Olanzapine (Zyprexa) is a second-generation antipsychotic drug that is used in the treatment of schizophrenia, bipolar depression, agitation, and other psychotic episodes.

Olanzapine (Zyprexa) Uses:

• P/O:
  • Manifestations of schizophrenia treatment.
  • Treatment of acute or mixed mania episodes linked to bipolar I illness (as monotherapy or in conjunction with lithium or valproate).
  • Maintenance treatment of bipolar I disorder.
  • Combined with fluoxetine for bipolar I or treatment-resistant depression
• IM, extended-release (Zyprexa Relprevv):
  • Schizophrenia treatment.
• IM, short-acting (Zyprexa Intra Muscular):
  • Treatment of acute agitation is linked to schizophrenia and manic phases of bipolar I disorder.

• Off Label Use of Olanzapine in Adults:

  • Chemotherapy-associated acute & delayed nausea or vomiting, prevention (adults)
  • Chemotherapy-associated breakthrough nausea or vomiting (adults)
  • Delirium
  • Delirium & agitation, intensive care unit (treatment) (alternative agent)
  • Delusional infestation (also called delusional parasitosis)
  • Psychosis/agitation associated with dementia
  • Posttraumatic stress disorder
  • Tourette syndrome

Olanzapine (Zyprexa) Dose in Adults

Olanzapine (Zyprexa) Dose in the treatment of Acute Agitation (associated with bipolar disorder or schizophrenia):

 

Initial dose:

• 10 mg (a lower dose of 5-7.5 mg might be investigated when clinical conditions permit) (a lower dose of 5-7.5 mg may be considered when clinical factors warrant).
• Additional dosages of up to 10 mg could be taken into account.
• However, there should be a 2-hour interval between the first and second dosages to gauge responsiveness (maximum daily dose: 30 mg).

Special risk patients:

• Patients who are frail, have a history of hypotensive reactions, or who might be more pharmacodynamically sensitive to olanzapine should be prescribed a lower dose of 2.5 mg.
• Only when patients can be thoroughly monitored, such as in emergency rooms, has the IV approach been studied for treating respiratory d
• The World Federation of Societies of Biological Psychiatry (WFSBP) expert consensus panel recommends, with certain exceptions
• Short-acting injection:
• IM:

• Short-acting injection: IV (off-label route):

Note:

• • Monotherapy: IV:
  • Initial:
    • 10 mg.
    • If needed, may provide two additional 5 mg doses in 5-min intervals.
  • Max:
    • 20 mg.

Note:

• However, using parenteral olanzapine and benzodiazepines simultaneously is not recommended due to the possibility of significant drowsiness and cardiorespiratory depression. Midazolam has been studied in combination with lower doses of 5 mg in a single dose.

Olanzapine (Zyprexa) Dose in the treatment of Bipolar I (acute mixed or manic episodes): Oral:

• Monotherapy:
  • Initial:
    • Once daily, take 10-15 mg.
    • Increase by 5 milligrammes each day, spaced no less than 24 hours apart.
  • Maintenance:
    • 5-20 mg daily.
  • Recommended max dose:
    • 20 mg/day.
• Combination therapy (with lithium or valproate):
  • Initial:
    • 10 mg once daily.
  • Dosing range:
    • 5-20 mg daily

Olanzapine (Zyprexa) Dose in the Chemotherapy-associated acute and delayed nausea or vomiting, prevention (off-label):

• P/O:
• 10 mg once daily on days 2-4, and 10 mg on the first day of chemotherapy come next (in combination with dexamethasone and palonosetron on day 1 only).

Olanzapine (Zyprexa) Dose in the Chemotherapy-associated breakthrough nausea or vomiting (off-label):

• P/O:
• For 3 days, 10 mg once daily (Navari 2013).

Olanzapine (Zyprexa) Dose in the treatment of Delirium (off-label):

• P/O: For up to 5 days, 5 mg once daily.

Olanzapine (Zyprexa) Dose as an alternative agent in the treatment of Delirium and/or agitation, intensive care unit (off-label):

Note:

• Nonpharmacologic therapies and the treatment of underlying disorders are first measures in the prevention and management of delirium.
• Antipsychotics may be utilised as a short-term supplementary treatment if disturbing symptoms (such as agitation or anxiety) are present.
• P/O: Initial:
  • 5–10 mg once daily (2.5 mg once daily in patients older than 60 years old).
  • Once the required clinical response is attained, titrate daily in 5 mg increments up to 20 mg/day as necessary.
  • Watch the QTc and ECG intervals.
  • After symptoms go away, olanzapine therapy should be decreased over a few days.
  • This plan is supported by professional judgement.
  • Safety and efficacy have not been formally assessed.

• Short-acting injection: IM:

  • 5-10 mg.
  • Repeat as necessary every 2-4 hours (maximum daily dose: 30 mg).

Olanzapine (Zyprexa) Dose in the treatment of Delusional infestation (also called delusional parasitosis) (off-label):

• P/O: Initial:
  • 2.5 mg once daily.
  • Increase gradually depending on response and tolerability, up to 5–10 mg/day.
• Max:
  • 20 mg/day.

Olanzapine (Zyprexa) Dose in the treatment of Depression:

• Depression associated with bipolar disorder (in combination with fluoxetine):

  • P/O: Initial:
    • 5 mg in the evening.
    • Adjust to the typical daily range of 5-12.5 mg as tolerated.
  • See "Note."

• Treatment-resistant depression (in combination with fluoxetine):

  • P/O: Initial:
    • 5 mg in the evening.
    • Adjust to a daily dose range of 5-20 mg as tolerated.
  • See "Note."

Note (olanzapine/fluoxetine combination [Symbyax]):

• When combining separate components of fluoxetine with olanzapine as opposed to a fixed-dose combination product (Symbyax), the approximate dosage correspondence is as follows.:
  • Olanzapine 2.5 mg + fluoxetine 20 mg = Symbyax 3/25
  • Olanzapine 5 mg + fluoxetine 20 mg = Symbyax 6/25
  • Olanzapine 12.5 mg + fluoxetine 20 mg = Symbyax 12/25
  • Olanzapine 5 mg + fluoxetine 50 mg = Symbyax 6/50
  • Olanzapine 12.5 mg + fluoxetine 50 mg = Symbyax 12/50

• Special risk patients:

  • Initial:
  • 2.5–5 mg once daily is advised for patients with a propensity for hypotensive responses, hepatic impairment, a combination of characteristics that may slow down the metabolism of olanzapine (e.g., female, elderly, nonsmoker status), or who may be more pharmacodynamically sensitive to olanzapine.
  • Carefully raise the dose as clinically indicated.

Olanzapine (Zyprexa) Dose in the treatment of Posttraumatic stress disorder (off-label):

• P/O: Initial:
  • 5-10 mg daily.
  • Depending on response and tolerance, adjust the dose up to 20 mg per day every one to two weeks.

