Zyprexa, Zyprexa Zydis
Classifications: psychotherapeutic agent, antipsychotic, atypical; Therapeutic:antipsychotic, antimanic
Pregnancy Category: C
2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg tablets; 10 mg, 15 mg, 20 mg orally disintegrating tablets; 10 mg powder for injection
Antipsychotic activity is thought to be due to antagonism for both serotonin 5-HT2A/2C and dopamine D14 receptors. May inhibit the CNS presynaptic neuronal reuptake of serotonin and dopamine. Antagonism of alpha-adrenergic
receptors results in the adverse effect of orthostatic hypotension.
Effective antipsychotic activity.
Management of psychotic disorders, treatment of bipolar disorder, acute agitation (IM).
Hypersensitivity to olanzapine; abrupt discontinuation, coma, severe CNS depression, subcutaneous or intramuscular injection
of olanzapine; tardive dyskinesia; infants, pregnancy (category C), lactation.
Known cardiovascular disease, neurological disease, stroke, cerebrovascular disease, Parkinson disease, dementia; history
of seizures, conditions that predispose to hypotension (i.e., dehydration, hypovolemia); history of syncope; history of breast
cancer; Japanese; diabetes mellitus; prostatic hypertrophy; closed-angle glaucoma; paralytic ileus; urinary retention; hepatic
or renal impairment, concurrent use of hepatotoxic drugs, jaundice; predisposition to aspiration pneumonia; may increase
risk of stroke in elderly patients with dementia; history of or high risk for suicide. Safety and effectiveness in children
and adolescents are not established.
Route & Dosage
Adult: PO Start with 510 mg once/d, may increase by 2.55 mg qwk until desired response (usual range 1015 mg/d, max:
Geriatric: PO Start with 5 mg once/d
Adult: PO Start with 1015 mg once/d, may increase by 5 mg q24h if needed
Adult: IM 10 mg, do not repeat more frequently than q2h (max: 30 mg/24h)
Geriatric: IM 2.55 mg once
- Do not push orally disintegrating tablet through blister foil. Peel foil back and remove tablet. Tablet will disintegrate
Adverse Effects (≥1%)Body as a Whole: Weight gain,
fever, back and chest pain, peripheral and lower extremity edema, joint pain, twitching, premenstrual syndrome
. CNS: Somnolence, dizziness, headache, agitation, insomnia, nervousness, hostility,
anxiety, personality disorder, akathisia, hypertonia, tremor amnesia, euphoria, stuttering, extrapyramidal symptoms
events, parkinsonism, akathisia
), tardive dyskinesia. CV:
Postural hypotension, hypotension, tachycardia. Special Senses:
Amblyopia, blepharitis. GI:
Abdominal pain, constipation
, dry mouth, increased appetite, increased salivation, nausea, vomiting, elevated liver function
, hematuria, urinary incontinence, metrorrhagia. Respiratory:
Rhinitis, cough, pharyngitis, dyspnea
May enhance hypotensive effects of antihypertensives
. May enhance effects of other CNS active drugs
, alcohol. Carbamazepine, omeprazole, rifampin
may increase metabolism
and clearance of olanzapine. Fluvoxamine
may inhibit metabolism
and clearance of olanzapine.
Rapidly from GI tract; 60% reaches systemic circulation. Onset:
15 min IM. Peak:
6 h. Distribution:
93% protein bound, secreted into breast milk of animals (human secretion unknown). Metabolism:
In liver (CYP1A2). Elimination:
Approximately 57% in urine, 30% in feces. Half-Life:
Assessment & Drug Effects
- Monitor diabetics for loss of glycemic control.
- Withhold drug and immediately report S&S of neuroleptic malignant syndrome (see Appendix F); assess for and report S&S of
tardive dyskinesia (see Appendix F).
- Lab tests: Periodically monitor ALT, especially in those with hepatic dysfunction or being treated with other potentially
hepatotoxic drugs. Periodic blood glucose monitoring.
- Monitor BP and HR periodically. Monitor temperature, especially under conditions such as strenuous exercise, extreme heat,
or treatment with other anticholinergic drugs.
- Monitor for seizures, especially in older adults and cognitively impaired persons.
Patient & Family Education
- Carefully monitor blood glucose levels if diabetic.
- Do not drive or engage in potentially hazardous activities until response to drug is known; drug increases risk of orthostatic
hypotension and cognitive impairment.
- Learn common adverse effects and possible drug interactions.
- Avoid alcohol and do not take additional medications without informing physician.
- Do not become overheated; avoid conditions leading to dehydration.