Adult Dosing
Zyprexa
Agitation associated with schizophrenia and bipolar I mania
- Initial recommended dose: 10 mg IM (range: 2.5-10 mg). If agitation persists, may give up to 10 mg IM 2 hrs after the initial dose, and then may repeat 4 hrs after the second dose PRN. Max: 30 mg/day
- A lower dose of 5 or 7.5 mg may be considered if clinically warranted
Notes:- If continuous olanzapine therapy is clinically indicated, consider initiating oral olanzapine in a range of 5-20 mg/day as soon as clinically appropriate
- Consider a dose of 5 mg/injection for geriatric patients and a lower dose of 2.5 mg/injection for patients who otherwise might be debilitated, be predisposed to hypotensive reactions, or be more sensitive to olanzapine
Zyprexa Relprevv
Treatment of schizophrenia
- Recommended dose range: 150-300 mg IM q2 wks; alt: 405 mg q4 wks
- Conversions from 10 mg qd PO
- 210 mg IM q2 wks; alt: 405 mg IM q4 wks x 8 wks and then 150 mg IM q2 wks; alt: 300 mg IM q4 wks
- Max: 300 mg q2 wks; alt: 405 mg q4 wks
- Conversions from 15 mg qd PO
- 300 mg IM q2 wks x 8 wks followed by 210 mg IM q2 wks; alt: 405 mg IM q4 wks
- Max: 300 mg q2 wks; alt: 405 mg q4 wks
- Conversions from 20 mg qd PO
- 300 mg IM q2 wks
- Max: 300 mg q2 wks
Notes:- Prior to initiating therapy, establish tolerability with oral olanzapine
- Injection should be administered by a healthcare professional q2-4 wks by deep IM gluteal injection; do not massage the injection site
- Periodically reassess to determine the need for continued treatment
- Recommended initial dose is 150 mg IM q4 wks in patients who are debilitated, predisposed to hypotensive reactions, have slower metabolism (e.g., nonsmoking female patients
65 years of age), and who may be more sensitive to olanzapine
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
See Supplemental Patient Information
- Elderly patients treated with antipsychotic drugs for dementia-related psychosis are at an increased risk of death; olanzapine is not approved for treatment of dementia-related psychosis [US Black Box Warning]
- Sedation (including coma) and delirium have been reported following an injection of Zyprexa Relprevv [US Black Box Warning]. Clinical signs and symptoms included dizziness, confusion, altered gait, disorientation, difficulty ambulating, weakness, agitation, slurred speech, extrapyramidal symptoms, convulsion, hypertension, and reduced level of consciousness ranging from mild sedation to coma
- Possibility of a suicide attempt exists in schizophrenia and bipolar I disorder. High-risk patients should be closely supervised with good clinical management to reduce the risk of overdose
- Neuroleptic malignant syndrome (NMS), characterized by hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability, has been reported during olanzapine therapy
- Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has occurred in patients receiving olanzapine
- Undesirable alterations in lipids, clinically significant elevations in triglyceride levels (in some cases >500 mg/dL), and modest mean increases in total cholesterol have been reported with therapy
- Consider potential consequences of weight gain prior to initiating olanzapine therapy; monitor weight regularly during therapy
- Olanzapine may produce a syndrome of potentially irreversible, involuntary dyskinetic movements; elderly patients, especially elderly women are at a higher risk
- Therapy may induce orthostatic hypotension associated with bradycardia, dizziness, tachycardia, and occasionally syncope, particularly during the initial dose-titration period
- Leukopenia, neutropenia, and agranulocytosis may occur during therapy
- Esophageal dysmotility and aspiration have occurred with therapy. Patients suffering from Alzheimer’s disease are at an increased risk of developing aspiration pneumonia; therapy not recommended for treatment of Alzheimer’s disease
- Antipsychotics are associated with disruption of the body’s ability to reduce core body temperature. Use with caution in patients experiencing conditions that may elevate their core temperature (e.g., exposure to extreme heat, concomitant anticholinergic therapy, strenuous exercise)
- Olanzapine elevates prolactin levels, which may suppress hypothalamic GnRH resulting in reduced pituitary gonadotropin secretion, which in turn may impair gonadal steroidogenesis in both male and female patients
- Should be used with caution in patients with a history of seizures or those with conditions that significantly lower seizure threshold
- Olanzapine may impair mental and/or physical abilities required for performance of hazardous tasks; caution patients against operating machinery, including automobiles, until they are reasonably certain that the therapy does not adversely affect their ability to engage in such activities
- Perform fasting blood glucose testing and lipid profile at the beginning of, and regularly during, treatment
- Intended for intramuscular use only; do not administer intravenously or subcutaneously
Cautions: Use cautiously in
- Hepatic impairment
- Elderly patients (dose reduction recommended)
- Dementia (increased risk of mortality)
- Cerebrovascular disease
- CNS depressant use
- Smoking habit changes
- Alcohol use
- Cardiovascular disease
- Seizure history or risk of seizures
- History of drug-induced leukopenia or neutropenia
- Concurrent hepatotoxic agent use
- Hypotension
- Hypovolemia
- Dehydration
- Diabetic mellitus risk
- GI/GU obstruction
- High environmental temperature
- Benign prostatic hypertrophy
- Angle-closure glaucoma
- Phenylketonuria (phenylalanine-containing forms)
- History of paralytic ileus or related conditions
Supplemental Patient Information
- Advice patients to change positions carefully to help prevent orthostatic hypotension, and to lie down if they feel dizzy or faint, until they feel better
- Advice patients not to work on hazardous machinery, including automobiles, while on medication
- Caution patients to avoid alcohol while taking olanzapine
Pregnancy Category:C
Breastfeeding: Maternal doses of olanzapine up to 20 mg daily produce low levels in milk and undetectable levels in the serum of breastfed infants. Short-term side effects have not been reported in most cases, but sedation has occurred. Very limited long-term follow-up of infants exposed to olanzapine reveals that infants developed normally, but combinations of antipsychotic agents can negatively affect development. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 12 January 2011). Manufacturer advises women receiving olanzapine not to breast feed.
