Adult Dosing
Schizophrenia
- Adults: Start 5-10 mg PO qd, with a target dose of 10 mg/day within several days
- Dose adjustments: Increase or decrease by 5 mg/day at intervals not <1 week. Max: 20 mg/day. Doses >10 mg/day were not demonstrated to be more efficacious than the 10 mg/day dose
Notes:- Initiate with 5 mg PO qd for debilitated patients, nonsmoking female patients
65 yrs, and those predisposed to hypotensive reactions; may titrate cautiously when indicated - Periodically reassess the need for therapy for the individual patient when used for extended periods
Bipolar I disorder (manic/mixed episodes)
Monotherapy
- Start 10-15 mg PO qd
- Dose adjustments: Increase or decrease by 5 mg/day at intervals not <24 hrs. Max: 20 mg/day
Adjuct to lithium or valproate
- 10 mg PO qd without regard to meals; Max: 20 mg/day
Note:
- Periodically reassess the need for therapy for the individual patient when used for extended periods
Obsessive-compulsive disorder [Non-FDA Approved]
- 5-20 mg/day PO
- Max dose: 20 mg/day
Pediatric Dosing
- Safety and effectiveness of olanzapine in children <13 yrs have not been established
Schizophrenia
- 13-17 yrs: Start at 2.5-5 mg PO qd, with a target dose of 10 mg/day
- Dose adjustments: Increments/decrements of 2.5 or 5 mg are recommended; Max: 20 mg/day
Note:
- Periodically reassess the patients to determine the need for maintenance therapy
Bipolar disorder (manic/mixed episodes)
Monotherapy
- 13-17 yrs: Start with 2.5-5 mg PO qd, with a target dose of 10 mg/day
- Dose adjustments: Increments/decrements of 2.5 or 5 mg are recommended; Max: 20 mg/day
Note:
- Periodically reassess the patients to determine the need for maintenance therapy
[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]
- Possibility of a suicide attempt is inherent in schizophrenia and bipolar I disorder. High-risk patients should be closely supervised and prescribed the smallest quantity of tablets consistent 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 taking 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
- Olanzapine may induce orthostatic hypotension associated with dizziness, tachycardia, bradycardia, 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; not recommended in 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)
- Should be used with caution in patients with a history of seizures or those with conditions that significantly lower seizure threshold
- 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
- 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
Cautions: Use cautiously in
- Hepatic impairment
- Elderly patients (dose reduction recommended)
- Cerebrovascular disease
- CNS depressant use
- Alcohol use
- Smoking habit changes
- Cardiovascular disease
- Significant prostatic hypertrophy
- Narrow angle glaucoma
- History of paralytic ileus or related conditions
- Concurrent hepatotoxic agent use
- Hypovolemia
- Dehydration
- Diabetic mellitus risk
- GI/GU obstruction
- Phenylketonuria (phenylalanine-containing forms)
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, but sedation has occurred. Monitor the infant for drowsiness and developmental milestones, especially if other antipsychotics are used simultaneously. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 11 January 2011). According to the manufacturer's data, women taking olanzapine should not breastfeed.
Pricing data from www.DrugStore.com in U.S.A.
- ZyPREXA 10 MG TABS [Bottle] (LILLY)
30 mg = $624.01
90 mg = $1788.98 - ZyPREXA Zydis 5 MG TBDP [Box] (LILLY)
30 mg = $470.01
90 mg = $1319.94 - ZyPREXA 2.5 MG TABS [Bottle] (LILLY)
30 mg = $331
90 mg = $960.97 - ZyPREXA 20 MG TABS [Bottle] (LILLY)
30 mg = $1285.99
90 mg = $3791.06 - ZyPREXA 15 MG TABS [Bottle] (LILLY)
30 mg = $908.03
90 mg = $2701.99 - ZyPREXA Zydis 10 MG TBDP [Box] (LILLY)
30 mg = $659.97
90 mg = $1927.89 - ZyPREXA 5 MG TABS [Bottle] (LILLY)
30 mg = $431.98
90 mg = $1215.99
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
