HALF-LIFE: 21-54 hours
STARTING DOSE: 5mg-10mg PO daily
TARGET DOSING RANGE: 10mg-20mg PO daily
BEST TIME TO DOSE: Bedtime
HOW TO DOSE:
>> Initial 5mg-10mg PO daily
>> Increase dose by 5mg per day each week to target dose of 10mg-20mg per day
>> Max approved dose 20mg/day (some patients may require up to 60mg/day)
>> For Bipolar depression:
Initial 6mg/25mg PO QHS
Increase to target dose range of olanzapine (6mg-12mg) / Fluoxetine (25mg-50mg) PO daily
PREGNANCY: Minimal data on safety.
BREASTFEEDING: Minimal data on safety.
- Dry mouth, sedation, orthostatic hypotension, fatigue, Neuroleptic Malignant Syndrome (rare), weight gain, metabolic side effects (dyslipidemia, insulin resistance), prolactin elevation, akathisia/restlessness, abnormal movements, seizures (rare)
- Schizophrenia, 13yo and older
- Bipolar mania (monotherapy and adjunctive), 13yo and older
- Bipolar maintenance (monotherapy)
- Acute agitation in schizophrenia or bipolar (Intramuscular formulation only)
- Bipolar depression (with fluoxetine*), 13yo and older
- Treatment resistant unipolar depression (with fluoxetine*)
*Olanzapine-Fluoxetine combination = Symbyax)
Mechanism(s) of Action
- Dopamine 2 (D2) Receptor antagonism, 5HT2A Receptor antagonism, 5HT2C Receptor Antagonism, Antihistaminic effects, alpha-1 receptor antagonism
- Comes in a Tablet or Orally Disintegrating Tablets (ODT, zydis), Intramuscular injection, and Depot (relprevv) injection
- Olanzapine has been studied and found helpful for chemotherapy induced nausea and vomiting
- Improvement in mood in Schizophrenia, Bipolar, and Refractory depression
- Olanzapine + Fluoxetine have possibly synergistic antidepressant effects due to 5HT2C/5HT2A properties
- Dose related risk for extrapyramidal symptoms (e.g., dystonia, parkinsonism)
- Low risk for prolactin elevation
- Sedation (dose dependent) is common
- Dry mouth (dose related) is common
- Weight gain is common (10-30 lbs weight gain common)
- Low risk for QTc prolongation
- High cardio-metabolic risk (↑triglycerides, insulin resistance)
- Orally disintegrating tablets (ODT, zydis) may reduce potential for weight gain
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