Olanzapine: Effective Atypical Antipsychotic for Symptom Control
| Product dosage: 2.5mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 60 | $0.63 | $37.84 (0%) | 🛒 Add to cart |
| 90 | $0.61 | $56.76 $55.04 (3%) | 🛒 Add to cart |
| 120 | $0.59 | $75.68 $71.38 (6%) | 🛒 Add to cart |
| 180 | $0.59 | $113.52 $105.78 (7%) | 🛒 Add to cart |
| 270 | $0.58 | $170.28 $156.52 (8%) | 🛒 Add to cart |
| 360 | $0.58
Best per pill | $227.04 $207.26 (9%) | 🛒 Add to cart |
| Product dosage: 5mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 60 | $0.86 | $51.60 (0%) | 🛒 Add to cart |
| 90 | $0.82 | $77.40 $73.96 (4%) | 🛒 Add to cart |
| 120 | $0.81 | $103.20 $97.18 (6%) | 🛒 Add to cart |
| 180 | $0.79 | $154.80 $142.76 (8%) | 🛒 Add to cart |
| 270 | $0.78 | $232.20 $210.70 (9%) | 🛒 Add to cart |
| 360 | $0.77
Best per pill | $309.60 $278.64 (10%) | 🛒 Add to cart |
| Product dosage: 7.5mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 30 | $1.23 | $36.98 (0%) | 🛒 Add to cart |
| 60 | $1.13 | $73.96 $67.94 (8%) | 🛒 Add to cart |
| 90 | $1.11 | $110.94 $99.76 (10%) | 🛒 Add to cart |
| 120 | $1.10 | $147.92 $131.58 (11%) | 🛒 Add to cart |
| 180 | $1.08 | $221.88 $194.36 (12%) | 🛒 Add to cart |
| 270 | $1.07 | $332.82 $288.96 (13%) | 🛒 Add to cart |
| 360 | $1.07
Best per pill | $443.76 $384.42 (13%) | 🛒 Add to cart |
Synonyms | |||
Olanzapine is a second-generation (atypical) antipsychotic medication indicated for the treatment of schizophrenia and bipolar I disorder. It functions primarily as a multi-receptor targeting agent, exhibiting high affinity for serotonin, dopamine, muscarinic, histamine, and adrenergic receptors. Its pharmacodynamic profile underpins its efficacy in managing both positive and negative symptoms of psychotic disorders, as well as acute manic or mixed episodes. This agent is available in oral (standard and orally disintegrating tablets) and intramuscular formulations, providing flexibility in administration across various clinical scenarios.
Features
- Active Ingredient: Olanzapine
- Pharmacological Class: Thienobenzodiazepine derivative; atypical antipsychotic
- Mechanism of Action: Antagonist activity at serotonin 5-HT2A/2C, dopamine D1-4, muscarinic M1-5, histamine H1, and adrenergic α1 receptors
- Available Formulations: Oral tablets (2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg), orally disintegrating tablets (Zydis), short-acting intramuscular injection
- Bioavailability: Approximately 60%, not significantly affected by food
- Half-life: 21–54 hours (permits once-daily dosing)
- Metabolism: Primarily hepatic via glucuronidation and CYP1A2-mediated oxidation
Benefits
- Demonstrates high efficacy in reducing positive symptoms (e.g., hallucinations, delusions) and negative symptoms (e.g., social withdrawal, apathy) in schizophrenia
- Effective in the acute treatment of manic or mixed episodes associated with bipolar I disorder, both as monotherapy and as an adjunct to mood stabilizers
- Lower incidence of extrapyramidal symptoms (EPS) and tardive dyskinesia compared to first-generation antipsychotics
- Rapid-acting intramuscular formulation provides swift control of acute agitation in schizophrenia and bipolar mania
- Once-daily dosing regimen supports medication adherence
- May improve sleep architecture and reduce anxiety symptoms due to potent histamine H1 receptor blockade
Common use
Olanzapine is FDA-approved for the treatment of schizophrenia in adults and adolescents aged 13–17 years. It is also indicated for acute monotherapy or adjunctive therapy (with lithium or valproate) for manic or mixed episodes in bipolar I disorder in adults and pediatric patients aged 10–17 years. Additionally, it is used in combination with fluoxetine (as Symbyax) for treatment-resistant depression and bipolar depression. Off-label uses may include behavioral disturbances in dementia (though with black box warnings), Tourette syndrome, and as an antiemetic in palliative care.
Dosage and direction
Initiation and titration should be individualized based on clinical status, tolerability, and treatment response.
