Olanzapine pamoate LAI

ZYPREXA RELPREVV

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Olanzapine pamoate LAI ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Olanzapine pamoate LAI ballicule

Olanzapine pamoate LAI ZYPREXA RELPREVV mascot mnemonic cartoon — Visual mnemonic: Olanzapine pamoate LAI mascot
**“Real pretzel”**
Spooky mascot → antipsychotic
Pretzel → weight gain
Mascot on left: “Real pretzel” soundalike
Mascot on right: actual appearance is a distinctive opaque yellow liquid

What it isIntramuscular olanzapine pamoate every 2-4 weeks for schizophrenia; distinct from monthly subcutaneous WELTRUZA.

Why this oneIt brings olanzapine’s efficacy to patients who respond to the molecule but cannot sustain oral adherence.

What limits itPost-injection delirium/sedation syndrome is the defining hazard: a REMS program requires administration at a registered facility with three hours of observation after every dose.

Olanzapine pamoate LAI molecular structure (skeletal formula) — Molecular structure: Olanzapine pamoate LAI

Classes and tags

Clinical profile

Therapeutic safety burden4 / 4

Overdose danger3 / 4

Weight-gain liability4 / 4

Sedation liability3 / 4

QT / Torsades1 / 4

Direct muscarinic antagonism2 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityPost-injection delirium/sedation syndrome after any injection (<0.1 % of injections): observe for at least 3 hours in a certified setting under the REMS; metabolic toxicity is substantial.

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Post-injection delirium/sedation syndrome — patients at risk of severe sedation (incl. coma) and/or delirium after each injection; observe ≥3 h in a certified healthcare setting with emergency response access; available only through the ZYPREXA RELPREVV REMS. Increased mortality in elderly patients with dementia-related psychosis (not approved for that use).

FDA dosing	Population	Start	Target	Max
Schizophrenia	Adults	First 8 weeks (per target oral olanzapine dose): 210 mg/2 wk or 300 mg/2 wk or 405 mg/4 wk	Maintenance after 8 wk: 150 mg/2 wk, 210 mg/2 wk, 300 mg/2 wk, or 300 mg/4 wk	405 mg/4 wk or 300 mg/2 wk (higher doses not evaluated)

Renal Undefined

Hepatic Undefined

Administered every 2 to 4 weeks

Instructions

Deep IM gluteal injection only; do not administer IV or SC
Establish tolerability with oral olanzapine before initiating
Observe patient at the healthcare setting ≥3 h after each injection (REMS)
Aspirate before injecting; do not massage the injection site

Available strengths

inj 210, 300, 405 mg

Cautions

Post-injection delirium/sedation syndrome
Increased mortality and cerebrovascular events in elderly with dementia-related psychosis
Suicide risk in schizophrenia
Neuroleptic malignant syndrome
DRESS
Metabolic changes (hyperglycemia/diabetes, dyslipidemia, weight gain)
Tardive dyskinesia
Orthostatic hypotension

Adverse reactions

Headache
Sedation/somnolence
Weight gain
Cough
Diarrhea
Back pain
Nausea
Dry mouth
Increased appetite
Vomiting

Pregnancy Third-trimester exposure risks neonatal extrapyramidal and/or withdrawal symptoms; epidemiologic data have not established a drug-associated risk of major birth defects

Lactation Present in human milk; reports of excess sedation, irritability, poor feeding, and extrapyramidal symptoms in exposed infants

Cost

Olanzapine pamoate LAI (ZYPREXA RELPREVV)

Strength		#/mo	CostPlus
210 mg	inj	per unit	not offered
300 mg	inj	per unit	not offered
405 mg	inj	per unit	not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Olanzapine pamoate LAI is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

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Self-check

How long must patients be observed after every olanzapine pamoate injection?
Three hours.
What syndrome drives olanzapine pamoate’s observation requirement?
Post-injection delirium/sedation syndrome.