Drugs List

Therapeutic Indications

Uses

Agitation & disturbed behaviour in manic episode: acute treatment
Agitation & disturbed behaviour in schizophrenic patients: acute treatment

Rapid control of agitation and disturbed behaviours in patients with schizophrenia or manic episode, when oral therapy is not appropriate.

Contraindications

Children under 18 years
Predisposition to narrow angle glaucoma
Bradycardia
Breastfeeding
Cardiac surgery
Dementia
Galactosaemia
Long QT syndrome
Myocardial infarction
Non-paced sinus node dysfunction
Severe hypotension
Torsade de pointes
Unstable angina

Precautions and Warnings

Acute alcohol intoxication
Drug intoxication
Elderly
Family history of long QT syndrome
Predisposition to venous thromboembolism
Tobacco smoking
Benign prostatic hyperplasia
Cardiac hypertrophy
Congestive cardiac failure
Diabetes mellitus
Disorder of lipid metabolism
Electrolyte imbalance
Elevated serum transaminases
Glucose-galactose malabsorption syndrome
Hepatic impairment
History of seizures
History of torsade de pointes
Hypereosinophilic disorder
Lactose intolerance
Leucopenia
Myeloproliferative disorder
Myelosuppression
Paralytic ileus
Parkinson's disease
Pregnancy
Renal impairment

Correct electrolyte disorders before treatment
Reduce dose in patients with hepatic impairment
Reduce dose in patients with renal impairment
Advise patient dizziness may affect ability to drive or operate machinery
Contains lactose
Do not give parenteral benzodiazepines within 1 hour of administration
For intramuscular injection only
Patient should be converted to oral therapy as soon as possible
Consider monitoring ECG in patients at risk of QT prolongation
Monitor blood pressure in elderly
Monitor BP, pulse, respiratory rate and level of consciousness regularly
Monitor patient for 4 hours after administration
Monitor patient's weight
Monitor patients receiving concurrent parenteral benzodiazepines
Monitor patients with existing or tendency towards diabetes mellitus
Monitor periodically for signs or symptoms of hyperglycaemia
Monitor serum electrolytes
Monitor serum lipids
Risk of narrow angle glaucoma
Symptoms of tardive dyskinesia can worsen or arise after discontinuation
Consider discontinuation if signs of tardive dyskinesia occur
Discontinue if hepatitis develops
Increased risk for venous thromboembolism - take preventive measures
May cause postural hypotension
Avoid abrupt withdrawal
Discontinue if patient develops neuroleptic malignant syndrome
Dose adjustment required if patient starts/stops smoking during therapy
Slower metabolisers with 2+ factors(female,elderly,non-smoke):modify dosing
Advise patient to avoid alcohol during treatment
Advise that effects are potentiated by CNS depressants (including alcohol)

If treatment leaves the patient feeling dizzy or drowsy, the patient should remain recumbent until examination indicates that they are not experiencing postural hypotension.

Clinical monitoring of physical health is required, the manufacturer states this must include blood glucose measurement at baseline, after 12 weeks then annually, weight at baseline, after 4, 8, 12 weeks then quarterly and lipid levels at baseline, after 12 weeks then every 5 years. Additional and/or more frequent monitoring may be recommended in other resources. The risk of hyperglycaemia and diabetes may be higher in patients with a prior increase in body weight.

Pregnancy and Lactation

Pregnancy

Use olanzapine with caution during pregnancy.

The manufacturer advises to only use olanzapine in pregnancy if the benefit justifies the potential risk to the foetus. There are no adequate studies in pregnant women.

New born infants exposed to olanzapine during the third trimester of pregnancy are at risk of adverse reactions including extrapyramidal and/or withdrawal symptoms. There has been reports of agitation, hypertonia, tremor, somnolence, respiratory distress or feeding disorder, therefore newborns should be monitored carefully.

Lactation

Olanzapine is contraindicated during breastfeeding.

The manufacturers advise not to breastfeed whilst taking olanzapine. Available data suggests olanzapine is expressed into breast milk.

Studies on second-generation antipsychotics (LactMed 2021) indicate that olanzapine seems to be a first-line agent during breastfeeding. Infants should be monitored for drowsiness and developmental milestones, especially if other antipsychotics are used concurrently.

