Description
Indications and Dosage for ZYPREXA (Olanzapine)
1. Schizophrenia
**Oral (PO):**
– **Initial Dose:** 5-10 mg/day
– **Titration:** May be increased in increments of 5 mg/day at intervals >1 week
– **Maintenance:** 10-20 mg/day; not to exceed 20 mg/day
2. Bipolar Mania
**Monotherapy:**
– **Initial Dose:** 10-15 mg/day PO
– **Titration:** May be increased in increments of 5 mg/day at intervals >24 hr
– **Maintenance:** 5-20 mg/day PO; not to exceed 20 mg/day
**Adjunct to Lithium or Valproate:**
– **Initial Dose:** 10 mg/day PO
– **Maintenance:** 5-20 mg/day PO; not to exceed 20 mg/day
3. Bipolar Depression
**In Combination with Fluoxetine:**
– **Initial Dose:** 5 mg PO in the evening
– **Titration:** Adjusted to a range of 5-12.5 mg/day
4. Chemotherapy-Associated Nausea or Vomiting (Off-label)
**Breakthrough Nausea and Vomiting:**
– 5-10 mg PO daily for 3 days
**Acute and Delayed Emesis Prevention:**
– **High Emetic Risk IV Chemotherapy:** 10 mg PO on the day of chemotherapy (day 1), followed by 10 mg PO daily (days 2-4)
– **Moderate Emetic Risk IV Chemotherapy:** 10 mg PO on the day of chemotherapy (day 1), followed by 10 mg PO daily (days 2-3)
Pediatrics
1. Bipolar I Disorder (Manic or Mixed Episodes)
– **<13 years:** Safety and efficacy not established
– **13-17 years:**
– **Initial Dose:** 2.5-5 mg/day PO
– **Target Dose:** 10 mg/day
– **Adjustment:** By increments/decrements of 2.5-5 mg
– **Dosage Range:** 2.5-20 mg/day
2. Schizophrenia
– **<13 years:** Safety and efficacy not established
– **13-17 years:**
– **Initial Dose:** 2.5-5 mg/day PO
– **Target Dose:** 10 mg/day
– **Adjustment:** By increments/decrements of 2.5-5 mg
– **Dosage Range:** 2.5-20 mg/day#### 3. Bipolar Depression
In Combination with Fluoxetine:**
– **<10 years:** Safety and efficacy not established
– **10-17 years:**
– **Initial Dose:** 2.5 mg PO in the evening with fluoxetine 20 mg PO in the evening
– **Adjustment:** Based on efficacy and tolerability
4. Stuttering (Off-label)
– **≥12 years:** 1.25 mg PO at bedtime for 4 weeks, then 2.5 mg at bedtime
Geriatric
**Not approved for dementia-related psychosis due to increased risk of cardiovascular or infection-related mortality.**
– **Schizophrenia:**
– **Initial Dose:** 2.5-5 mg/day PO
– **IM (Extended-release):** 150 mg every 4 weeks for debilitated patients
– **Schizophrenia or Bipolar-Related Agitation:**
– **IM (Short-acting):** 5 mg; consider 2.5 mg for patients predisposed to hypotensive reactions
Interactions
**Click here for interactions.**
Adverse Effects
>10%
– Orthostatic hypotension (≥20%)
– Weight gain (dose-dependent) (5-40%)
– Hypertriglyceridemia (≥39%)
– Hypercholesterolemia (≥39%)
– Somnolence (dose-dependent) (6-39%)
– Extrapyramidal symptoms (EPS) (dose-dependent) (15-32%)
– Xerostomia (9-22%)
– Weakness (2-20%)
– Dizziness (4-18%)
– Accidental injury (12%)
– Insomnia (12%)
– Elevated alanine aminotransferase (ALT) level (5-12%)
– Constipation (9-11%)
– Dyspepsia (7-11%)
– Hyperprolactinemia (30%)
– Hyperglycemia (12.8%)
1-10%
– Hypotension (2%)
– Postural hypotension (1%)
– Tremor (1%)
– Asthenia (2%)
– Akathisia reactions (2%)
– Parkinsonism reactions (4%)
<1%
– Syncope
– Sudden cardiac death
– Hyperglycemia
– Diabetic coma with ketoacidosis
– Diabetic ketoacidosis
– Acute hemorrhagic pancreatitis
– Venous thromboembolism
– Immune hypersensitivity reaction
– Cerebrovascular disease
– Seizure, status epilepticus
– Suicidal intent
– Pulmonary embolism
– Death
– Neuroleptic malignant syndrome (NMS)
– Tardive dyskinesia
