Olanzapine
ZYPREXA
What it isBroad D2, 5-HT2A, histamine, muscarinic, and adrenergic antagonist; schizophrenia and bipolar disorder.
Why this oneAmong the most effective antipsychotics, it also has an intramuscular option for acute agitation.
What limits itWeight, lipids, and glucose can worsen dramatically; smoking cessation raises exposure through loss of CYP1A2 induction.
FDA-approved for
- schizophrenia (1996)
- bipolar disorder (2000)
Off-label
- chemo nausea
- anorexia nervosa
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Schizophrenia | Adult | 5–10 mg QD | 10 mg/day | 20 mg/day |
| Schizophrenia | Adolescent | 2.5–5 mg QD | 10 mg/day | 20 mg/day |
| Bipolar I, manic/mixed (monotherapy) | Adult | 10 or 15 mg QD | 5–20 mg/day | 20 mg/day |
| Bipolar I, manic/mixed (monotherapy) | Adolescent | 2.5–5 mg QD | 10 mg/day | 20 mg/day |
| Bipolar I, manic/mixed (with lithium or valproate) | Adult | 10 mg QD | 5–20 mg/day | 20 mg/day |
| Depressive episodes in Bipolar I (with fluoxetine) | Adult | 5 mg olanzapine + 20 mg fluoxetine QD | ||
| Depressive episodes in Bipolar I (with fluoxetine) | Child/adolescent | 2.5 mg olanzapine + 20 mg fluoxetine QD | ||
| Treatment-resistant depression (with fluoxetine) | Adult | 5 mg olanzapine + 20 mg fluoxetine QD |
Renal Undefined
Hepatic Undefined
Instructions
- May be given without regard to meals
- Use lower starting dose in debilitated or pharmacodynamically sensitive patients, those prone to hypotension, or with slowed metabolism
- For combination with fluoxetine, adjust each component individually
Cautions
- Elderly with dementia-related psychosis: increased death and cerebrovascular events
- Suicide risk in schizophrenia/bipolar
- Neuroleptic malignant syndrome
- DRESS
- Metabolic changes: hyperglycemia/diabetes (incl. ketoacidosis), dyslipidemia, weight gain
- Orthostatic hypotension, seizures, tardive dyskinesia
Adverse reactions
- Somnolence/sedation
- Weight gain, increased appetite
- Dizziness, postural hypotension
- Constipation, dry mouth
- Akathisia, tremor
- Asthenia/fatigue
Pregnancy Third-trimester exposure risks extrapyramidal/withdrawal symptoms in neonates; no established drug-associated major-malformation risk. Pregnancy registry available.
Lactation Present in human milk; monitor infant for sedation, irritability, poor feeding, extrapyramidal symptoms.
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Cost, est. cash$300–$2,500/month
Generic entryLong generic
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityPost-injection delirium/sedation syndrome requires monitored administration; metabolic toxicity is substantial.
Mechanism of action: Olanzapine ballicule
Open Olanzapine in the interactive console ↗
Memory aids: mascots and interaction avatars
Spooky mascot → antipsychotic
Crown → antihistamine
Pretzel → weight gain