Olanzapine (Zyprexa) Dose in the treatment of Schizophrenia:

• P/O:

• Initial:
  • 5-10 mg once daily (within 5 to 7 days, increase to 10 mg once daily).
  • After then, adjust by 5 mg per day at 1-week intervals, up to the maximum daily dose that is advised.
• Maintenance:
  • 10–20 mg once each day.
  • For schizophrenia that is resistant to therapy, doses up to 60 mg per day have been used.
  • However, there is little supporting data (APA [Lehman 2004]).

• Special risk patients:

  • Initial:
    • In patients who are elderly, have a history of hypotensive responses, are debilitated, demonstrate a combination of variables that may slow the metabolism of olanzapine, such as nonsmoking female patients, or who may be more pharmacodynamically sensitive to olanzapine, daily, 5 mg once is advised.
    • Carefully increase the dose as clinically necessary.

• Extended-release injection: IM:

Note:

• Tolerance to oral olanzapine should be established before switching to extended-release injectable.
• Max dose:
  • 300 mg every 2 weeks or 405 mg every 4 weeks.
  • Patients established on oral olanzapine 10 mg daily:
    • Initial dose:
      • four dosages of 210 mg every two weeks or two doses of 405 mg every four weeks.
    • Maintenance dose:
      • 150 mg once every two weeks or 300 mg once every four.
  • Patients established on oral olanzapine 15 mg daily:
    • Initial dose:
      • Every two weeks, 300 mg for 4 doses.
    • Maintenance dose:
      • 405 mg every four weeks, or 210 mg every two.
  • Patients established on oral olanzapine 20 mg daily:
    • Initial & maintenance dose:
      • 300 mg every 2 weeks.

• Special risk patients:

  • Initial:
    • In patients who are elderly, have a history of hypotensive responses, are debilitated, demonstrate a combination of variables that may slow the metabolism of olanzapine, such as nonsmoking female patients, or who may be more pharmacodynamically sensitive to olanzapine, 150 mg is advised every 4 weeks.
    • Carefully increase the dose as clinically necessary.

Olanzapine (Zyprexa) Dose in the treatment of Tourette syndrome (off-label):

• Initial:
  • 2.5-5 mg daily.
  • Gradually increase to the typical dosage range of 2.5–20 mg per day based on response and tolerability.
  • Clinical trials typically employed weekly or biweekly dosage changes after the initial dose of 2.5 to 5 mg, with a daily maximum of 20 mg.

• Discontinuation of therapy:

  • Gradual dose decrease is indicated to prevent withdrawal symptoms (such as sleeplessness, headaches, and GI issues), unless stopping is necessary owing to serious side effects.
  • To enable the detection of prodromal symptoms of disease return in patients with schizophrenia or bipolar disorder when terminating chronic antipsychotic medication, reducing the dose very gradually over months to years with close monitoring is advised.

• Switching antipsychotics:

• Limited data available; optimal universal strategy is unknown. Strategies include:

  • A sudden change and cross-titration (gradually stopping the first antipsychotic and gradually increasing the new antipsychotic) (abruptly discontinuing the first antipsychotic & either increasing the new antipsychotic gradually or starting it at a treatment dose).
  • In individuals with schizophrenia who are at a high risk of relapsing, the current medication may be kept at its full dose while the new medicine is raised (ie, overlap).
  • Once the new medicine is at the therapeutic dose, the first medication is gradually reduced and withdrawn over the course of one to two weeks.
  • According to some specialists, cross-titration and overlap strategies are preferable to sudden change based on clinical experience.

Olanzapine (Zyprexa) Dose in Children

Olanzapine (Zyprexa) Dose in the treatment of Bipolar I disorder (acute manic or mixed episodes):

P/O:

• Children 4 to <6 years:

• Limited data available:

  • Initial:
    • 1.25 mg once daily.
  • Increase at weekly intervals according to response and tolerability to target dose:
    • 10 mg/day.
  • Dosing based on an open-label trial in 15 children mean age: 5 ± 0.8 years; mean weight:
    • 20.8 kg.
  • Mean required dose:
    • 6.3 ± 2.3 mg/day that showed significant improvement in manic symptoms.

• Children 6-12 years:

• Limited data available:

  • Initial:
    • 2.5 mg once daily.
    • To reach the goal dose of 10 mg once daily, increase the dose by 2.5 or 5 mg per week.
  • Max dose:
    • 20 mg/day.

• Adolescents:

  • Initial:
    • 2.5-5 mg once daily.
    • To reach the goal dose of 10 mg once daily, increase the dose every week by 2.5 or 5 mg.
  • Max dose:
    • 20 mg/day.
    • The mean modal dose in clinical trials for adolescents receiving flexible dosing (2.5–20 mg/day) was 10.7 mg/day (mean dose: 8.9 mg/day).

Olanzapine (Zyprexa) Dose in the treatment of Schizophrenia:

• Children ≥8 years (Limited data available) and Adolescents:

  • P/O:
• Initial:
  • 2.5-5 mg once daily.
  • To reach the goal dose of 10 mg once daily, increase the dose by 2.5 or 5 mg per week.
• Max dose:
  • 20 mg/day.
• Note:
  • In one trial, dosages as high as 30 mg/day were used to teenagers who had failed to respond to treatment.
  • Some patients, meanwhile, could not handle doses greater than 20 mg/day (Kumra, 2008).
  • Doses more than 20 mg/day have not been thoroughly assessed for safety and effectiveness.
  • In adolescent flexible-dosing (2.5-20 mg/day) clinical trials, the mean dose was 11.1 mg/day, while the mean modal dose was 12.5 mg/day.
  • The two double-blind comparison trials that included both children and adolescents (n=35, age: 8–19 years with seven children; n=13, age: 7–16 years; mean age: 12.8 + 2.4 years) served as the foundation for the dosing recommendations for children.

Olanzapine (Zyprexa) Dose in the treatment of Anorexia nervosa:

• Children ≥9 years and Adolescents:

• Limited data available:

• P/O:
  • 1.25 to 2.5 mg once daily have been shown in one small trial and numerous case reports to improve BMI and other disease-related symptoms (such as eating habits and anxiety).
• Reported range:
  • 1.25-12.5 mg/day.
  • Higher doses (>2.5 mg once daily) might not, however, be more effective, according to certain theories.

Olanzapine (Zyprexa) Dose in the treatment of Tourette syndrome, tic disorder:

• Children ≥7 years and Adolescents:

• Limited data available:

• P/O:

• Patient weight ≤40 kg:
  • Initial:
    • 2.5 mg every other day for three days, then 2.5 mg every day for the rest of the week.
    • By the second week, if necessary, increase to 5 mg/day.
    • Then, if tolerated, increase in 5 mg increments per week.
  • Max dose:
    • 20 mg/day
• Patient weight >40 kg:
  • Initial:
    • 2.5 mg every day for three days.
    • The balance of the week, if necessary, should be increased to 5 mg per day, followed by weekly increases of 5 mg as tolerated.
  • Max dose:
    • 20 mg/day
• At a mean final dose of 14.5 mg/day after 8 weeks of therapy, an open-label research involving 10 juvenile patients (7–13 years old) found statistically significant decreases in tic severity [Yale Global Tic Severity Scale (YGTSS)] from baseline.
• An open-label experiment with 12 children and adolescents (7–14 years old) found a significant reduction (30%) in the overall severity of tics at a final mean dose of 11.3 mg/day (range: 2.5–20 mg/day).

