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ZYPREXA
Mood disorders
Psychosis
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Drug Name:

ZYPREXA Rx

Generic Name and Formulations:
Olanzapine 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg; tabs.

Company:
Lilly, Eli and Company

Therapeutic Use:

Indications for ZYPREXA:

Bipolar disorder: as monotherapy or with lithium or valproate for short-term use in acute mixed or manic episodes, or for maintenance. In combination with fluoxetine: depressive episodes associated with bipolar I disorder, or treatment resistant depression (TRD).

Adult:

Bipolar disorder: Monotherapy: initially 10–15mg once daily; may increase by 5mg/day. Concomitant lithium or valproate: initially 10mg once daily. For both: max 20mg/day. Maintenance: usual range 5–20mg/day. Bipolar depression: initially olanzapine 5mg + fluoxetine 20mg once daily in the PM; range olanzapine 5–12.5mg + fluoxetine 20–50mg. TRD: initially olanzapine 5mg + fluoxetine 20mg once daily in the PM; range: olanzapine 5–20mg + fluoxetine 20–50mg. Risk of hypotension, hepatic impairment, slow metabolizers, or sensitive to olanzapine: initially olanzapine 2.5–5mg + fluoxetine 20mg; increase cautiously. Dose adjustments: see full labeling. Zydis: Dissolve in mouth and swallow with or without fluids.

Children:

Bipolar disorder: <13yrs: not established. 13–17yrs: Monotherapy: initially 2.5–5mg once daily; increase to target dose of 10mg/day, adjust by 2.5–5mg if needed; max 20mg/day. Maintenance: continue at lowest dose to maintain remission: see full labeling. Bipolar depression: <10yrs: not established. 10–17yrs: initially olanzapine 2.5mg + fluoxetine 20mg once daily in the PM.

Contraindications:

Combination therapies: see other drug monographs.

Warnings/Precautions:

Elderly with dementia-related psychosis (not approved use); increased risk of death or cerebrovascular events (eg, stroke, TIA). Cardio- or cerebrovascular disease. Discontinue if neuroleptic malignant syndrome occurs or if DRESS is suspected; consider discontinuation if tardive dyskinesia occurs. Diabetes. Monitor for hyperglycemia, hyperlipidemia; do fasting blood glucose and lipids testing at beginning, and during therapy. Monitor for weight gain. Hypovolemia. Dehydration. History of seizures. Conditions that affect metabolism or hemodynamic responses. Hepatic impairment (monitor ALT/AST). Prostatic hypertrophy. Narrow angle glaucoma. History of paralytic ileus or breast cancer. Pre-existing low WBCs or history of leukopenia/neutropenia; monitor CBCs during 1st few months of treatment; discontinue if WBCs decline. Perform fall risk assessments when initiating and recurrently on long-term therapy. Exposure to extreme heat. Dysphagia. Suicidal ideation (monitor). Reevaluate periodically. Write ℞ for smallest practical amount. Debilitated. Labor & delivery. Neonates: risk of extrapyramidal and/or withdrawal symptoms post delivery (due to exposure during 3rd-trimester pregnancy). Pregnancy (Cat.C). Nursing mothers: not recommended.

Interactions:

Orthostatic hypotension with antihypertensives, alcohol (caution), diazepam. Caution with other CNS drugs, anticholinergics, hepatotoxic agents. Concomitant IV benzodiazepine: not recommended with IM olanzapine. May antagonize levodopa, dopamine agonists. May be antagonized by rifampin, omeprazole, carbamazepine, others that induce CYP1A2 or glucuronyl transferase. May be potentiated by fluvoxamine, others that inhibit CYP1A2. Smokers may have increased clearance.

See Also:

ZYPREXA ZYDIS

ZYPREXA INTRAMUSCULAR

Pharmacological Class:

Thienobenzodiazepine.

Adverse Reactions:

Somnolence, sedation, dizziness, constipation, weight gain, increased appetite, personality disorder, akathisia, asthenia, postural hypotension, headache, abdominal pain, dry mouth, fatigue, tremor, extremity/back pain, nausea, diarrhea, vomiting, cough, nasopharyngitis; neutropenia, hyperprolactinemia, elevated liver enzymes, EPS.

How Supplied:

Tabs—30; Zydis—30; Vial—1

Indications for ZYPREXA:

Schizophrenia.

Adult:

Initially 5–10mg once daily; increase to target dose of 10mg/day within several days, adjust by 5mg/day at intervals of 1 week; max 20mg/day. Maintenance: usual range 10–20mg/day. Debilitated, risk of hypotension, slow metabolizers, or sensitive to olanzapine: initially 5mg once daily; increase cautiously. Zydis: Dissolve in mouth and swallow with or without fluids.

Children:

<13yrs: not established. 13–17yrs: initially 2.5–5mg once daily; increase to target dose of 10mg/day, adjust by 2.5–5mg if needed; max 20mg/day. Maintenance: continue at lowest dose to maintain remission: see full labeling.

Warnings/Precautions:

Relprevv: post-injection delirum/sedation syndrome: monitor after each injection. Elderly with dementia-related psychosis (not approved use); increased risk of death or cerebrovascular events (eg, stroke, TIA). Cardio- or cerebrovascular disease. Discontinue if neuroleptic malignant syndrome occurs or if DRESS is suspected; consider discontinuation if tardive dyskinesia occurs. Diabetes. Monitor for hyperglycemia, hyperlipidemia; do fasting blood glucose and lipids testing at beginning, and during therapy. Monitor for weight gain. Hypovolemia. Dehydration. History of seizures. Conditions that affect metabolism or hemodynamic responses. Hepatic impairment (monitor ALT/AST). Prostatic hypertrophy. Narrow angle glaucoma. History of paralytic ileus or breast cancer. Pre-existing low WBCs or history of leukopenia/neutropenia; monitor CBCs during 1st few months of treatment; discontinue if WBCs decline. Perform fall risk assessments when initiating and recurrently on long-term therapy. Exposure to extreme heat. Dysphagia. Suicidal ideation (monitor). Reevaluate periodically. Write ℞ for smallest practical amount. Debilitated. Labor & delivery. Neonates: risk of extrapyramidal and/or withdrawal symptoms post delivery (due to exposure during 3rd-trimester pregnancy). Pregnancy (Cat.C). Nursing mothers: not recommended.

Interactions:

Orthostatic hypotension with antihypertensives, alcohol (caution), diazepam. Caution with other CNS drugs, anticholinergics, hepatotoxic agents. Concomitant IV benzodiazepine: not recommended with IM olanzapine. May antagonize levodopa, dopamine agonists. May be antagonized by rifampin, omeprazole, carbamazepine, others that induce CYP1A2 or glucuronyl transferase. May be potentiated by fluvoxamine, others that inhibit CYP1A2. Smokers may have increased clearance.

See Also:

ZYPREXA ZYDIS

ZYPREXA INTRAMUSCULAR

ZYPREXA RELPREVV

Pharmacological Class:

Thienobenzodiazepine.

Adverse Reactions:

Somnolence, sedation, dizziness, constipation, weight gain, increased appetite, personality disorder, akathisia, asthenia, postural hypotension, headache, abdominal pain, dry mouth, fatigue, tremor, extremity/back pain, nausea, diarrhea, vomiting, cough, nasopharyngitis; neutropenia, hyperprolactinemia, elevated liver enzymes, EPS.

How Supplied:

Tabs—30; Zydis—30; Vial—1; Relprevv (kit)—1 (w. diluent + supplies)

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