Side Effects

Abdominal distension
Akathisia
Alopecia
Amenorrhoea
Amnesia
Anticholinergic effects
Arthralgia
Asthenia
Blood lipid changes
Bradycardia
Breast enlargement
Coma
Constipation
Creatine phosphokinase increased
Deep vein thrombosis (DVT)
Diabetes
Dizziness
Drug rash with eosinophilia and systemic symptoms (DRESS)
Dry mouth
Dysarthria
Dyskinesia
Dystonia
Elevated triglyceride levels
Eosinophilia
Epistaxis
Erectile dysfunction
Exacerbation of diabetes
Fatigue
Galactorrhoea
Gamma glutamyl transferase (GGT) increased
Glucosuria
Gynaecomastia
Hepatitis
Hypercholesterolaemia
Hyperglycaemia
Hypotension
Hypothermia
Hypoventilation
Increase in alkaline phosphatase
Increase in serum glucose
Increase of liver transaminases
Increased appetite
Increased prolactin
Increased uric acid level
Ketoacidosis
Leucopenia
Local pain (injection site)
Neuroleptic malignant syndrome
Neutropenia
Oedema
Orthostatic hypotension
Pancreatitis
Parkinsonism
Photosensitivity
Priapism
Prolongation of QT interval
Pulmonary embolism
Rash
Reduced libido
Restless legs
Rhabdomyolysis
Rise in body temperature
Salivary hypersecretion
Seizures
Serum bilirubin increased
Sinus arrest
Somnolence
Speech disturbances
Stuttering
Sudden death reported
Syncope
Tachycardia
Tardive dyskinesia
Thrombocytopenia
Thromboembolism
Urinary hesitancy
Urinary incontinence
Urinary retention
Ventricular fibrillation
Ventricular tachycardia
Weight gain
Withdrawal symptoms
Worsening of Parkinson's disease

Presentation

Parenteral formulations of olanzapine.

Drugs List

Therapeutic Indications

Uses

Agitation & disturbed behaviour in manic episode: acute treatment
Agitation & disturbed behaviour in schizophrenic patients: acute treatment

Rapid control of agitation and disturbed behaviours in patients with schizophrenia or manic episode, when oral therapy is not appropriate.

Dosage

Oral olanzapine should replace powder for solution for injection treatment as soon as clinically appropriate. Maximum treatment duration of 3 consecutive days.

Adults

Elderly

Patients with Renal Impairment

Patients with Hepatic Impairment

Contraindications

Children under 18 years
Predisposition to narrow angle glaucoma
Bradycardia
Breastfeeding
Cardiac surgery
Dementia
Galactosaemia
Long QT syndrome
Myocardial infarction
Non-paced sinus node dysfunction
Severe hypotension
Torsade de pointes
Unstable angina

Precautions and Warnings

Acute alcohol intoxication
Drug intoxication
Elderly
Family history of long QT syndrome
Predisposition to venous thromboembolism
Tobacco smoking
Benign prostatic hyperplasia
Cardiac hypertrophy
Congestive cardiac failure
Diabetes mellitus
Disorder of lipid metabolism
Electrolyte imbalance
Elevated serum transaminases
Glucose-galactose malabsorption syndrome
Hepatic impairment
History of seizures
History of torsade de pointes
Hypereosinophilic disorder
Lactose intolerance
Leucopenia
Myeloproliferative disorder
Myelosuppression
Paralytic ileus
Parkinson's disease
Pregnancy
Renal impairment

Correct electrolyte disorders before treatment
Reduce dose in patients with hepatic impairment
Reduce dose in patients with renal impairment
Advise patient dizziness may affect ability to drive or operate machinery
Contains lactose
Do not give parenteral benzodiazepines within 1 hour of administration
For intramuscular injection only
Patient should be converted to oral therapy as soon as possible
Consider monitoring ECG in patients at risk of QT prolongation
Monitor blood pressure in elderly
Monitor BP, pulse, respiratory rate and level of consciousness regularly
Monitor patient for 4 hours after administration
Monitor patient's weight
Monitor patients receiving concurrent parenteral benzodiazepines
Monitor patients with existing or tendency towards diabetes mellitus
Monitor periodically for signs or symptoms of hyperglycaemia
Monitor serum electrolytes
Monitor serum lipids
Risk of narrow angle glaucoma
Symptoms of tardive dyskinesia can worsen or arise after discontinuation
Consider discontinuation if signs of tardive dyskinesia occur
Discontinue if hepatitis develops
Increased risk for venous thromboembolism - take preventive measures
May cause postural hypotension
Avoid abrupt withdrawal
Discontinue if patient develops neuroleptic malignant syndrome
Dose adjustment required if patient starts/stops smoking during therapy
Slower metabolisers with 2+ factors(female,elderly,non-smoke):modify dosing
Advise patient to avoid alcohol during treatment
Advise that effects are potentiated by CNS depressants (including alcohol)