Olanzapine (Zyprexa) Dose in the treatment of Acute Agitation associated with bipolar disorder or schizophrenia:

Limited data available:

IM (short-acting):

• Children:
  • 5 mg.
• Adolescents:
  • 10 mg.
  • Use in an inpatient mental health environment; dosage based on a retrospective study of 50 paediatric patients treated with IM olanzapine (children; n=15; mean age: 11 years).
  • Teenagers (n=35; average age: 15 years)] & assessed the 163 given dosages.
  • A 90.2% response rate was seen in the results.

Olanzapine (Zyprexa) Pregnancy Risk Factor: C

• Studies on animal reproduction have revealed negative outcomes.
• When a baby is born, olanzapine can be found in the cord blood because it crosses the placenta.
• Antipsychotic usage in the third trimester is linked to extrapyramidal syndromes (EPS), which are aberrant muscle movements, and withdrawal symptoms in newborns.
• Agitation, feeding issues, and hypotonia can all affect a newborn.
• These side effects may subside on their own or may necessitate hospitalisation.
• Individualized care during pregnancy is advised by ACOG.
• The mental healthcare professional, obstetrician, and primary care provider should all contribute their clinical knowledge to the treatment with psychiatric medication during pregnancy.
• There are very few safety studies on the use of atypical antipsychotics during pregnancy. Regular use is not advised.
• Continued therapy may be more advantageous than stopping treatment if a woman unintentionally takes an atypical antipsychotic while pregnant.
• Olanzapine can be used to treat a woman who is pregnant or for treatment that is already in progress.
• Olanzapine can cause hyperprolactinemia in both males as well as females. This may lead to decreased reproductive function.

Use of Olanzapine while breastfeeding

• Breast milk contains Olanzapine.
• When compared to a maternal dose of 286 mg/kg/day, the relative infant dose (RID), of olanzapine was 1.7%.
• When the RID of the medication is less than 10%, breastfeeding is acceptable.
• Some sources state that breastfeeding should be considered only if the RID for psychotropic drugs is less than 5%.
• Using a milk content of 0.033 mg/mL to calculate the RID of olanzapine, an estimated daily infant dosage via breastmilk of 4.95 mg/kg/day was obtained.
• Following maternal dose of olanzapine 266, mcg/kg/day, this milk concentration was attained.
• The paper also included breast milk concentrations for additional mother-infant couples.
• The average max milk concentration was found 5.2 hours after the maternal dosage. The RID was 1.02%. Data were taken from six women (range 0.93% to 1.12%).
• The study included women who received oral olanzapine from 5-20 mg/day (mean: 7.75 mg/day), took the medication for 19-395 consecutive days prior to sampling. Infants were between 0.1 and 4.3 months old.
• Olanzapine was detected in the serum of a nursing infant.
• CYP metabolism, which matures with age, may explain why concentrations were higher at 4 months and then decreased as time passed.
• Maternal symptoms vary, but the average maternal dose was between 5-15 mg/day.
• Breastfeeding infants have never experienced adverse events in most cases.
• The most frequent adverse events that were reported to the manufacturer included insomnia, irritability and somnolence.
• For the first month, infants who have been exposed to second-generation antipsychotics via breast milk should be closely monitored for signs such as lethargy, insomnia, appetite changes, and irritability.
• Even though the manufacturer does not advise it, olanzapine is approved for nursing. However, breastfeeding mothers might need to take antipsychotic medication.

Olanzapine (Zyprexa) Dose in Kidney Disease:

• No dosage adjustment is necessary.
• Not removed by dialysis.

Olanzapine (Zyprexa) Dose in Liver Disease:

• Except when taken in conjunction with fluoxetine (as distinct components), the first olanzapine dose should be kept at 2.5–5 mg per day, according to the manufacturer's instructions.
• Use cautiously (cases of hepatitis and liver injury have been reported with olanzapine use).

Common Side Effects of Oral Olanzapine (Zyprexa):

• Cardiovascular:

  • Orthostatic Hypotension

• Central Nervous System:

  • Drowsiness
  • Extrapyramidal Reaction
  • Akathisia
  • Parkinsonian-Like Syndrome
  • Dizziness
  • Headache
  • Fatigue
  • Insomnia

• Endocrine & Metabolic:

  • Increased Serum Prolactin
  • Weight Gain

• Gastrointestinal:

  • Increased Appetite
  • Xerostomia
  • Dyspepsia
  • Constipation

• Hepatic:

  • Increased Serum AST
  • Decreased Serum Bilirubin
  • Increased Serum ALT

• Neuromuscular & Skeletal:

  • Weakness

• Miscellaneous:

  • Accidental Injury

Less Common Side Effects Of Olanzapine (Zyprexa):

• Cardiovascular:

  • Chest Pain
  • Peripheral Edema
  • Tachycardia
  • Hypertension

• Central Nervous System:

  • Personality Disorder
  • Abnormal Gait
  • Hypertonia
  • Restlessness
  • Falling
  • Articulation Impairment

• Endocrine & Metabolic:

  • Increased Gamma-Glutamyl Transferase
  • Increased Uric Acid
  • Menstrual Disease
  • Breast Changes

• Gastrointestinal:

  • Abdominal Pain
  • Vomiting
  • Diarrhea

• Genitourinary:

  • Urinary Incontinence
  • Sexual Disorder
  • Urinary Tract Infection

• Hematologic & Oncologic:

  • Bruise

• Hepatic:

  • Increased Liver Enzymes
  • Increased Serum Alkaline Phosphatase

• Neuromuscular & Skeletal:

  • Tremor
  • Limb Pain
  • Arthralgia
  • Back Pain
  • Muscle Rigidity
  • Dyskinesia

• Ophthalmic:

  • Amblyopia

• Respiratory:

  • Rhinitis
  • Cough
  • Nasopharyngitis
  • Pharyngitis
  • Epistaxis
  • Respiratory Tract Infection
  • Sinusitis

• Miscellaneous:

  • Fever

Rare Side effects of Olanzapine (Zyprexa) Injection:

• Cardiovascular:

  • Hypertension
  • Hypotension
  • Prolonged Q-T Interval On ECG
  • Orthostatic Hypotension

• Central Nervous System:

  • Headache
  • Sedation
  • Drowsiness
  • Akathisia
  • Dizziness
  • Fatigue
  • Extrapyramidal Reaction
  • Abnormality In Thinking
  • Auditory Hallucination
  • Parkinsonian-Like Syndrome
  • Restlessness
  • Pain
  • Abnormal Dreams
  • Procedural Pain
  • Sleep Disorder
  • Dysarthria

