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Olanzapine

Medical and Pharmacy Editor:

Brand Name: Zyprexa, Zyprexa Relprevv, Zyprexa Zydis

Generic Name: olanzapine

Drug Class: Antipsychotics, 2nd Generation; Antimanic Agents

What Is Olanzapine and How Does It Work?

Olanzapine is used to treat certain mental/mood conditions (such as schizophrenia, bipolar disorder). It may also be used in combination with other medication to treat depression. This medication can help to decrease hallucinations and help you to think more clearly and positively about yourself, feel less agitated, and take a more active part in everyday life.

Olanzapine belongs to a class of drugs called atypical antipsychotics. It works by helping to restore the balance of certain natural substances in the brain.

Talk to the doctor about the risks and benefits of treatment (especially when used in teenagers).

Olanzapine is available under the following different brand and other names: Zyprexa, Zyprexa Relprevv, Zyprexa Zydis.

Dosages of Olanzapine

Adult Dosage Forms & Strengths

Tablet

  • 2.5 mg
  • 5 mg
  • 7.5 mg
  • 10 mg
  • 15 mg
  • 20 mg

Tablet, orally disintegrating

  • 5 mg
  • 10 mg
  • 15 mg
  • 20 mg

Intramuscular (IM) injection, short-acting

  • 10 mg

Intramuscular (IM), extended-release suspension

  • 210 mg/vial
  • 300 mg/vial
  • 405 mg/vial

Pediatric Dosage Forms & Strengths

Tablet

  • 2.5 mg
  • 5 mg
  • 7.5 mg
  • 10 mg
  • 15 mg
  • 20 mg

Tablet, orally disintegrating

  • 5 mg
  • 10 mg
  • 15 mg
  • 20 mg

Dosage Considerations – Should be Given as Follows:

Schizophrenia in Adults

Taken orally

  • 5-10 mg per day initially; if necessary, may be titrated upward in increments of 5 mg per day at intervals greater than 1 week
  • Maintenance: 10-20 mg per day; not to exceed 20 mg per day

Intramuscular (IM), extended-release

  • Recommended dosing based on oral dosing
  • Oral dosage 10 mg per day: Give 210 mg IM every 2 weeks or 405 mg IM every 4 weeks for 1st 8 weeks, then 150 mg every 2 weeks or 300 mg every 4 weeks
  • Oral dosage 15 mg per day: Give 300 mg IM every 2 weeks for 1st 8 weeks, then 210 mg every 2 weeks or 405 mg every 4 weeks
  • Oral dosage 20 mg per day: Give 300 mg IM every 2 weeks for 1st 8 weeks, then 300 mg every 2 weeks

Schizophrenia in Children

Less than 13 years: Safety and efficacy not established

  • 13-17 years: 2.5-5 mg per day taken orally initially
  • target dosage, 10 mg per day
  • adjust by increments/decrements of 2.5-5 mg; dosage range, 2.5-20 mg per day

Bipolar Mania in Adults

Used as monotherapy or in combination with lithium or valproate

Monotherapy: 10-15 mg/day taken orally initially

Adjunct to lithium or valproate: 10 mg/day taken orally initially

Maintenance: 5-20 mg/day taken orally; not to exceed 20 mg/day

Depression in bipolar disorder

  • Use in combination with fluoxetine
  • 5 mg in evening; adjusted to range of 5-12.5 mg/day; may be increased up to 20 mg/day in resistant depression

Dosing considerations

  • Dosage adjustments, if necessary, should be made at intervals greater than 24 hours

Schizophrenia or Bipolar-Related Agitation in Adults

  • 10 mg IM (short-acting)
  • Consider 5-7.5 mg for geriatric patients or if circumstances warrant
  • Subsequent IM doses up to 10 mg may be administered 2 hours after 1st dose and 4 hours after 2nd dose; not to exceed 30 mg/day

Bipolar I Disorder (Manic or Mixed Episodes) in Children

Less than 13 years: Safety and efficacy not established

  • 13-17 years: 2.5-5 mg/day taken orally initially
  • target dosage, 10 mg/day
  • Adjust by increments/decrements of 2.5-5 mg
  • Dosage range, 2.5-20 mg/day

Stuttering (Off-label) in Children

Children 12 years of age or under

  • 1.25 mg taken orally at bedtime for 4 weeks, then 2.5 mg at bedtime

Children older than 12 years of age

  • 2.5 mg taken orally at bedtime for 4 weeks, then 5 mg at bedtime

Dosing Modifications

Renal impairment: Dose adjustment not necessary

Hepatic impairment: Dose adjustment may be necessary; use caution

Administration

IM administration

  • Short-acting and extended-release IM preparations are not interchangeable
  • Short-acting: Dissolve in 2.1 mL SWI to yield 5 mg/mL solution; inject deep and slow within 1 hour of reconstitution
  • Extended-release: Reconstitute with supplied diluent (210-mg vial in 1.3 mL; 300-mg vial in 1.8 mL; 405-mg vial in 2.3 mL); inject deep in gluteal muscle
  • Do not use lorazepam injection for reconstitution, and do not mix with haloperidol or diazepam in syringe

Geriatric Dosing Considerations

Not approved for dementia-related psychosis, because of increased risk of cardiovascular or infection-related mortality

Consider lower starting dosage

Schizophrenia

  • 2.5-5 mg/day taken orally initially

IM (extended-release): 150 mg every 4 weeks in patients who are debilitated or predisposed to hypotensive episodes; not studied in patients with renal or hepatic impairment; requires deep IM administration (muscle mass in elderly may be sufficient)

Schizophrenia or Bipolar-Related Agitation

IM (short-acting):

  • 5 mg; consider 2.5 mg if patient is predisposed to hypotensive reactions
Medically Reviewed by a Doctor on 3/2/2017



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