Generic Name: olanzapine (injection) (oh LAN za peen)
Brand Names: ZyPREXA, ZyPREXA Relprevv
What is olanzapine injection?
Olanzapine is an antipsychotic medication that affects chemicals in the brain.
Olanzapine injection is used to treat adults who are in an agitated state due to schizophrenia or bipolar disorder (manic depression). Olanzapine injection is not for daily use to treat any psychotic condition.
Olanzapine injection may also be used for purposes not listed in this medication guide.
What is the most important information I should know about olanzapine injection?
You should not receive this medication if you are allergic to olanzapine.
If possible before you receive olanzapine injection, tell your doctor if you have heart disease, congestive heart failure, a heart rhythm disorder, a history of heart attack or stroke, or if you are also using a sedative such as Valium.
You may need to stop breast-feeding for a short time after receiving an olanzapine injection. Follow your doctor's instructions.
In an emergency situation it may not be possible before you are treated to tell your caregivers about your health conditions or if you are pregnant or breast feeding. Make sure any doctor caring for you afterward knows that you have received this medicine.
Treatments for depression are getting better everyday and there are things you can start doing right away.
Olanzapine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
What should I discuss with my healthcare provider before receiving olanzapine injection?
Olanzapine is not for use in psychotic conditions related to dementia. Olanzapine may cause heart failure, sudden death, or pneumonia in older adults with dementia-related conditions. You should not receive this medication if you are allergic to olanzapine.
If possible before you receive olanzapine injection, tell your doctor if you have:
heart disease;
congestive heart failure;
a heart rhythm disorder;
a history of heart attack or stroke; or
if you are also using a sedative such as Valium.
FDA pregnancy category C. It is not known whether olanzapine injection will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Olanzapine can pass into breast milk and may harm a nursing baby. You may need to stop breast-feeding for a short time after receiving an olanzapine injection. Follow your doctor's instructions. In an emergency situation, it may not be possible before you are treated with olanzapine to tell your caregivers if you are pregnant or breast feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medicine.
How is olanzapine injection given?
Olanzapine is injected into a muscle. You will receive this injection in a clinic or hospital setting.
An olanzapine injection is usually given only once. If you still have symptoms after 2 hours, your caregivers may use a second or third dose.
What happens if I miss a dose?
Since olanzapine injection is given by a healthcare professional in an emergency setting, you are not likely to miss a dose.
What happens if I overdose?
Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.
What should I avoid after receiving olanzapine injection?
Olanzapine may impair your thinking or reactions. Be careful if you do anything that requires you to be alert.
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.
Drinking alcohol can increase sleepiness caused by olanzapine.
Olanzapine injection side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Tell your caregivers at once if you have a serious side effect such as:
fast or slow heart rate;
feeling like you might pass out;
twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs; or
being unable to sit still.
Less serious side effects may include:
dizziness, drowsiness;
weakness;
tremors or shaking;
nausea; or
pain where the injection was given.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Olanzapine Dosing Information
Usual Adult Dose for Bipolar Disorder:
Oral (monotherapy):
Initial dose: 10 to 15 mg orally once a day.
Maintenance dose: 5 to 20 mg orally once a day.
Maximum dose: 20 mg orally once a day.
Oral (combination therapy with lithium or valproate):
Initial dose: 10 mg orally once a day.
Maintenance dose: 5 to 20 mg orally once a day.
Maximum dose: 20 mg orally once a day.
Injection:
Initial dose: 10 mg IM once.
Recommended dose: 10 mg IM once. A lower dose of 5 mg or 7.5 mg may be considered when clinical factors warrant. If agitation warranting additional intramuscular doses persists following the initial dose, subsequent doses up to 10 mg may be given. The efficacy of repeated doses of IM olanzapine in agitated patients has not been systematically evaluated in controlled clinical trials.
The safety of total daily dose greater than 30 mg (or 10 mg injections given more frequently than 2 hours after the initial dose and four hours after the second dose) has not been evaluated in clinical trials.
Dosage range: 2.5 mg to 10 mg IM once.
If ongoing olanzapine therapy is clinically indicated, oral olanzapine may be initiated in a range of 5 to 20 mg per day as soon as clinically appropriate.
Usual Adult Dose for Schizophrenia:
Oral:
Initial dose: 5 to 10 mg orally once a day.
Maintenance dose: 10 mg orally once a day.
Maximum dose: 20 mg orally once a day.
There are two olanzapine intramuscular formulations with different dosing schedules. Olanzapine intramuscular (10 mg/vial) is a short-acting formulation and should not be confused with olanzapine extended release injectable suspension (Brand Name: RELPREVV).
Short-acting Injection:
Initial dose: 10 mg IM once.
Recommended dose: 10 mg IM once. A lower dose of 5 mg or 7.5 mg may be considered when clinical factors warrant. If agitation warranting additional intramuscular doses persists following the initial dose, subsequent doses up to 10 mg may be given. The efficacy of repeated doses of IM olanzapine in agitated patients has not been systematically evaluated in controlled clinical trials.
