Olanzapine

Tranquilizer, Sedative/Hypnotic · Thienobenzodiazepine

Indications

Schizophrenia.

Dosage

Adults: ORAL: Schizophrenia: Usual: 5-10 mg daily. Titrate: Adjust weekly by 5 mg/day. Max: 20 mg/day. Bipolar Disorder: Acute Manic & Mixed Episodes: Monotherapy: Initial: 10-15 mg daily. Combination therapy with lithium or valproate: Initial: 10 mg daily. Range: 5-20 mg/day. Max: 20 mg/day. Titrate: Adjust by 5 mg/day. Max: 20 mg/day. Maintenance monotherapy: 5-20 mg/day. Children: Not recommended. INJECTION: Adults: By deep IM injection into the gluteal muscle. Patients taking oral olanzapine 10 mg daily, initially 210 mg every 2 wk or 405 mg every 4 wk, then maintenance dose after 2 mth treatment, 150 mg every 2 wk or 300 mg every 4 wk; Patients taking oral olanzapine 15 mg daily, initially 300 mg every 2 wk, then maintenance dose after 2 mth treatment, 210 mg every 2 wk or 405 mg every 4 wk; Patients taking oral olanzapine 20 mg daily, initially 300 mg every 2 wk, then maintenance…

Administration

Short acting IM Inj: For IM use only. Inject slowly deep into muscle. Extended release IM Inj: For IM gluteal injection only after needle insertion in to muscle, aspirate to verify that no blood appears. Do not massage injection site. Stability: Injection extended release: Store at 20°C-25°C; excursions permitted to 15°C-30°C. Dilute as directed to final concentration of 150 mg/mL following the reconstitution, it may be stored at room temperature and use within 24 hours. Shake well to resuspend prior to administration. Injection short acting: Store at 20°C-25°C; excursions permitted to 15°C-30°C. Do not freeze. Protect from light. Reconstitute 10 mg vial with 2.1 mL SWFI. Resulting solution is 5 mg/mL. Use within 1 hour.

Adverse Effects

Somnolence, weight gain, increased appetite, dizziness, peripheral oedema, orthostatic hypotension, leucopenia, eosinophilia, neutropenia, akathisia, parkinsonism, dyskinesia, rash, erectile dysfunction, decreased libido, asthenia, oedema, arthralgia, pyrexia, fatigue, postural hypotension, anticholinergics effects, glucosuria, raised prolactin, LFTs, creatine kinase, uric acid, glucose, triglyceride and cholesterol levels. Abnormal gait, falls, pneumonia, raised body temp, lethargy, erythema, visual hallucinations, urinary incontinence in elderly patients with dementia. Sudden cardiac death.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: Narrow angle glaucoma. Precautions: Hepatic or renal impairment, prostatic hypertrophy, paralytic ileus, blood dyscrasias, bone marrow suppression, seizures, tardive dyskinesia, parkinson's disease, congenital long QT syndrome, CHF, cardiac hypertrophy, hypokalaemia, hypomagnesaemia, dyslipidaemia. Monitor lipids. Elderly, female, non-smokers. Monitor BP in elderly. Warn patients to report fever or muscle rigidity; suspect neuroleptic malignant syndrome. Diabetes or risk factors for diabetes. Monitor for hyperglycaemia, ketoacidosis and wt change. Risk factors for VTE. Withdraw gradually.

Interactions

Hepatotoxic drugs, CNS active drugs, alcohol, drugs that increase QTc interval, charcoal, smoking, CYP1A2 inducers or inhibitors (particularly carbamazepine, fluvoxamine, ciprofloxacin, nicotine), benzodiazepines, other CNS depressants, alcohol, dopaminergics.

Advice to Patient

Take with or without meals. Open the blister pack of disintegrating tablets only when you are ready to take the tablet. Peel back the foil and do not push tablet through the foil because doing so could damage the tablet. Place the tablet on tongue without breaking it and let it dissolve with saliva. Contact prescriber if there is difficulty in breathing, unrelieved constipation, unusual cough, flu-like symptoms, trembling in fingers, change in gait, change in vision, change in personality, anxiety, increased sleepiness, confusion, unusual movements, seizures, abnormal thoughts, unrelieved constipation. Avoid alcohol, smoking and caffeine during therapy. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Change position slowly from sitting or lying to standing. On start of therapy or change of dosage, patient should be…

Pharmacokinetics

Onset of action: Within 1 to 2 weeks for control of aggression, agitation, insomnia; 3 to 6 weeks for control of mania and positive psychotic symptoms. Adequate trial: Typically 6 weeks at maximum tolerated doses. Absorption: Oral: Well absorbed; not affected by food. Short-acting injection: Rapidly absorbed. Metabolism: Hepatic. Half-life elimination: Oral and IM (short-acting): Children: (10 to 18 years; n=8): 37.2 ± 5.1 hours; Adults: 30 hours (21 to 54 hours (5th to 95th percentile)]; approximately 1.5 times greater in elderly. Extended-release injection: Approx.30 days. Time to peak, plasma: Maximum plasma concentrations after IM administration are 5 times higher than maximum plasma concentrations produced by an oral dose. Extended-release injection: Approx.7 day. Short-acting injection: 15 to 45 minutes. Oral: Children (10 to 18 years; n=8): 47 ± 3.7 hours; Adults: Approx. 6…

Brands with this active ingredient

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