- Type: Antipsychotic, second generation
- Dosage Forms: tablets, solution, suspension
- Routes of Administration: oral, intramuscular
- Oral rapidly dispersible wafer considered bioequialent to tablet form 
- Common Trade Names: Zyprexa, Zydis
- Acute agitation (associated with schizophrenia or bipolar disorder): Short-acting IM injection:
- initial dose: 10 mg IM (consider lowering to 5 or 7.5 mg depending on clinical factors), additional dose of 10 mg IM maybe considered. Allowed 2 hours after the first dose and 4 hours after the second dose to evaluate response (maximum dose: 30 mg/day).
- Special risk patients: consider lowering dose to 2.5 mg IM in patients who are debilitated, who have risk of hypotension or who maybe more pharmacodynamically sensitive to olanzapine.
- Schizophrenia: Oral
- Initial dose 5-10 mg once daily, increase to 10 mg daily by the first week, adjust by 5 mg daily at 1-week interval (maximum dose: 20 mg daily), maintenance dose: 10-20 mg daily.
- Special risk patient: Initial dose: 5 mg once daily in patients who are debilitated, who have risk of hypotension or who maybe more pharmacodynamically sensitive to olanzapine.
- Bipolar I (acute mixed or manic episode): Oral
- Monotherapy: Initial dose: 10-15 mg once daily, increase by 5 mg daily with interval >24 hours, maintenance dose: 5-20 mg daily (maximum dose: 20 mg daily).
- Combination therapy with lithium or valproate: Initial dose 10 mg daily (dose range: 5-20 mg daily)
- Depression: Oral
- Depression associated with bipolar disorder (in combination with fluoxetine): Initial dose: 5 mg once daily, adjust to dose range of 5-12.5 mg daily.
- Schizophrenia: Adolescent ≥13 years: Oral: Initial dose: 2.5-5 mg once daily, adjust by 2.5-5 mg daily to target dose of 10 mg daily (dose range: 2.5-20 mg daily).
- Bipolar I (acute or mixed manic episode): Adolescent ≥13 years: Oral: Initial dose: 2.5-5 mg once daily, adjust by 2.5-5 mg daily to target dose of 10 mg daily (dose range: 2.5-20 mg daily).
- Depression associated with bipolar I disorder (in combination with fluoxetine: Children and adolescent 10 to 17 years: Oral: Initial dose: 2.5 mg once daily in the evening, adjust if needed, safety for dose >12 mg daily of olanzapine and >50 mg daily of fluoxetine has not been studied.
- Pregnancy Rating: C
- Lactation risk: Olanzapine is excreted into breast milk. Brest-feeding is not recommended by manufacturer.
- No dosage adjustment is necessary, not removed by dialysis.
- Use with caution, in combination with fluoxetine, initial dose of olanzapine should not exceed 2.5-5 mg daily.
- Allergy to class/drug
- Orthostatic hypotension (3%-20%)
- Extrapyramidal reaction
- Parkinsonian-like syndrome
- Increase serum prolactin
- Increase serum AST, ALT, GGT and bilirubin
- Accidental injury
- Personality disorder
- Weight gain
- Increase appetite
- Abnormal gait
- Increase uric acid
- Limb pain
- Back pain
- Half-life: Oral and short-acting IM: children 10 to 18 years ~37 hours, adult ~30 hours, 1.5 times greater in elderly.
- Metabolism: Liver: CYP1A2, CYP2D6, 40% removed via first pass metabolism
- Excretion: Urine (~70%), feces (30%)
Mechanism of Action
- Potent antagonism of serotonin 5-HT2A and 5T2C, Dopamine1-4, histamine H1 and α1-adrenergic recepter
- Montgomery W, Treuer T, Karagianis J, Ascher-Svanum H, Harrison G. Orally disintegrating olanzapine review: effectiveness, patient preference, adherence, and other properties. Patient Prefer Adherence. 2012;6:109-125. doi:10.2147/PPA.S27344