The safety of total daily dose greater than 30 mg (or 10 mg injections given more frequently than 2 hours after the initial dose and four hours after the second dose) has not been evaluated in clinical trials.
Dosage range: 2.5 mg to 10 mg IM once.
If ongoing olanzapine therapy is clinically indicated, oral olanzapine may be initiated in a range of 5 to 20 mg per day as soon as clinically appropriate.
Extended Release Injectable Suspension:
The extended release injectable suspension is intended for deep intramuscular gluteal injection only and should not be administered intravenously or subcutaneously.
Tolerability should be established with oral olanzapine prior to initiating treatment with the extended release injectable suspension.
The efficacy of olanzapine extended release injectable suspension has been demonstrated within the range of 150 mg to 300 mg administered every 2 weeks and with 405 mg administered every 4 weeks.
Recommended Dosing for Olanzapine Extended Release Injectable Suspension Based on Correspondence to Oral Olanzapine Doses:
1) If the target oral olanzapine dose is 10 mg/day, then the dosing during the first 8 weeks is 210 mg/2 weeks or 405 mg/4 weeks, and the maintenance dose after 8 weeks is 150 mg/2 weeks or 300 mg/4 weeks.
2) If the target oral olanzapine dose is 15 mg/day, then the dosing during the first 8 weeks is 300 mg/2 weeks, and the maintenance dose after 8 weeks is 210 mg/2 weeks or 405 mg/4 weeks.
3) If the target oral olanzapine dose is 20 mg/day, then the dosing during the first 8 weeks is 300 mg/2 weeks, and the maintenance dose after 8 weeks is 300 mg/2 weeks.
Olanzapine extended release injectable suspension doses greater than 405 mg every 4 weeks or 300 mg every 2 weeks have not been evaluated in clinical trials.
For patients who are debilitated, who have a predisposition to hypotensive reactions, who otherwise exhibit a combination of factors that may result in slower metabolism of olanzapine (e.g., nonsmoking female patients 65 years of age or older), or who may be more pharmacodynamically sensitive to olanzapine:
Recommended starting dose: 150 mg/4 weeks
When indicated, dose escalation should be undertaken with caution in these patients.
Maintenance: Although no controlled studies have been conducted to determine how long patients should be treated with olanzapine extended release injectable suspension, efficacy has been demonstrated over a period of 24 weeks in patients with stabilized schizophrenia. Patients should be periodically reassessed to determine the need for continued treatment.
Usual Geriatric Dose for Bipolar Disorder:
Oral:
Initial dose: 5 mg orally once a day if debilitated or predisposed to hypotension.
Maintenance dose: May increase cautiously.
Injection:
Initial Dose: 5 mg IM once. A lower dose of 2.5 mg per injection should be considered for patients who otherwise may be debilitated, predisposed to hypotensive reactions, or who are more pharmacodynamically sensitive to olanzapine.
Usual Geriatric Dose for Schizophrenia:
Oral:
Initial dose: 5 mg orally once a day if debilitated or predisposed to hypotension.
Maintenance dose: May increase cautiously.
There are two olanzapine intramuscular formulations with different dosing schedules. Olanzapine intramuscular (10 mg/vial) is a short-acting formulation and should not be confused with olanzapine extended release injectable suspension (Brand Name: RELPREVV).
Short-acting Injection:
Initial Dose: 5 mg IM once. A lower dose of 2.5 mg per injection should be considered for patients who otherwise may be debilitated, predisposed to hypotensive reactions, or who are more pharmacodynamically sensitive to olanzapine.
Extended Release Injectable Suspension:
For patients who are debilitated, who have a predisposition to hypotensive reactions, who otherwise exhibit a combination of factors that may result in slower metabolism of olanzapine (e.g., nonsmoking female patients 65 years of age or older), or who may be more pharmacodynamically sensitive to olanzapine:
Recommended starting dose: 150 mg/4 weeks
When indicated, dose escalation should be undertaken with caution.
Maintenance: Although no controlled studies have been conducted to determine how long patients should be treated with olanzapine extended release injectable suspension, efficacy has been demonstrated over a period of 24 weeks in patients with stabilized schizophrenia. Patients should be periodically reassessed to determine the need for continued treatment.
Usual Pediatric Dose for Schizophrenia:
8 to 12 years (Limited data available):
Initial: 2.5 to 5 mg once daily; increase dose in 2.5 or 5 mg increments at weekly intervals to target dose of 10 mg once daily; maximum dose: 20 mg/day.
13 to 17 years old:
Initial dose: 2.5 to 5 mg orally once a day
Maintenance dose: 10 mg orally once a day
Efficacy in adolescents with schizophrenia has been demonstrated based on a flexible dose range of 2.5 mg to 20 mg/day in clinical trials. When dosage adjustments are necessary, dose increments/decrements of 2.5 mg or 5 mg are recommended.