• Dermatologic:

  • Acne Vulgaris

• Endocrine & Metabolic:

  • Weight Gain

• Gastrointestinal:

  • Diarrhea
  • Vomiting
  • Xerostomia
  • Increased Appetite
  • Nausea
  • Tooth Infection
  • Toothache
  • Abdominal Pain
  • Flatulence

• Genitourinary:

  • Vaginal Discharge

• Hepatic:

  • Increased Liver Enzymes

• Infection:

  • Viral Infection

• Local:

  • Pain At Injection Site
  • Abscess At Injection Site

• Neuromuscular & Skeletal:

  • Arthralgia
  • Back Pain
  • Muscle Spasm
  • Stiffness
  • Tremor

• Otic:

  • Otalgia

• Respiratory:

  • Cough
  • Nasal Congestion
  • Nasopharyngitis
  • Upper Respiratory Tract Infection
  • Pharyngolaryngeal Pain
  • Sneezing

• Miscellaneous:

  • Fever

Contraindications to Olanzapine (Zyprexa):

• The labelling from the manufacturer does not list any contraindications.

Canadian labeling

 

• Hypersensitivity to olanzapine and/or any formulation ingredient

Warnings and precautions

• Modified cardiac conduction

  • The QT interval may be prolonged and cardiac conduction altered.
  • Life-threatening arrhythmias can be caused by therapeutic doses antipsychotics.
  • Concomitant medication or conditions that cause hypokalemia, bradycardia, and hypomagnesemia may increase the risk.
  • Patients with conduction abnormalities should be cautious.

• Anticholinergic effects

  • Possible anticholinergic side effects: constipation, xerostomia and blurred vision.
  • Patients with reduced gastrointestinal motility, paralytic and ileus, urinary retentions, BPH, xerostomia, and visual problems (including narrow angle glaucoma) should be cautious.
  • Comparatively to other neuroleptics olanzapine is a mild cholinergic antagonist.

• Blood dyscrasias

  • Antipsychotic use has been linked to Leukopenia and Neutropenia in clinical trials and post-marketing reports.
  • Periodic blood count assessments should be done if there are any risk factors, such as low WBC (preexisting) or history of drug-induced neutro-/leukoemia.
  • Stop treatment at the first sign of blood dyscrasias, or if your absolute neutrophil count is 1,000/mm3.

• Effects on the cerebrovascular system:

  • In placebo-controlled studies of olanzapine's unapproved use in dementia-related psychosis patients aged over 60, there was an increase in cerebrovascular effects, including stroke, in some elderly patients.

• Depression in the CNS:

  • CNS depression can lead to mental and physical impairments.
  • It is important to warn patients about tasks that require mental alertness, such as driving or operating machinery.
  • Comparable to other antipsychotics it may be moderately to very sedating.
  • It has been shown that dose-related effects can be observed.

• Dyslipidemia

  • It has been shown that dose-related increases in cholesterol and triglycerides are possible.
  • Patients with abnormally high lipid profiles should be cautious.
  • Dyslipidemia is a higher risk than other antipsychotics.

• Esophageal dysmotility/aspiration

  • Antipsychotic use has been linked to esophageal dysmotility and aspiration.
  • Age increases the risk of developing a health condition.
  • Patients at high risk for aspiration pneumonia (ie Alzheimer's disease) should be treated with caution, especially patients over 75 years.

• Extrapyramidal symptoms

  • Extrapyramidal symptoms (EPS) may occur, including pseudo parkinsonism and acute dystonic reactions.
  • These reactions are generally less common than those caused by conventional antipsychotics. Frequency reports are comparable to placebo.
  • Higher doses of antipsychotics and use by younger patients may increase the risk of dystonia.
  • There are several factors that increase the vulnerability to tardive dyskinesia, including older age, female gender, postmenopausal status and Parkinson disease symptoms.
  • If you have tardive dyskinesia symptoms, discontinue therapy.

• Falls

  • Increased risk of falls from somnolence and orthostatic hypotension, as well as motor or sensory instability.
  • Patients with chronic diseases or taking medications that can increase fall risk should have their fall risk assessed at baseline and periodically throughout treatment.

• Hyperglycemia

  • Hyperglycemia has been linked to the use of antipsychotics.
  • Hyperglycemia can be severe in some cases and may lead to hyperosmolar or even death.
  • Olanzapine could be more associated with hyperglycemia that other antipsychotics atypicals.
  • Patients with diabetes and other disorders of glucose regulation should be cautious.
  • Watch out for a worsening glucose control.
  • Patients at high risk for diabetes (eg obesity or family history), should have a baseline fasting glucose (FBS) and periodic glucose regulation assessments.
  • Hyperglycemia can be dangerous when taken with antipsychotics.

• Hyperprolactinemia

  • It can cause an increase in serum prolactin level due to increased doses.
  • It is not known if hyperprolactinemia can be a clinical sign in breast cancer patients or other prolactin dependent tumours.
  • Prolactin levels were increased in clinical manifestations such as breast-, sexual- and menstrual-related events.

• Multiorgan hypersensitivity reactions (drug response with eosinophilia or systemic symptoms [DRESS]).

  • Multiple-organ hypersensitivity reactions (DRESS), which have been reported, have the potential to be lethal and serious.
  • Myocarditis, nephritis, or pneumonitis, as well as a cutaneous reaction (rash, exfoliative dermatitis), fever, eosinophilia, and lymphadenopathy are possible side effects.
  • Stop taking olanzapine if DRESS is thought to be present.

• Neuroleptic malignant Syndrome (NMS).

  • NMS can be utilised in addition to the utilisation.
  • Keep an eye out for changes in mood, fever, muscle rigidity, and autonomic instability.

• Orthostatic hypotension

  • Orthostatic hypotension may occur.
  • Patients at high risk for this effect and those who cannot tolerate temporary hypotension (cerebrovascular disease or cardiovascular disease), should be cautious.

• Suicidal thoughts:

  • Psychotic illness and bipolar disorder can lead to suicide attempts.
  • Use caution in high-risk patients when initiating therapy
  • Prescriptions for the smallest amount should be written in accordance with good patient care.

• Temperature regulation

  • It is possible to have impaired core body temperature regulation.
  • Be careful with heat exposure, strenuous exercise, heat, dehydration, or concomitant anticholinergic medication.

• Weight loss

  • Significant weight gain (>7%) has been seen with antipsychotic therapy.
  • Product-specific incidences vary.
  • Dose-related changes were observed with olanzapine.
  • Keep an eye on your waist measurement and BMI.
  • The risk of weight gain can be higher with this antipsychotic than with other antipsychotics.

• Cardiovascular disease

  • Patients with severe heart disease, hemodynamic instability or hypercholesterolemia should be cautious.

