Olanzapine 10mg

Second Generation (atypical) Antipsychotic; Antimanic Agent

“ALERT: US Boxed Warning

Increased mortality in elderly patients with dementia-related psychosis:

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of 17 placebo-controlled trials (modal duration, 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients between 1.6 and 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was approximately 4.5%, compared with a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patient is not clear. Olanzapine is not approved for treatment of patients with dementia-related psychosis.”

CSA NA – FDA Approved – REMS (N) – Can Ship; Cannot ship injectable version

Olanzapine/Zyprexa is a second generation thienobenzodiazepine antipsychotic that works as an antagonist at various neurotransmitter receptors in the brain such as serotonin (5-HT2A, 5-HT2C), dopamine (D1-4), histamine (H1), and adrenergic (Alpha1).  It has moderate antagonistic activity at 5-HT3, and muscarinic M1-5, and weak activity at beta-adrenergic, GABA-A and benzodiazepine receptors.  Brains response to altered chemistry results in desired effects.

Olanzapine/Zyprexa is officially indicated for acute agitation/aggression associated with psychiatric disorders, acute manic or mixed episodes in bipolar disorder, as an adjunct in treatment resistant major depressive disorder, and schizophrenia.  It is also prescribed off-label for use in anorexia nervosa, hypomanic episodes of bipolar disorder, chemotherapy induced acute and delayed nausea/vomiting, ICU delirium, Huntington disease-associated chorea, and delusional infestation. (may be used for other conditions not listed)

Before starting Olanzapine/Zyprexa make sure your physician is aware of any allergies or medications you currently take, if you have kidney disease, liver disease, a history of seizures, Parkinson’s disease, cardiovascular disease, dementia or are pregnant or breastfeeding.  This medication can cause suicidal ideation in young patients with major depressive disorder so must be used with caution and any major changes in personality or mood should be reported to the physician immediately.

This medication also required regular blood work and follow up with your physician to monitor for adverse reactions

2.5-50mg daily depending on what condition it is used for and patient response.  In most cases doses over 30mg are avoided due to side effects. 

How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day unless otherwise directed, store at room temperature.

You Need to Avoid: Operating heavy machinery or driving at least until you know how the medication affects you.  Do not stop this medication suddenly, make sure your physician is aware and can create a tapering schedule so you can come off slowly and prevent any withdrawal symptoms.   This medication has many drug interactions so ask your pharmacist before starting any over the counter medications or supplements.

Orthostatic hypotension, weight gain, constipation, hunger, dry mouth, increased serum prolactin, increased liver enzymes, weakness, agitation, dizziness, drowsiness, fatigue, headache, insomnia, neuroleptic malignant syndrome, withdrawal syndrome, and extrapyramidal reaction (involuntary movement)

Note- this is not a complete list of side effects, only common ones and are generally dosage dependent.  When higher doses are required the physician has weighed the risks and found the benefits to be greater, however regular monitoring (blood sugar, cholesterol, blood pressure, etc.) is important to make sure this does not change.

1. What can I do if this medication sedates me too much?
   It is a common side effect but in most cases the tablet can be split for smaller dosages to alleviate fatigue.  Discuss with your pharmacist or physician a plan to manage this or potential alternative medications.
2. This medication has a lot of scary side effects, is it safe?
   All medications have side effects however this medication works on a lot of different neurotransmitter receptors in the brain which can lead to a variety of intentional and unintentional effects.  These are mostly dosage dependent and in lower doses the risk is minimal.  In all cases regular lab work will allow your physician to see if your blood sugar, cholesterol etc. start to move in the wrong direction so action can be taken before they become a problem.
3. What are extra-pyramidal reactions?
   Blocking dopamine in the extra-pyramidal system in the central nervous system that regulates posture and skeletal muscle tone may cause a variety of movement disorders.  This can include dystonic reactions (muscular spasms, usually repetitive), akathisia (motor restlessness/uneasiness), pseudoparkinsonism (drug induced Parkinsonism – tremor, rigidity, bradykinesia, etc.), tardive dyskinesia (involuntary complex muscle movements in lower face and extremities).  These side effects are generally dose dependant and generally occur with long term use of medications that block dopamine.  If any of these effects may be occurring, speak to your physician as soon as possible to discuss your options.
4. Why would my doctor give me an antipsychotic? Does this mean I am psychotic?
   This medication can be used for many conditions outside of its original classification.  It commonly is also used for nonpsychotic mood disorders, but this class of medication was given its name back when we knew a lot less about their capabilities.   
5. What is Neuroleptic Malignant Syndrome?
   NMS is a rare but serious reaction from significant blockade of dopamine which can occur from antipsychotic medications or from being on high dosages of levodopa (dopamine analogue) and stopping suddenly.  Presents initially as muscle cramps, tremors, fever, unstable blood pressure, and sudden changes in mental status.  As it progresses over 8-40 hours it can lead to complications of rhabdomyolysis, hyperkalemia, kidney failure, or seizures.  Seek medical attention immediately if this reaction is suspected.