If treatment leaves the patient feeling dizzy or drowsy, the patient should remain recumbent until examination indicates that they are not experiencing postural hypotension.

Clinical monitoring of physical health is required, the manufacturer states this must include blood glucose measurement at baseline, after 12 weeks then annually, weight at baseline, after 4, 8, 12 weeks then quarterly and lipid levels at baseline, after 12 weeks then every 5 years. Additional and/or more frequent monitoring may be recommended in other resources. The risk of hyperglycaemia and diabetes may be higher in patients with a prior increase in body weight.

Pregnancy and Lactation

Pregnancy

Use olanzapine with caution during pregnancy.

The manufacturer advises to only use olanzapine in pregnancy if the benefit justifies the potential risk to the foetus. There are no adequate studies in pregnant women.

New born infants exposed to olanzapine during the third trimester of pregnancy are at risk of adverse reactions including extrapyramidal and/or withdrawal symptoms. There has been reports of agitation, hypertonia, tremor, somnolence, respiratory distress or feeding disorder, therefore newborns should be monitored carefully.

Lactation

Olanzapine is contraindicated during breastfeeding.

The manufacturers advise not to breastfeed whilst taking olanzapine. Available data suggests olanzapine is expressed into breast milk.

Studies on second-generation antipsychotics (LactMed 2021) indicate that olanzapine seems to be a first-line agent during breastfeeding. Infants should be monitored for drowsiness and developmental milestones, especially if other antipsychotics are used concurrently.

Side Effects

Abdominal distension
Akathisia
Alopecia
Amenorrhoea
Amnesia
Anticholinergic effects
Arthralgia
Asthenia
Blood lipid changes
Bradycardia
Breast enlargement
Coma
Constipation
Creatine phosphokinase increased
Deep vein thrombosis (DVT)
Diabetes
Dizziness
Drug rash with eosinophilia and systemic symptoms (DRESS)
Dry mouth
Dysarthria
Dyskinesia
Dystonia
Elevated triglyceride levels
Eosinophilia
Epistaxis
Erectile dysfunction
Exacerbation of diabetes
Fatigue
Galactorrhoea
Gamma glutamyl transferase (GGT) increased
Glucosuria
Gynaecomastia
Hepatitis
Hypercholesterolaemia
Hyperglycaemia
Hypotension
Hypothermia
Hypoventilation
Increase in alkaline phosphatase
Increase in serum glucose
Increase of liver transaminases
Increased appetite
Increased prolactin
Increased uric acid level
Ketoacidosis
Leucopenia
Local pain (injection site)
Neuroleptic malignant syndrome
Neutropenia
Oedema
Orthostatic hypotension
Pancreatitis
Parkinsonism
Photosensitivity
Priapism
Prolongation of QT interval
Pulmonary embolism
Rash
Reduced libido
Restless legs
Rhabdomyolysis
Rise in body temperature
Salivary hypersecretion
Seizures
Serum bilirubin increased
Sinus arrest
Somnolence
Speech disturbances
Stuttering
Sudden death reported
Syncope
Tachycardia
Tardive dyskinesia
Thrombocytopenia
Thromboembolism
Urinary hesitancy
Urinary incontinence
Urinary retention
Ventricular fibrillation
Ventricular tachycardia
Weight gain
Withdrawal symptoms
Worsening of Parkinson's disease

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: 25 May 2021

Reference Sources

Summary of Product Characteristics: Zyprexa 10mg powder for solution for injection. Eli Lilly Nederland. Revised January 2021.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/
Olanzapine Last revised: 19 April 2021
Last accessed: 27 May 2021