• Dementia[US Boxed Warning]

  • If given antipsychotics, patients with dementia-related psychosis in their old are more likely to pass away.
  • The majority of deaths were either from cardiovascular disease (eg heart failure, sudden death, etc.) or infectious diseases (eg pneumonia).
  • Patients with Parkinson's disease or Lewy body dementia should be cautious. 
  • The use of olanzapine to treat psychosis brought on by dementia is not authorised.

• Hepatic impairment

  • Patients with hepatic impairment or disease should be cautious.
  • Could raise transaminases, especially ALT.

• Parkinson disease

  • Patients with Parkinson's disease should be treated with caution
  • Motor disturbances can be aggravated by antipsychotics.

• Renal impairment

  • Patients with kidney disease should be cautious.

• Seizures

  • Patients at high risk of seizures should be treated with caution, especially those who have had seizures in the past, are brain damaged, suffered from head trauma or have been drinking, and/or are receiving concurrent treatment with medication that could lower their seizure threshold.
  • Due to an increase in predisposing factors, elderly patients could be at greater risk for seizures.

Olanzapine: Drug Interaction

Risk Factor C (Monitor therapy)
Abiraterone Acetate	May elevate CYP1A2 substrates' serum concentration (High risk with Inhibitors).
Acetylcholinesterase Inhibitors	May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors.
Acetylcholinesterase Inhibitors (Central)	May enhance the neurotoxic (central) effect of Antipsychotic Agents. Severe extrapyramidal symptoms have occurred in some patients.
Alcohol (Ethyl)	CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl).
Alizapride	May enhance the CNS depressant effect of CNS Depressants.
Amifampridine	Agents With Seizure Threshold Lowering Potential may enhance the neuroexcitatory and/or seizure-potentiating effect of Amifampridine.
Amphetamines	Antipsychotic Agents may diminish the stimulatory effect of Amphetamines.
Anticholinergic Agents	May enhance the adverse/toxic effect of other Anticholinergic Agents.
Antidiabetic Agents	Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents.
Antihepaciviral Combination Products	May decrease the serum concentration of OLANZapine.
Blood Pressure Lowering Agents	Could make antipsychotic drugs' hypotensive effects stronger (Second Generation [Atypical]).
Botulinum Toxin-Containing Products	May strengthen an anticholinergic agent's anticholinergic effect.
Brexanolone	Brexanolone's CNS depressing effects may be amplified by other CNS depressants.
Brimonidine (Topical)	CNS depressants may have an enhanced CNS depressant impact.
Broccoli	May lower the serum level of CYP1A2 substrates (High risk with Inducers).
BuPROPion	Agents Having Seizure Threshold Lowering Potential may have an enhanced neuroexcitatory and/or seizure-potentiating impact.
Cannabidiol	CNS depressants may have an enhanced CNS depressant impact.
Cannabis	May lower the serum level of CYP1A2 substrates (High risk with Inducers).
Cannabis	CNS depressants may have an enhanced CNS depressant impact.
CarBAMazepine	OLANZapine's serum concentration can drop.
Chloral Betaine	May worsen anticholinergic agents' harmful or hazardous effects.
Chlorphenesin Carbamate	CNS depressants' harmful or toxic effects could be increased.
Clarithromycin	Clarithromycin's QTc-prolonging impact may be strengthened by QT-prolonging antipsychotics (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Individuals may be considerably more at risk for QTc prolongation if they have additional risk factors.
CloZAPine	The QTc-prolonging action of CloZAPine may be strengthened by QT-prolonging antipsychotics (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Individuals may be considerably more at risk for QTc prolongation if they have additional risk factors.
CNS Depressants	Other CNS depressants' harmful or toxic effects might be exacerbated.
CYP1A2 Inducers (Moderate)	May lower the serum level of CYP1A2 substrates (High risk with Inducers).
CYP1A2 Inhibitors (Moderate)	May slow down CYP1A2 substrate metabolism (High risk with Inhibitors).
Cyproterone	May lower the serum level of CYP1A2 substrates (High risk with Inducers).
Deferasirox	May elevate CYP1A2 substrates' serum concentration (High risk with Inhibitors).
Deutetrabenazine	Could intensify the negative or hazardous effects of antipsychotic drugs. Particularly, there may be a higher chance of developing akathisia, parkinsonism, or neuroleptic malignant syndrome.
Dimethindene (Topical)	CNS depressants may have an enhanced CNS depressant impact.
Doxylamine	CNS depressants may have an enhanced CNS depressant impact. Management: The producer of the pregnancy-safe drug Diclegis (doxylamine/pyridoxine) particularly advises against combining it with other CNS depressants.
Dronabinol	May enhance the CNS depressant effect of CNS Depressants.
Droperidol	QT-prolonging Antipsychotics (Moderate Risk) may enhance the QTc-prolonging effect of Droperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Esketamine	May enhance the CNS depressant effect of CNS Depressants.
Flupentixol	QT-prolonging Antipsychotics (Moderate Risk) may enhance the QTc-prolonging effect of Flupentixol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
FluvoxaMINE	May increase the serum concentration of OLANZapine.
Gastrointestinal Agents (Prokinetic)	Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).
Glucagon	Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased.
Guanethidine	Antipsychotic Agents may diminish the therapeutic effect of Guanethidine.
Haloperidol	QT-prolonging Antipsychotics (Moderate Risk) may enhance the QTc-prolonging effect of Haloperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
HydrOXYzine	May enhance the CNS depressant effect of CNS Depressants.
Itopride	Anticholinergic Agents may diminish the therapeutic effect of Itopride.
Kava Kava	May enhance the adverse/toxic effect of CNS Depressants.
LamoTRIgine	May enhance the sedative effect of OLANZapine.
Lithium	May enhance the neurotoxic effect of Antipsychotic Agents. Lithium may decrease the serum concentration of Antipsychotic Agents. Specifically noted with chlorpromazine.
Magnesium Sulfate	May enhance the CNS depressant effect of CNS Depressants.
Methylphenidate	Antipsychotic Agents may enhance the adverse/toxic effect of Methylphenidate. Methylphenidate may enhance the adverse/toxic effect of Antipsychotic Agents.
MetyroSINE	The sedative effects of metyroSINE may be strengthened by CNS depressants.
MetyroSINE	Could intensify the negative or hazardous effects of antipsychotic drugs.
Mianserin	May strengthen an anticholinergic agent's anticholinergic action.
Minocycline	CNS depressants may have an enhanced CNS depressant impact.
Mirabegron	Anticholinergic drugs may make Mirabegron's harmful or hazardous effects worse.
Mirtazapine	The CNS depressing action of mirtazapine may be enhanced by CNS depressants.
Nabilone	CNS depressants may have an enhanced CNS depressant impact.
Nitroglycerin	Nitroglycerin absorption may be decreased by anticholinergic agents. Anticholinergic medications specifically have the potential to impede or prevent the absorption of nitroglycerin by reducing the breakdown of sublingual nitroglycerin pills.
Obeticholic Acid	May elevate CYP1A2 substrates' serum concentration (High risk with Inhibitors).
Ondansetron	Maybe intensifies the action of QT-prolonging antipsychotics (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Individuals may be considerably more at risk for QTc prolongation if they have additional risk factors.
Peginterferon Alfa-2b	May elevate CYP1A2 substrates' serum concentration (High risk with Inhibitors).
Pentamidine (Systemic	May enhance the QTc-prolonging effect of QT-prolonging Antipsychotics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
