Olanzapine
Acute agitation, Schizophrenia, Bipolar disorder (acute mania), Chemotherapy-induced nausea
Indications
- Acute agitation
- Schizophrenia
- Bipolar disorder (acute mania)
- Chemotherapy-induced nausea
Adult dosing
- agitation po: dose: 10; unit: mg; route: PO/ODT; interval: May repeat 5-10mg in 2h; max 20mg/day; fixed: true; agitation im: dose: 10; unit: mg; route: IM; interval: May repeat 5-10mg in 2h; max 30mg/day; fixed: true; maintenance: dose: 5; unit: mg; route: PO daily; interval: Titrate 5-20mg daily; fixed: true
Contraindications
- Do NOT combine IM olanzapine with IM benzodiazepine — risk of fatal respiratory depression/hypotension
Clinical pearls
- IM olanzapine + IM benzodiazepine = NEVER. At least 1 hour apart minimum.
- ODT (orally disintegrating tablet) useful for patients who may cheek/spit medications
- Metabolic effects: weight gain, hyperglycemia, dyslipidemia — monitor fasting glucose and lipids
- Acute agitation: olanzapine 10mg IM is as effective as haloperidol + lorazepam with fewer EPS
Source and review
- APA Practice Guidelines; Breier et al., Am J Psychiatry 2002. Last reviewed: 2024-11-01