The safety and effectiveness of doses above 20 mg/day have not been evaluated in clinical trials.
Maintenance: The efficacy of olanzapine for the maintenance treatment of schizophrenia in the adolescent population has not been systematically evaluated. However, maintenance efficacy can be extrapolated from adult data along with comparisons of olanzapine pharmacokinetic parameters in adult and adolescent patients. It is generally recommended that responding patients be continued beyond the acute response, but at the lowest dose needed to maintain remission. Patients should be periodically reassessed to determine the need for maintenance treatment.
Usual Pediatric Dose for Bipolar Disorder:
4 to 5 years: Limited data available: Initial: 1.25 mg orally once daily; increase at weekly intervals according to response and tolerability to target dose: 10 mg/day.
6 to 12 years: Limited data available: Initial: 2.5 mg orally once daily; increase dose in 2.5 or 5 mg increments at weekly intervals to target dose of 10 mg once daily; maximum dose: 20 mg/day.
13 to 17 years old:
Initial dose: 2.5 mg to 5 mg orally once a day
Maintenance dose: 10 mg orally once a day
Efficacy in adolescents with bipolar I disorder (manic or mixed episodes) was demonstrated based on a flexible dose range of 2.5 to 20 mg/day in clinical trials. When dosage adjustments are necessary, dose increments/decrements of 2.5 or 5 mg are recommended.
The safety and effectiveness of doses above 20 mg/day have not been evaluated in clinical trials.
Maintenance: The efficacy of olanzapine for the maintenance treatment of bipolar I disorder in the adolescent population has not been evaluated. However, maintenance efficacy can be extrapolated from adult data along with comparisons of olanzapine pharmacokinetic parameters in adult and adolescent patients. It is generally recommended that responding patients be continued beyond the acute response, but at the lowest dose needed to maintain remission. Patients should be periodically reassessed to determine the need for maintenance treatment.
Usual Pediatric Dose for Anorexia Nervosa:
9 years and older: (Limited data available): 1.25 to 2.5 mg orally once daily has been shown in one small trial and several case reports to improve BMI and other disease related symptoms (e.g., eating attitudes, anxiety); another case series used initial doses of 2.5 mg once daily and final doses of 5 mg to 10 mg once daily; reported range: 1.25 to 12.5 mg/day; however, it has been suggested that higher doses (greater than 2.5 mg once daily) may not be associated with greater efficacy. Further studies are needed.
Usual Pediatric Dose for Tourette's Syndrome:
Tourette syndrome, tic disorder:
7 years and older: Limited data available:
Patient weight less than 40 kg: Initial: 2.5 mg orally every other day for 3 days, increase to 2.5 mg every day for remainder of week; increase to 5 mg/day by second week if needed; then increase in 5 mg increments at weekly intervals as tolerated; maximum dose: 20 mg/day
Patient weight greater than 40 kg: Initial: 2.5 mg every day for 3 days; increase to 5 mg every day for remainder of week if needed, then increase in 5 mg increments at weekly intervals as tolerated; maximum dose: 20 mg/day
An open-label study of 10 pediatric patients (7 to 13 years of age) reported significant reductions in tic severity [Yale Global Tic Severity Scale (YGTSS)] from baseline at a mean final dose of 14.5 mg/day after 8 weeks of treatment. An open-label trial of 12 children and adolescents (7 to 14 years of age) reported a significant reduction (30%) in total tic severity (YGTSS) at a final mean dose of 11.3 mg/day (range: 2.5 to 20 mg/day).
What other drugs will affect olanzapine injection?
Tell your doctor about all other medicines you use, especially:
blood pressure medication;
alprazolam (Xanax)
diazepam (Valium);
clonazepam (Klonopin);
lorazepam (Ativan);
temazepam (Restoril); or
if you take olanzapine by mouth (Zyprexa, Symbyax, or Zyprexa Zydis).
This list is not complete and other drugs may interact with olanzapine injection. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
More olanzapine resources
- Olanzapine Side Effects (in more detail)
- Olanzapine Use in Pregnancy & Breastfeeding
- Drug Images
- Olanzapine Drug Interactions
- Olanzapine Support Group
- 90 Reviews for Olanzapine - Add your own review/rating
Compare olanzapine with other medications
- Agitation
- Anorexia
- Asperger Syndrome
- Bipolar Disorder
- Body Dysmorphic Disorder
- Borderline Personality Disorder
- Depression
- Insomnia
- Obsessive Compulsive Disorder
- Paranoid Disorder
- Schizoaffective Disorder
- Schizophrenia
- Tourette's Syndrome
Where can I get more information?
- Your doctor or pharmacist can provide more information about olanzapine injection.
See also: olanzapine side effects (in more detail)
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