to some of its therapeutic (and adverse) actions; produces fewer extrapyramidal effects than most antipsychotics.
Indications
Treatment of schizophrenia
Treatment of acute mixed or manic episodes associated with bipolar 1 disorder and maintenance of bipolar 1 disorder as monotherapy, or combined with lithium or valproate
Treatment of agitation associated with schizophrenia and bipolar 1 mania (injection)
Treatment of treatment-resistant depression and depression associated with bipolar 1 disorder, in combination with fluoxetine
Unlabeled uses: Delusional parasitosis, stuttering
Contraindications and Cautions
Contraindicated with allergy to olanzapine, myeloproliferative disorders, severe CNS depression, comatose states, lactation.
Use cautiously in elderly or debilitated patients or with CV or cerebrovascular disease, dehydration, seizure disorders, Alzheimer disease, prostate enlargement, narrow-angle glaucoma, history of paralytic ileus or breast cancer, pregnancy, phenylketonuria (if using orally disintegrating tablets, contain phenylalanine).
Available Forms
Tablets—2.5, 5, 7.5, 10, 15, 20 mg; orally disintegrating tablets—5, 10, 15, 20 mg; powder for injection—10 mg; powder for suspension—210, 300, 405 mg/vial
Dosages
Adults
Schizophrenia: Initially, 5–10 mg PO daily, increase to 10 mg PO daily within several days; may be increased by 5 mg/day at 1-wk intervals to achieve desired effect. Do not exceed 20 mg/day.
Bipolar mania: 10–15 mg/day PO; adjust at 5-mg intervals as needed, not less than every 24 hr. Maximum dose, 20 mg/day. For maintenance, 5–20 mg/day PO. The initial dose is 10 mg of olanzapine when combined with lithium or valproate.
Agitation: 10 mg IM; range 5–10 mg IM; dose may be repeated in 2 hr if needed; safety of giving more than 30 mg/24 hr not established.
Long-acting injection (Zyprexa Relprevv): 150, 210, or 300 mg IM every 2 wk or 300 or 405 mg IM every 4 wk; establish dosage based on patient response.
Treatment-resistant depression: 5 mg/day PO with fluoxetine 20 mg/day PO; adjust dosage as needed to range of 5–12.5 mg/day olanzapine with 20–50 mg/day PO fluoxetine.
Pediatric patients 13–17 yr
Schizophrenia, bipolar disorder: Initially, 2.5–5 mg/day PO; titrate to target dose of 10 mg/day.
Pediatric patients younger than 13 yr
Safety and efficacy not established.
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