Pharm
Olanzapine
search
Olanzapine
, Zyprexa
Class
Atypical Antipsychotic
(Second
Gene
ration agent)
Neuroleptic
Thienobenzodiazepine
Mechanism
Primarily
Serotonin
Type II Antagonist (
5-HT
2 antagonist)
Also
Dopamine
, muscarinic
Anticholinergic
, alpha-1 and histamine H1 antagonist
Chemical structure similar to
Clozapine
Indications
Primary Indications
Schizophrenia
Acute mania phase of
Bipolar Disorder
Agitated Delirium
(emergency department)
Other Indications
Migraine Headache
Appears to have similar efficacy to
Droperidol
(
Inapsine
) for
Migraine Headache
Hill (2008) Acad Emerg Med 15(9):806-11 +PMID:19244630 [PubMed]
Avoid use in
Psychosis in Dementia
Higher risk of CVA and overall mortality in elderly
Dosing
Adults
Start: 5 to 10 mg orally daily
Increase in 5 mg increments weekly as tolerated
Maximum: 20 mg/day
Elderly
Initial: 1.25 to 2.5 mg PO qd
Titrate up as tolerated (watch for
Hypotension
)
Maximum: 10 mg/day
Acute management of
Agitation
Dose: 10 mg IM every 4 hours (up to 30 mg/day)
Emerging: Intravenous dosing
Only FDA approved for oral and IM delivery
Large HCMC ED study in 2016 demonstrated safety of IV doses (typically 5 mg)
No serious complications including no
QT Prolongation
(although
Hypoxia
did occur)
Martel (2016) Acad Emerg Med 23(1): 29-35 +PMID:26720055 [PubMed]
Adverse Effects
See
Antipsychotic
s
Weight gain (4 kg)
Sedation
Orthostatic Hypotension
Seizure
s (nearly 1% of patients)
Overall higher mortality in elderly
Lowest risk of
QTc Prolongation
compared with other
Antipsychotic
s
Hyperglycemia
Increased risk of
Diabetes Mellitus
Koro (2002) BMJ 325:243-5 [PubMed]
Hyperlipidemia
Koro (2002) Arch Gen Psychiatry 59:1021-6 [PubMed]
Other effects
Neuroleptic
malignant sydnrome (rare, but lethal)
Extrapyramidal Side Effect
s
Increased
Liver Function Test
s
Increased
Creatine Kinase
Pancreatitis
Anticholinergic
side effects
Drug Interactions
Increase
Antipsychotic
levels (toxicity risk): Monitor for toxicity
Ciprofloxacin
Fluvoxamine
Decrease
Antipsychotic
levels (lower efficacy)
Carbamazepine
Phenytoin
Nicotine
Rifampin
Omeprazole
Cardiorespiratory depression (includes sedation,
Bradycardia
and
Hypotension
)
Benzodiazepine
s (e.g.
Midazolam
)
Based on warning in prescribing information since 2005
Combination appears safe from studies in which Olanzapine was combined with
Benzodiazepine
s
EMA recommends separating dosing by 60 minutes
Williams (2018) Ment Health Clin 8(5): 208–213 +PMID: 30206503 [PubMed]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125121/
Safety
Pregnancy Category C
Not recommended during
Lactation
(found in
Breast Milk
)
Monitoring
See
Antipsychotic
References
Glauser and Peters (2016) Crit Dec Emerg Med 30(4): 17-27
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