Schizophrenia (Adults): Starting dose 5–10 mg once daily. Target range: 10–15 mg/day. Maximum: 20 mg/day. Schizophrenia (Adolescents 13–17): Start with 2.5–5 mg once daily. Target: 10 mg/day. Max: 20 mg/day. Bipolar Mania (Adults): Monotherapy start: 10–15 mg once daily. Adjunctive start: 10 mg once daily. Target: 5–20 mg/day. Bipolar Mania (Pediatric 10–17): Start: 2.5–5 mg once daily. Target: 10 mg/day. Max: 20 mg/day. Elderly/Debilitated: Consider lower starting dose (2.5 mg). Hepatic Impairment: Consider starting dose of 5 mg in moderate to severe impairment. Administration: Can be taken with or without food. Orally disintegrating tablets should be placed on the tongue and allowed to dissolve; no water needed.
Precautions
Metabolic monitoring is mandatory. Obtain baseline and periodic:
- Weight and BMI
- Fasting blood glucose or HbA1c
- Fasting lipid profile Monitor for emergence of akathisia, Parkinsonian symptoms, or dystonia. Orthostatic hypotension may occur, especially during initial dose titration. Use caution in patients with cardiovascular disease, cerebrovascular disease, or conditions predisposing to hypotension. May impair cognitive and motor performance; advise against operating machinery until response is known. Not recommended during pregnancy unless potential benefit justifies potential risk to the fetus. Neonates exposed to antipsychotics during third trimester are at risk for extrapyramidal symptoms or withdrawal. Olanzapine is excreted in breast milk; decision to discontinue nursing or drug should consider importance of drug to mother.
Contraindications
Known hypersensitivity to olanzapine or any component of the formulation. Concomitant use with other drugs known to cause QT prolongation (though olanzapine’s effect is modest) in patients with congenital long QT syndrome or history of cardiac arrhythmias requires extreme caution.
Possible side effect
Very Common (≥1/10): Somnolence, weight gain, increased appetite, dizziness, orthostatic hypotension, hyperprolactinemia (usually asymptomatic), elevated liver transaminases. Common (1/10 to 1/100): Dry mouth, constipation, dyspepsia, akathisia, Parkinsonism, peripheral edema, fatigue. Uncommon (1/100 to 1/1000): Leukopenia, neutropenia, seizures, bradycardia, QT prolongation, rash. Rare (<1/1000): Neuroleptic malignant syndrome (NMS), tardive dyskinesia, pancreatitis, diabetic ketoacidosis. Post-marketing reports: Hepatitis, jaundice, venous thromboembolism.
Drug interaction
Strong CYP1A2 inhibitors (e.g., fluvoxamine): May increase olanzapine concentrations; consider dose reduction. CYP1A2 inducers (e.g., carbamazepine, omeprazole, smoking): May decrease olanzapine concentrations; monitor efficacy. Centrally-acting drugs (e.g., benzodiazepines, opioids, alcohol): Additive sedative and CNS depressant effects. Antihypertensives: Potentiation of hypotensive effects. Levodopa and dopamine agonists: Olanzapine may antagonize effects. Drugs that prolong QT interval (e.g., antiarrhythmics, certain antibiotics/antifungals): Additive risk; monitor ECG if combined.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Doubling of doses is not recommended.
Overdose
Symptoms may include drowsiness, slurred speech, tachycardia, hypotension, extrapyramidal symptoms, agitation, coma. Rarely, may cause respiratory depression, seizures, or cardiac arrhythmias. There is no specific antidote. Provide symptomatic and supportive care. Ensure adequate airway. Cardiovascular monitoring is essential. Consider activated charcoal if presented early. Hemodialysis is unlikely to be beneficial due to high protein binding.
Storage
Store at controlled room temperature (20–25°C or 68–77°F). Protect from light and moisture. Keep orally disintegrating tablets in original blister pack until use. Keep all medications out of reach of children and pets.
Disclaimer
This information is for educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read here. Dosage and indications may vary based on individual patient factors and latest clinical guidelines.
Reviews
“As a consulting psychiatrist with over 20 years of experience, olanzapine remains a cornerstone in my armamentarium for acute psychosis and agitation. Its broad receptor profile offers reliable efficacy, though vigilant metabolic monitoring is non-negotiable. The Zydis formulation is particularly valuable in non-adherent populations.” – Dr. A., MD, Psychiatry
“I’ve prescribed olanzapine for treatment-resistant cases of bipolar mania with significant success. The rapid IM formulation is indispensable in the ER for behavioral emergencies. The trade-off for efficacy is often weight gain, which requires proactive management with lifestyle counseling.” – Clinical Pharmacist Specialist, Bipolar Clinic
“From a nursing perspective, patient education on potential sedation and orthostasis during initiation is critical. We see good overall symptom control, but consistent follow-up on metabolic parameters is a key part of our monitoring protocol.” – RN, Inpatient Psychiatric Unit