Class: Thienobenzodiazepine, Antipsychotic
Dosage Forms. Tablet: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg; Tablet (Disintegrating): 5 mg, 10 mg, 15 mg, 20 mg
Common FDA Label Indication, Dosing, and Titration.
1. Bipolar disorder, acute mixed or manic episodes: Adults, 10-15 mg/d po, may titrate in 5-mg/d increments; Children 13-17 y, 2.5-5 mg/d po, may titrate in 2.5- to 5-mg/d increments
2. Schizophrenia: Adults, 5-10 mg/d po, may titrate to 10-20 mg/d po within several days; Children 13-17 y, 2.5-5 mg/d po, may titrate to 10 mg/d po
Off-Label Uses. None
MOA. Olanzapine is an atypical antipsychotic agent that is a potent serotonin-5HT2 and dopamine-D2 antagonist. Antipsychotic effect is most likely related to blockade of postsynaptic dopaminergic receptors in the mesolimbic and prefrontal cortexes of the brain, although other neurotransmitter systems also are involved.
Drug Characteristics: Olanzapine
Medication Safety Issues: Olanzapine
Drug Interactions: Olanzapine
Adverse Reactions: Olanzapine
Efficacy Monitoring Parameters. Improvement in schizophrenia, bipolar disorder, agitation, or treatment-resistant depression.
Toxicity Monitoring Parameters. FPG prior to treatment and periodically in patients with DM. CBC, lipid profiles at baseline and periodically thereafter. Symptoms of neuroleptic malignant syndrome. Check body weight regularly during treatment.
Key Patient Counseling Points. Avoid activities requiring mental alertness or coordination until drug effects are realized. Drug may impair heat regulation. Rise from a sitting/lying-down position slowly. Report symptoms of tardive dyskinesia or neuroleptic malignant syndrome. Diabetic patients should monitor for hyperglycemia and report difficulties with glycemic control. Avoid alcohol while taking this drug.
Clinical Pearls. Max dose is 20 mg/d. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death compared to placebo. Although the causes of death in clinical trials were varied, most of the deaths were cardiovascular or infectious in nature.