Zyprexa: Generic Name: Olanzapine

Zyprexa
Generic name: Olanzapine

Drug classes
Antipsychotic
Dopaminergic blocking agent
Therapeutic actions
Mechanism of action not fully understood; blocks dopamine receptors in the brain,
depresses the RAS; blocks serotonin receptor sites; anticholinergic, antihistaminic
(H1), and alpha-adrenergic blocking activity may contribute to some of its therapeutic
(and adverse) actions; produces fewer extrapyramidal effects than
most antipsychotics.
Indications
 Treatment of schizophrenia
 Treatment of acute manic episodes associated with bipolar 1 disorder and
maintenance of bipolar 1 disorder as monotherapy, or combined with lithium or
valproate
 Treatment of agitation associated with schizophrenia and bipolar 1 mania
(injection)
 Unlabeled use: Dementia related to Alzheimer's disease
Contraindications and cautions

 Contraindicated with allergy to olanzapine, myeloproliferative disorders,
severe CNS depression, comatose states, lactation.
 Use cautiously in elderly or debilitated patients, or with CV or cerebrovascular
disease, dehydration, seizure disorders, Alzheimer's disease, prostate
enlargement, narrow-angle glaucoma, history of paralytic ileus or breast cancer,
pregnancy.
Available forms
Tablets—2.5, 5, 7.5, 10, 15, 20 mg; orally disintegrating tablets—5, 10, 15, 20 mg;
powder for injection—10 mg
Dosages
ADULTS
 Schizophrenia: Initially, 5–10 mg PO daily, increase to 10 mg PO daily within
several days; may be increased by 5 mg/day at 1-wk intervals to achieve
desired effect. Do not exceed 20 mg/day.
 Bipolar mania: 10–15 mg/day PO; adjust at 5-mg intervals as needed, not less
than q 24 hr. Maximum dose, 20 mg/day. For maintenance, 5–20 mg/day PO.
The initial dose is 10 mg of olanzapine when combined with lithium or
valproate.
 Agitation: 10 mg IM; range 5–10 mg IM; dose may be repeated in 2 hr if
needed, safety of > 30 mg/24 hr not established.
PEDIATRIC PATIENTS
Safety and efficacy not established in patients < 18 yr.
Adverse effects
 CNS: Somnolence, dizziness, nervousness, headache, akathisia, personality
disorders, tardive dyskinesia, neuroleptic malignant syndrome
 CV: Orthostatic hypotension, peripheral edema, tachycardia
 GI: Constipation, abdominal pain
 Respiratory: Cough, pharyngitis
 Other: Fever, weight gain, joint pain, development of diabetes mellitus
Nursing considerations
CLINICAL ALERT!
Name confusion has occurred between Zyprexa (olanzapine)
and Zyrtec (cetirizine); use caution.
Assessment
 History: Allergy to olanzapine, myeloproliferative disorders, severe CNS
depression, comatose states, history of seizure disorders, lactation; CV
or cerebrovascular disease, dehydration, Alzheimer's disease, prostate
enlargement, narrow-angle glaucoma, history of paralytic ileus or breast cancer,
elderly or debilitated patients, pregnancy
 Physical: T, weight; reflexes, orientation, IOP, ophthalmologic examination;
P, BP, orthostatic BP, ECG; R, adventitious sounds; bowel sounds, normal
output, liver evaluation; prostate palpation, normal urine output; CBC,
urinalysis, liver and renal function tests
 Monitor for orthostatic hypotension and provide appropriate safety measures as
needed.
Teaching points
 Take this drug exactly as prescribed; do not change dose without consulting
your physician.
 Peel back foil on blister pack of disintegrating tablets; do not push through foil;
use dry hands to remove tablet, place entire tablet in mouth.
 This drug cannot be taken during pregnancy. If you think you are pregnant or
wish to become pregnant, contact your health care provider.
 You may experience these side effects: Drowsiness, dizziness, sedation,
seizures (avoid driving, operating machinery, or performing tasks that require
concentration); dizziness, faintness on arising (change positions slowly, use
caution); increased salivation (if bothersome, contact your health care
provider); constipation (consult with your health care provider for appropriate
relief measures); fast heart rate (rest and take your time if this occurs).
 Report lethargy, weakness, fever, sore throat, malaise, mouth ulcers,
and flulike symptoms.

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Generic name: Olanzapine

Contraindications and cautions

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