QT-prolonging Antidepressants (Moderate Risk)	QT-prolonging Antipsychotics (Moderate Risk) may enhance the QTc-prolonging effect of QT-prolonging Antidepressants (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
QT-prolonging Antipsychotics (Moderate Risk)	May enhance the QTc-prolonging effect of OLANZapine. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Exceptions: Amisulpride; CloZAPine; Droperidol; Flupentixol; OLANZapine; Pimozide.
QT-prolonging Class IC Antiarrhythmics (Moderate Risk)	May enhance the QTc-prolonging effect of QT-prolonging Antipsychotics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
QT-prolonging Kinase Inhibitors (Moderate Risk)	QT-prolonging Antipsychotics (Moderate Risk) may enhance the QTc-prolonging effect of QT-prolonging Kinase Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
QT-prolonging Miscellaneous Agents (Moderate Risk	May enhance the QTc-prolonging effect of QT-prolonging Antipsychotics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Exceptions: Domperidone.
QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk)	May enhance the QTc-prolonging effect of QT-prolonging Antipsychotics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
QT-prolonging Quinolone Antibiotics (Moderate Risk)	May enhance the QTc-prolonging effect of QT-prolonging Antipsychotics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Quinagolide	Antipsychotic Agents may diminish the therapeutic effect of Quinagolide.
Ramosetron	Anticholinergic Agents may enhance the constipating effect of Ramosetron.
RifAMPin	OLANZapine's serum concentration can drop.
Ritonavir	OLANZapine's serum concentration can drop.
Rufinamide	May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced.
Saquinavir	QT-prolonging Antipsychotics (Moderate Risk) may enhance the QTc-prolonging effect of Saquinavir. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Selective Serotonin Reuptake Inhibitors	CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.
Serotonin Modulators	May enhance the adverse/toxic effect of Antipsychotic Agents. Specifically, serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Exceptions: Nicergoline.
Teriflunomide	May decrease the serum concentration of CYP1A2 Substrates (High risk with Inducers).
Tetrabenazine	May enhance the adverse/toxic effect of Antipsychotic Agents.
Tetrahydrocannabinol	May enhance the CNS depressant effect of CNS Depressants.
Tetrahydrocannabinol and Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Thiazide and Thiazide-Like Diuretics	Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics.
Tobacco (Smoked)	May diminish the therapeutic effect of OLANZapine. Tobacco (Smoked) may decrease the serum concentration of OLANZapine.
Topiramate	Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate.
Trimeprazine	May enhance the CNS depressant effect of CNS Depressants.
Valproate Products	May decrease the serum concentration of OLANZapine.
Voriconazole	May enhance the QTc-prolonging effect of QT-prolonging Antipsychotics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Risk Factor D (Consider therapy modification)
Anti-Parkinson Agents (Dopamine Agonist	Antipsychotic Agents (Second Generation [Atypical]) may diminish the therapeutic effect of Anti-Parkinson Agents (Dopamine Agonist). Management: Consider using an alternative antipsychotic agent when possible in patients with Parkinson disease. If an atypical antipsychotic is necessary, consider using clozapine or quetiapine, which may convey the lowest interaction risk.
Blonanserin	CNS Depressants may enhance the CNS depressant effect of Blonanserin.
Buprenorphine	CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants.
Chlormethiazole	May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used.
Domperidone	QT-prolonging Agents (Moderate Risk) may enhance the QTc-prolonging effect of Domperidone. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk.
HYDROcodone	CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Iohexol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iomeprol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iomeprol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iopamidol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Mequitazine	Antipsychotic Agents may enhance the arrhythmogenic effect of Mequitazine. Management: Consider alternatives to one of these agents when possible. While this combination is not specifically contraindicated, mequitazine labeling describes this combination as discouraged.
Methotrimeprazine	CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established.
Opioid Agonists	CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
OxyCODONE	CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Perampanel	May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination.
Pramlintide	May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract.
QT-prolonging Agents (Highest Risk)	May enhance the QTc-prolonging effect of OLANZapine. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities.
Secretin	Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin.
Sodium Oxybate	May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated.
Suvorexant	CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended.
Tapentadol	May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Zolpidem	CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol.
Risk Factor X (Avoid combination)
Aclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.
Amisulpride	Antipsychotic Agents may enhance the adverse/toxic effect of Amisulpride. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Amisulpride	May enhance the QTc-prolonging effect of QT-prolonging Antipsychotics (Moderate Risk).
Azelastine (Nasal	CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal).
Benzodiazepines	OLANZapine may enhance the adverse/toxic effect of Benzodiazepines. Management: Avoid concomitant use of parenteral benzodiazepines and IM olanzapine due to risks of additive adverse events (e.g., cardiorespiratory depression). Olanzapine prescribing information provides no specific recommendations regarding oral administration.
Bromopride	May enhance the adverse/toxic effect of Antipsychotic Agents.
Bromperidol	May enhance the CNS depressant effect of CNS Depressants.
Cimetropium	Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium.
Eluxadoline	Anticholinergic Agents may enhance the constipating effect of Eluxadoline.
Glycopyrrolate (Oral Inhalation	Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation).
Glycopyrronium (Topical)	May enhance the anticholinergic effect of Anticholinergic Agents.
Ipratropium (Oral Inhalation	May enhance the anticholinergic effect of Anticholinergic Agents.
Levosulpiride	Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride.
Metoclopramide	May enhance the adverse/toxic effect of Antipsychotic Agents.
Orphenadrine	CNS Depressants may enhance the CNS depressant effect of Orphenadrine.
Oxatomide	May enhance the anticholinergic effect of Anticholinergic Agents.
Oxomemazine	May enhance the CNS depressant effect of CNS Depressants.
Paraldehyde	CNS Depressants may enhance the CNS depressant effect of Paraldehyde.
Pimozide	May enhance the QTc-prolonging effect of QT-prolonging Agents (Moderate Risk).
Piribedil	Antipsychotic Agents may diminish the therapeutic effect of Piribedil. Piribedil may diminish the therapeutic effect of Antipsychotic Agents. Management: Use of piribedil with antiemetic neuroleptics is contraindicated, and use with antipsychotic neuroleptics, except for clozapine, is not recommended.
Potassium Chloride	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride.
Potassium Citrate	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate.
Revefenacin	Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin.
Sulpiride	Antipsychotic Agents may enhance the adverse/toxic effect of Sulpiride.
Thalidomide	CNS Depressants may enhance the CNS depressant effect of Thalidomide.
Tiotropium	Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium.
Umeclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.

