Olanzapine

Indications
 Oral
Schizophrenia
Adult: Initially, 5-10 mg daily adjusted in steps of 5 mg, according to response. Usual range: 5-20 mg daily. Doses >10 mg should be given only after clinical reassessment. Max: 20 mg daily.
Renal impairment: Initiate at lower dose (5 mg) and increase cautiously.
Hepatic impairment: Initiate at lower dose (5 mg) and increase cautiously.
Oral
Acute mixed or manic episodes in bipolar disorder
Adult: Initially, 10 or 15 mg daily as monotherapy or 10 mg daily when used as part of combination therapy. Adjust dose in steps of 5 mg; usual range: 5-20 mg daily. For prevention of recurrence: Start with 10 mg daily.
Renal impairment: Initiate at lower dose (5 mg) and increase cautiously
Hepatic impairment: Initiate at lower dose (5 mg) and increase cautiously
Intramuscular
Rapid control of agitation and disturbed behaviour in schizophrenia or mania
Adult: Initially, 5-10 mg followed by 5-10 mg as required 2 hr later. Max: 3 inj per 24-hr period; max (including oral olanzapine): 20 mg/day. May give injections for up to 3 days but should transfer to oral therapy as soon as possible.
Hepatic impairment: Dose adjustments may be needed.

Special Populations: Initial oral and IM dose is 5 mg daily for patients with renal and hepatic impairment. Reduce IM dose to ½ in the elderly.
Contraindications
 Angle-closure glaucoma; lactation. IM: History of CVS disease, heart surgery.
Warnings / Precautions
 Impaired renal, hepatic, cardiovascular function; prostatic hypertrophy; paralytic ileus; DM; parkinsonism; pregnancy. History of blood dyscrasias, myelosuppression, seizures; dementia; dyslipidaemia. IM: Hypotension, bradyarrhythmia, hypoventilation; monitor BP carefully. Caution when used in adolescents due to increased risk of weight gain and hyperlipidaemia. Efficacy and safety have not been established in paediatric patients <13 yr.
Adverse Reactions
 Postural hypotension; constipation; dizziness; wt gain; agitation; insomnia; akathisia; tremor; personality disorders; oedema; somnolence; increased appetite; antimuscarinic effects; speech difficulty; exacerbation of Parkinson's disease; hallucinations; asthenia; increased body temperature; bradycardia; hyperprolactinaemia; QT prolongation (uncommon); asymptomatic elevations of hepatic transaminases.
Potentially Fatal: Exacerbation of preexisting diabetes sometimes leading to ketoacidosis. Neuroleptic malignant syndrome.
Overdose Reactions
 Symptoms: Tachycardia, agitation/aggressiveness, dysarthria, extrapyrimidal symptoms, sedation/coma. Induction of emesis is not recommended, gastric lavage and admin of activated charcoal may be effective. Monitor closely and treat symptomatically.
Drug Interactions
 Olanzapine may antagonise the effects of levodopa and dopamine agonists. Drugs that induce CYP1A2 or glucuronyl transferase enzymes e.g. omeprazole and rifampicin, may increase olanzapine clearance. Inhibitors of CYP1A2 may potentially inhibit olanzapine elimination. Carbamazepine may increase the clearance of olanzapine. Concomitant admin of activated charcoal reduced the oral bioavailability of olanzapine by 50-60%. Caution should be taken when olanzapine is administered with centrally acting drugs and alcohol.
See Below for More olanzapine Drug Interactions
Mechanism of Actions
 Olanzapine is an atypical antipsychotic with affinity for serotonin 5-HT2A/2C, dopamine, muscarinic M1-M5, histamine H1 and adrenergic α1 receptors.
Absorption: Well absorbed from the GI tract (oral); peak plasma concentrations after 5-8 hr (oral) or 15-45 min (IM).
Distribution: Protein-binding: 93%.
Metabolism: Extensively hepatic by direct glucuronidation and oxidation.
Excretion: Urine (as metabolites), faeces; 30-38 hr (elimination half-life).
Administration
 May be taken with or without food.
Storage Conditions
 Intramuscular: Store at 15-30°C. Oral: Store at 15-30°C.
ATC Classification
 N05AH03 - olanzapine ; Belongs to the class of diazepines, oxazepines and thiazepines antipsychotics
Storage
 Intramuscular: Store at 15-30°C. Oral: Store at 15-30°C.
Available As
  • Olanzapine 10 mg
  • Olanzapine 15 mg
  • Olanzapine 2.5 mg
  • Olanzapine 20 mg
  • Olanzapine 5 mg
  • Olanzapine 7.5 mg

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