ADMINISTRATION ROUTES:
PO, IM, NG, NJ
ALTERNATIVE NAMES:
Zyprexa
ICU INDICATIONS:
- Agitation and delirium
- Psychosis
PRESENTATION AND ADMINISTRATION:
IM:
Zyprexa IM 10 mg. Reconstitute with 2.1 mL of sterile water for injection and administer by IM injection
PO / NG:
Tablets:
Zyprexa 2.5mg tablets (white), Zyprexa 5mg tablets (white), Zyprexa 10 mg tablets (white)
Wafers:
Zyprexa 5mg wafer (yellow), Zyprexa 10 mg wafer (yellow)
Note: for NG or NJ administration, dissolve wafers and give via NG/NJ tube
DOSAGE:
IM:
5-10 mg
Additional dose up to 10 mg after 2 hours
Further dose up to 10 mg given 4 hours after second dose
Maximum dose 30 mg in 24 hours
PO:
5 - 20 mg daily
Can be administered in divided doses
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose in renal impairment
| GFR (ml/min) | DOSE |
|---|---|
| <10 | 5 mg, titrate as needed |
| 10-20 | 5 mg, titrate as needed |
| >20-50 | 5 mg, titrate as needed |
Dose in renal replacement therapy
| MODALITY | DOSE |
|---|---|
| CAPD | 5 mg, titrate as needed |
| HD | 5 mg, titrate as needed |
| CVVHDF | 5 mg, titrate as needed |
DOSAGE IN PAEDIATRICS:
0.1 - 0.2 mg/kg daily PO
Can increase to 0.4 mg/kg daily PO
CLINICAL PHARMACOLOGY:
Olanzapine is a selective monoaminergic antagonist. The mechanism of action of olanzapine is unknown; however, it has been proposed that this drug's efficacy is mediated through a combination of dopamine and serotonin type 2 (5HT2) antagonism.
CONTRAINDICATIONS:
- Sensitivity to olanzapine
WARNINGS:
Increased risk of deaths in patients with dementia
Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo.
Hyperglycaemia and Diabetes Mellitus
Hyperglycaemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics including olanzapine.
Neuroleptic Malignant Syndrome (NMS)
A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with administration of antipsychotic drugs, including olanzapine.
Tardive Dyskinesia
A syndrome of potentially irreversible, involuntary, dyskinetic movements may develop in patients treated with antipsychotic drugs.
PRECAUTIONS:
General:
Olanzapine may induce hypotension. It has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease. Patients with these diagnoses were excluded from premarketing clinical studies. Because of the risk of orthostatic hypotension with olanzapine, use with caution in cardiac patients.
During premarketing testing, seizures occurred around 1% of patients. Olanzapine should be used cautiously in patients with a history of seizures or with conditions that potentially lower the seizure threshold.
Laboratory Tests:
No tests additional to routine ICU tests are indicated
Drug/Laboratory Test Interactions:
None reported
IMPORTANT DRUG INTERACTIONS IN ICU:
Because of its potential for inducing hypotension, olanzapine may enhance the effects of antihypertensive agents.
ADVERSE REACTIONS:
Body as a Whole:
Fever
Cardiovascular System:
Hypotension, tachycardia, hypertension
Digestive System:
Dry mouth, constipation, dyspepsia, vomiting
Nervous System:
Somnolence, dizziness, tremor, hypertonia