Monitoring Parameters:

• Mental state
• Vital signs (as indicated by a doctor).
• Blood pressure (baseline); repeat 3 months after antipsychotic initiation. Then, yearly.
• Height, weight, BMI, waist circumference, and height (baseline) - Repeat at 4, 8 and 12 weeks after starting or changing therapy. Then quarterly.
• Switch to another antipsychotic if you want to gain >=5% of your initial weight.
• CBC (as indicated by a physician; patients with low WBC, or a history of drug-induced neutropenia/neutropenia should be monitored frequently for the first few months.
• Annually, and as indicated by a physician, electrolytes and liver function.
• Obesity, diabetes, dyslipidemia and hypertension (baseline; repeated annually).
• Fasting plasma glucose/HbA (baseline); repeat this 3 months after you start an antipsychotic and then every year.
• Fasting lipid panel (baseline); repeat 3 months after antipsychotics are started; if LDL levels are normal, repeat every 2-5 years or more if clinically necessary.
• Changes in menstruation, fertility, and development of galactorrhea (at each visit for 12 weeks after antipsychotics are initiated, or until the dose becomes stable, then annually).
• Abnormal involuntary movement or parkinsonian signs (baseline); repeat weekly until dose stabilization is achieved for at least two weeks after introduction, and 2 weeks following any significant dose increases.
• Tardive dyskinesia (every 12 Months; high-risk patients, every 6 Months).
• Ocular examination: Annually for patients over 40 years old; once every two years for younger patients
• Extended-release IM injection
  • Each dose is followed by sedation/delirium lasting for 3 hours

How to administer Olanzapine (Zyprexa)?

• Short-acting injection:
  • Is able to be given IV or IM (off-label route).
  • Subcutaneous injections should not be given.
  • When administering intramuscularly, inject slowly and deeply.
  • For an IV route that is not on the label, administer quickly.
  • If vertigo and sleepiness are noticed, the patient should stay in a reclined position until an examination shows bradycardia and postural hypotension are not an issue.
• Extended-release injection:
  • Only for IM gluteal injection.
  • Don't give intravenously or subcutaneously.
  • Aspirate to make sure no blood is seen after a needle is inserted into a muscle.
  • Never rub the injection site.
  • Use the diluent, syringes, and needles included in the first aid package.
  • If there is blood aspiration, get a new kit.
• Tablet:
  • May be given without consideration to food.
• Orally-disintegrating:
  • Peel back the foil blister to remove (do not push the tablet through the foil).
  • As soon as the tablet is removed, put it in your mouth.
  • The tablet can be eaten with or without fluids because it dissolves quickly in saliva.
  • Applied with or without food or meals.

Mechanism of action of Olanzapine (Zyprexa):

• Olanzapine, a second-generation thienobenzodiazepine-antimotic, acts as a powerful antagonist of serotonin 5HT-2A and 5HT-2C, dopamine 1-4, histamine h-1 and alpha -1 adrenergic receptors.
• Moreover, it has a somewhat antagonistic effect on 5-HT-3 and muscarinic M1-5 receptors.
• Olanzapine's precise mode of action in schizophrenia and bipolar illness is uncertain, although it is thought that the medicine antagonises dopamine and serotonin type 2 to produce its desired effects.

The onset of action:

• • For the treatment of aggression, agitation, and insomnia during a week or two.
  • 3–6 weeks for mania and positive psychotic symptoms to be under control.
• Adequate trial:
  • Usually six weeks at the highest doses tolerable

Absorption:

• P/O:
• Well absorbed.
• Not affected by food.
• Tablets and orally disintegrating tablets are bioequivalent
• Short-acting injection:
• Rapidly absorbed.

Protein binding, plasma:

• 93% bound to albumin & alpha -glycoprotein

Metabolism:

• Highly metabolised by cytochrome P450-mediated oxidation and direct glucuronidation (CYP1A2, CYP2D6).
• 40% removed via first-pass metabolism

Half-life elimination:

• Oral and IM (short-acting):
• Children:
• (10-18 years; n=8):
  • 37.2 ± 5.1 hours.
• Adults:
  • 30 hours [21-54 hours (5th to 95th percentile)].
  • Approximately 1.5 times greater in elderly
• Extended-release injection:
  • ~30 days

Time to peak, plasma:

• Peak plasma concentrations achieved by an oral dosage are 5 times lower than those produced by IM treatment.
• Extended-release injection:
  • ~7 day
• Short-acting injection:
  • 15-45 mins
• P/O:
  • Children (10-18 years; n=8):
    • 4.7 ± 3.7 hours.
  • Adults:
    • ~6 hours

Excretion:

• Urine (57%, 7% as unchanged drug).
• Feces (30%)

Clearance:

• P/O:
• Children (10 to 18 years; n=8):
  • Apparent:
    • 9.6 ± 2.4 L/hour.
• Adults:
  • Apparent:
    • 25 L/hour [12 to 47 L/hour (5th to 95th percentile)].
    • 40% increase in olanzapine clearance in smokers.
    • 30% decrease in females

International Brand Names of Olanzapine:

• ZyPREXA
• ZyPREXA Relprevv
• ZyPREXA Zydis
• Abbott-OLANZapine ODT
• ACCEL-OLANZapine
• ACT OLANZapine ODT
• ACT OLANZapine
• APO-OLANZapine
• APO-OLANZapine ODT
• Auro-Olanzapine ODT
• JAMP OLANZapine FC
• JAMP OLANZapine ODT
• Mar-OLANZapine ODT
• Mar-OLANZapine
• MINTOLANZapine ODT
• MYLAN-OLANZapine ODT
• MYLAN-OLANZapine
• PHLOLANZapine ODT
• PHL-OLANZapine
• PMS-OLANZapine
• PMS-OLANZapine ODT
• RAN-OLANZapine
• RAN-OLANZapine ODT
• RIVA-OLANZapine
• RIVA-OLANZapine ODT
• SANDOZ OLANZapine
• SANDOZ OLANZapine ODT
• TEVA-OLANZapine
• TEVA-OLANZapine OD
• TEVA-OLANZapine ODT
• VAN-OLANZapine
• ZyPREXA
• ZyPREXA Zydis
• Aedon
• Arenbil
• Benexafrina OD
• Benzopain
• Dozic
• Egolanza
• Exzapine
• Lanzek
• Lanzek Zydis
• Lanzine
• Lanzine ODT
• Lapozan
• Lopez
• Marathon
• Meflax
• Midax
• Nodoff
• Nykob
• Okpine
• Olan
• Olandoz
• Olankline
• Olanpin
• Olanza
• Olanza OD
• Olanza ODT
• Olanzamed
• Olanzapro
• Olanzax
• Olapin-10
• Olapine
• Olazax
• Olazax Disperzi
• Oleanz
• Olmed
• Onzapin
• Onzapin OD
• Onzapin ODT
• Ozapex
• Ozin
• Placet
• Prexal
• Remital
• Rolyprexa
• Schisolazine
• Tolanz
• Tolaz MD
• Torolan
• Xytrex
• Zalasta
• Zanprex
• Zapilux
• Zapine
• Zappa
• Zelta
• Zeprex
• Zolafren
• Zozapin
• Zypadhera
• ZypAdhera
• Zypeace OD
• Zypine
• Zypine ODT
• Zyprexa
• Zyprexa Velotab
• Zyprexa Zydis
• Zyrepin

