Olanzapine: Effective Management of Schizophrenia and Bipolar Disorder
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Synonyms | |||
Olanzapine is an atypical antipsychotic medication primarily indicated for the treatment of schizophrenia and bipolar I disorder. It functions by modulating dopamine and serotonin activity in the brain, helping to restore neurotransmitter balance. This agent is recognized for its efficacy in managing both positive and negative symptoms of schizophrenia, as well as acute manic or mixed episodes associated with bipolar disorder. Clinical evidence supports its role in maintenance therapy and as part of comprehensive treatment plans.
Features
- Active ingredient: Olanzapine
- Available formulations: Oral tablets, orally disintegrating tablets, and intramuscular injection
- Typical strengths: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg
- Pharmacologic class: Second-generation (atypical) antipsychotic
- Half-life: Approximately 21–54 hours
- Metabolism: Hepatic, primarily via CYP1A2 and CYP2D6 isoenzymes
Benefits
- Reduces hallucinations, delusions, and disorganized thinking in schizophrenia
- Stabilizes mood and decreases severity of manic episodes in bipolar disorder
- May improve negative symptoms such as social withdrawal and apathy
- Offers flexible dosing and administration options for individualized treatment
- Demonstrates efficacy in treatment-resistant cases when used appropriately
- Can be used as both acute intervention and long-term maintenance therapy
Common use
Olanzapine is FDA-approved for the treatment of schizophrenia in adults and adolescents aged 13–17 years, and for acute manic or mixed episodes associated with bipolar I disorder in adults and pediatric patients aged 13–17 years. It is also indicated for maintenance treatment of bipolar I disorder. Off-label uses may include treatment of agitation associated with dementia (with caution due to mortality risk in elderly patients with dementia-related psychosis), treatment-resistant depression (as an adjunct), and prevention of chemotherapy-induced nausea and vomiting.
Dosage and direction
Initial dosage for schizophrenia in adults typically ranges from 5–10 mg once daily, with adjustments based on clinical response and tolerability. For bipolar mania, starting doses of 10–15 mg daily are common. Dosage may be adjusted at intervals of not less than 24 hours. The maximum recommended daily dose is 20 mg. For geriatric patients or those with hepatic impairment, consider lower starting doses (2.5–5 mg daily). Administration is typically oral, with or without food. Orally disintegrating tablets should be placed on the tongue immediately after opening the blister.
Precautions
Patients should be monitored for weight gain, hyperglycemia, and dyslipidemia. Regular assessment of fasting blood glucose and lipid profiles is recommended. Orthostatic hypotension may occur, particularly during initial dose titration. Use with caution in patients with cardiovascular disease, cerebrovascular disease, or conditions that predispose to hypotension. Olanzapine may impair cognitive and motor performance; patients should be cautioned about operating machinery or driving. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at increased risk of death.
Contraindications
Olanzapine is contraindicated in patients with known hypersensitivity to olanzapine or any components of the formulation. It should not be used in patients with narrow-angle glaucoma due to anticholinergic effects. Concurrent use with other CNS depressants requires careful risk-benefit assessment. Olanzapine is not approved for use in patients under 13 years of age except for specific indications.
Possible side effect
Common adverse reactions (≥5%) include: weight gain, somnolence, dizziness, increased appetite, hyperprolactinemia, orthostatic hypotension, constipation, dry mouth, and fatigue. Serious side effects may include: neuroleptic malignant syndrome, tardive dyskinesia, metabolic changes (hyperglycemia, dyslipidemia), seizures, and leukopenia/neutropenia. Elderly patients with dementia-related psychosis have increased mortality risk. Regular monitoring for extrapyramidal symptoms and metabolic parameters is essential.
Drug interaction
Olanzapine may interact with CYP1A2 inhibitors (fluvoxamine, ciprofloxacin) leading to increased olanzapine concentrations. Carbamazepine and other CYP1A2 inducers may decrease olanzapine levels. Concurrent use with other CNS depressants (alcohol, benzodiazepines, opioids) may enhance sedative effects. Antihypertensive agents may potentiate orthostatic hypotension. Olanzapine may antagonize the effects of levodopa and dopamine agonists. Use with fluoxetine may increase olanzapine concentrations.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is close to the time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed dose. Consistent daily administration at approximately the same time is recommended for maintained therapeutic effect.
Overdose
Symptoms of overdose may include drowsiness, slurred speech, tachycardia, agitation, extrapyramidal symptoms, and reduced consciousness. In severe cases, respiratory depression, coma, or cardiac arrhythmias may occur. There is no specific antidote for olanzapine overdose. Management involves supportive care, including maintaining airway patency, ensuring adequate oxygenation and ventilation, and continuous cardiac monitoring. Gastric lavage may be considered if presented early. Activated charcoal may be administered if the patient presents within 1-2 hours of ingestion.
Storage
Store at controlled room temperature (20–25°C or 68–77°F), with excursions permitted between 15–30°C (59–86°F). Protect from light and moisture. Keep in original container with lid tightly closed. Orally disintegrating tablets should remain in blister packaging until immediately before use. Keep out of reach of children and pets. Do not use after expiration date. Properly dispose of any unused medication according to local regulations.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Olanzapine is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to medication may vary. Patients should consult their healthcare provider for personalized medical advice, including potential risks and benefits specific to their condition. Never initiate, adjust, or discontinue medication without professional medical guidance.
Reviews
Clinical trials demonstrate olanzapine’s efficacy in reducing Positive and Negative Syndrome Scale (PANSS) scores in schizophrenia by approximately 30-40% compared to placebo. In bipolar mania, studies show significant improvement in Young Mania Rating Scale scores. Long-term maintenance studies indicate reduced relapse rates in both schizophrenia and bipolar disorder. However, weight gain (averaging 2.5-4.5 kg in short-term studies) and metabolic concerns remain significant considerations in treatment decisions. Patient-reported outcomes often note improvement in quality of life and functional capacity when metabolic effects are properly managed.