Olanzapine Brand Names in Pakistan:

Olanzapine Tablets 5 Mg in Pakistan
Absolute	Xenon Pharmaceuticals (Pvt) Ltd.
Amprexa	Amarant Pharmaceuticals (Pvt)
Amprexa	Shrooq Pharmaceuticals
Avenia	Paramount Pharmaceuticals
Aziva	Noa Hemis Pharmaceuticals
Cirinzapine	Cirin Pharmaceuticals (Pvt) Ltd.
Furmium	Indus Pharma (Pvt) Ltd.
Lepinza	Organic Pharmaceuticals.
Linzap	Hiranis Pharmaceuticals Pvt Ltd
Mirapine	Miracle Pharmaceuticals(Pvt) Ltd
Nirvanol	Standpharm Pakistan (Pvt) Ltd.
Nozapin	Novins International
O-Zip	Glitz Pharma
Olan	Medizan Labs (Pvt) Ltd
Olan-Z	Lowitt Pharmaceuticals (Pvt) Ltd
Olanpia	Aries Pharmaceuticals (Pvt) Ltd
Olansaf	Saaaf Pharmaceuticals
Olanz	Gray`S Pharmaceuticals
Olanzi	Opal Laboratories (Pvt) Ltd.
Olanzia	Werrick Pharmaceuticals
Olanzil	Candid Pharmaceuticals
Olanzin	Rasco Pharma
Olanzip	Ferroza International Pharmaceuticals (Pvt) Ltd.
Olaz	Tg Pharma
Oleanz	Genome Pharmaceuticals (Pvt) Ltd
Olepra	Genetics Pharmaceuticals
Olifass	Fassgen Pharmaceuticals
Olimag	Caraway Pharmaceuticals
Olpresa	Maark Pharma
Olzar	Bryon Pharmaceuticals (Pvt) Ltd.
Onza	Shaheen Pharmaceuticals
Opine	Medicaids Pakistan (Pvt) Ltd.
Ozapine	Medicraft Pharmaceuticals (Pvt) Ltd.
Phrenno	Saydon Pharmaceutical Industries (Pvt) Ltd.
Pinaz	Bio Labs (Pvt) Ltd.
Pinsure	Medisure Laboratories Pakistan (Pvt.) Ltd.
Supzine	Maple Pharmaceuticals (Pvt) Ltd
Swazapin	Swan Pharmaceuticals(Pvt) Ltd
Unexapine	Tg Pharma
Zanzia	English Pharmaceuticals Industries
Zapin	Glitz Pharma
Zapsel	Hansel Pharmacueutical Pvt (Ltd)
Zestine	Pulse Pharmaceuticals
Zopera	Linear Pharma
Zydis	Eli Lilly Pakistan (Pvt) Ltd.
Zypirex	Everest Pharmaceuticals
Zyprexa	Eli Lilly Pakistan (Pvt) Ltd.

 

Olanzapine Tablets 10 Mg in Pakistan
Absolute	Xenon Pharmaceuticals (Pvt) Ltd.
Amprexa	Amarant Pharmaceuticals (Pvt)
Amprexa	Shrooq Pharmaceuticals
Avenia	Paramount Pharmaceuticals
Aziva	Noa Hemis Pharmaceuticals
Cirinzapine	Cirin Pharmaceuticals (Pvt) Ltd.
Furmium	Indus Pharma (Pvt) Ltd.
Lapin	Wise Pharmaceuticals (Pvt) Ltd
Lepinza	Organic Pharmaceuticals.
Linzap	Hiranis Pharmaceuticals Pvt Ltd
Mirapine	Miracle Pharmaceuticals(Pvt) Ltd
Nirvanol	Standpharm Pakistan (Pvt) Ltd.
Nozapin	Novins International
Olan	Medizan Labs (Pvt) Ltd
Olan-Z	Lowitt Pharmaceuticals (Pvt) Ltd
Olanpia	Aries Pharmaceuticals (Pvt) Ltd
Olansaf	Saaaf Pharmaceuticals
Olanz	Gray`S Pharmaceuticals
Olanzi	Opal Laboratories (Pvt) Ltd.
Olanzia	Werrick Pharmaceuticals
Olanzin	Rasco Pharma
Olanzip	Ferroza International Pharmaceuticals (Pvt) Ltd.
Olaz	Tg Pharma
Oleanz	Genome Pharmaceuticals (Pvt) Ltd
Olepra	Genetics Pharmaceuticals
Olifass	Fassgen Pharmaceuticals
Olimag	Caraway Pharmaceuticals
Olinzib	Bloom Pharmaceuticals (Pvt) Ltd.
Olpresa	Maark Pharma
Olzar	Bryon Pharmaceuticals (Pvt) Ltd.
Onza	Shaheen Pharmaceuticals
Ozapine	Medicraft Pharmaceuticals (Pvt) Ltd.
Ozip	Global Pharmaceuticals
Phrenno	Saydon Pharmaceutical Industries (Pvt) Ltd.
Pinaz	Bio Labs (Pvt) Ltd.
Supzine	Maple Pharmaceuticals (Pvt) Ltd
Swazapin	Swan Pharmaceuticals(Pvt) Ltd
Unexapine	Tg Pharma
Zanzia	English Pharmaceuticals Industries
Zapin	Glitz Pharma
Zapsel	Hansel Pharmacueutical Pvt (Ltd)
Zestine	Pulse Pharmaceuticals
Zopera	Linear Pharma
Zydis	Eli Lilly Pakistan (Pvt) Ltd.
Zyprexa	Eli Lilly Pakistan (Pvt) Ltd.
Zyripine	Zain Pharmaceutical

 

Olanzapine Tablets 7.5 Mg in Pakistan
Nilcosyn	Indus Pharma (Pvt) Ltd.
Olanzia	Werrick Pharmaceuticals
Olzar	Bryon Pharmaceuticals (Pvt) Ltd.
Pinsure	Medisure Laboratories Pakistan (Pvt.) Ltd.
Zapsel	Hansel Pharmacueutical Pvt (Ltd)
Zyprexa	Eli Lilly Pakistan (Pvt) Ltd.

 

Olanzapine Capsules 5 Mg in Pakistan
Olanziscot	Scotmann Pharmaceuticals
Prelap	Aptcure Private Limited

 

Olanzapine Capsules 10 Mg in Pakistan
Olanziscot	Scotmann Pharmaceuticals
Prelap	Aptcure Private Limited

 

Olanzapine Capsules 12 Mg in Pakistan
Olanco	Genome Pharmaceuticals (Pvt) Ltd