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olanzapine
Zyprexa · Zyprexa Zydis · Zyprexa IntraMuscular · Zyprexa Relprevv · Symbyax (with fluoxetine)
Second-generation antipsychotic⚠ Unverified beta content
At a glance
- Class
- Atypical antipsychotic (thienobenzodiazepine)
- Black box
- ⚠ Increased mortality in elderly patients with dementia-related psychosis
- ⚠ When used with fluoxetine (Symbyax)
- ⚠ Olanzapine pamoate LAI (Relprevv)
- Key monitoring
- Metabolic monitoring (ADA/APA schedule) — Weight/BMI, waist, BP, fasting glucose/A1c, fasting lipids
- Vitals / sedation after IM dose
- Usual adult dose
- Schizophrenia: 5–10 mg/day start; usual 10–20 mg/day
- Call provider / escalate if
- High fever, stiffness, confusion, sweating (NMS) • Extreme thirst, frequent urination, fruity breath, nausea (high blood sugar/DKA) • Fainting / dizziness on standing
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- olanzapine (Zyprexa, Zyprexa Zydis, Zyprexa IntraMuscular) — atypical antipsychotic (thienobenzodiazepine).
- Used for: Schizophrenia; Bipolar I – acute mania/mixed; maintenance; Agitation associated with schizophrenia/bipolar mania; Treatment-resistant depression.
Usual adult dosing
- Schizophrenia: 5–10 mg/day start; usual 10–20 mg/day (Max 20 mg/day (higher not well studied).)
- Bipolar mania: 10–15 mg/day start; 5–20 mg/day
- IM agitation: 10 mg IM (5–7.5 mg if debilitated) (Up to 3 doses 2–4 h apart; max 30 mg/day total (all routes).)
Boxed warning
- Increased mortality in elderly patients with dementia-related psychosis: not approved for treatment of dementia-related psychosis.
- When used with fluoxetine (Symbyax): also review boxed warning for fluoxetine (suicidality).
- Olanzapine pamoate LAI (Relprevv): Post-Injection Delirium/Sedation Syndrome (PDSS) – observe patient for ≥3 h after each injection at a registered facility.
Monitor
- Metabolic monitoring (ADA/APA schedule) — Weight/BMI, waist, BP, fasting glucose/A1c, fasting lipids [Baseline; weight at 4, 8, 12 wks then quarterly; BP/glucose/lipids at 12 wks then annually (lipids q5y if normal); more often if abnormal]
- Vitals / sedation after IM dose
Nursing priorities
- Baseline psychiatric symptoms (positive/negative, agitation), suicidality, and aggression risk.
- Baseline vitals incl. orthostatic BP, weight/BMI, waist circumference.
- Assess for EPS, akathisia, and abnormal movements each shift/visit (AIMS at baseline and periodically per policy).
- Check orthostatic vitals; teach slow position changes; fall precautions.
- Weigh regularly and encourage healthy diet and activity.
Major interactions
- Parenteral benzodiazepines (IM lorazepam): Excess sedation and cardiorespiratory depression.
Key teaching
- Take it every day even when you feel well. Do not stop suddenly.
- It can make you dizzy when you stand up – rise slowly.
- Weight gain and changes in blood sugar and cholesterol can happen. You will have regular weight and blood tests.
Optional: AI explanation
Off by default. To enable, add your own API key in Settings (stored only on this device).
Boxed warning
- Increased mortality in elderly patients with dementia-related psychosis: not approved for treatment of dementia-related psychosis.
- When used with fluoxetine (Symbyax): also review boxed warning for fluoxetine (suicidality).
- Olanzapine pamoate LAI (Relprevv): Post-Injection Delirium/Sedation Syndrome (PDSS) – observe patient for ≥3 h after each injection at a registered facility.
Other serious warnings
- Significant weight gain / metabolic syndrome (high risk)
- Hyperglycemia / DKA
- NMS
- Tardive dyskinesia
- Orthostatic hypotension
- DRESS
- Seizures
- Anticholinergic effects (urinary retention, constipation)
- Dysphagia
- Concurrent IM olanzapine + parenteral benzodiazepine: avoid – risk of oversedation/cardiorespiratory depression
Sources: FDA label (DailyMed): ZYPREXA (OLANZAPINE) TABLET ZYPREXA ZYDIS (OLANZ
- Metabolic monitoring (ADA/APA schedule)Target: Weight/BMI, waist, BP, fasting glucose/A1c, fasting lipidsWhen: Baseline; weight at 4, 8, 12 wks then quarterly; BP/glucose/lipids at 12 wks then annually (lipids q5y if normal); more often if abnormal
- Vitals / sedation after IM doseOrthostatic hypotension, bradycardia, respiratory depression
- AIMS / EPSWhen: Baseline and at least every 6–12 months
- LFTsWhen: Baseline and periodically
- ProlactinIf symptomatic
Sources: FDA label (DailyMed): ZYPREXA (OLANZAPINE) TABLET ZYPREXA ZYDIS (OLANZ · ADA/APA Consensus Development Conference on Antipsychotic Drugs and Ob
Assessment
- Baseline psychiatric symptoms (positive/negative, agitation), suicidality, and aggression risk.
- Baseline vitals incl. orthostatic BP, weight/BMI, waist circumference.
- Baseline AIMS (abnormal movements) and EPS screen.
- History of diabetes, dyslipidemia, cardiac disease, seizures, dementia.
- Substance use and medication/supplement list.
- Baseline fasting glucose/A1c & lipids.
Interventions
- Assess for EPS, akathisia, and abnormal movements each shift/visit (AIMS at baseline and periodically per policy).
- Check orthostatic vitals; teach slow position changes; fall precautions.
- Weigh regularly and encourage healthy diet and activity.
- Monitor adherence (consider cheeking checks per policy).
- Report fever, rigidity, or altered mental status immediately (NMS).
- Do NOT give IM olanzapine at the same time as parenteral lorazepam or other IM benzodiazepines; monitor vitals/sedation after IM dose.
- Orally disintegrating tablets: place on tongue, allow to dissolve.
- Early, aggressive weight management counseling.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- High fever, stiffness, confusion, sweating (NMS)
- Extreme thirst, frequent urination, fruity breath, nausea (high blood sugar/DKA)
- Fainting / dizziness on standing
- Involuntary face/tongue movements
- Seizure
- After LAI: confusion, extreme sleepiness, slurred speech, trouble walking (PDSS)
- Trouble swallowing
- Rash with fever
Sources: FDA label (DailyMed): ZYPREXA (OLANZAPINE) TABLET ZYPREXA ZYDIS (OLANZ · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Sedation / somnolence
- Weight gain, increased appetite
- Dry mouth
- Dizziness, orthostatic hypotension
- Constipation
- Hyperglycemia, dyslipidemia
- Elevated prolactin (mild), ↑ liver enzymes
Sources: FDA label (DailyMed): ZYPREXA (OLANZAPINE) TABLET ZYPREXA ZYDIS (OLANZ
- Parenteral benzodiazepines (IM lorazepam) MajorExcess sedation and cardiorespiratory depression.
- Fluvoxamine, ciprofloxacin (CYP1A2 inhibitors)↑ olanzapine levels.
- Smoking / carbamazepine (CYP1A2 inducers)↓ olanzapine levels; changes in smoking status alter levels.
- AntihypertensivesAdditive hypotension.
- Alcohol, other CNS depressantsAdditive sedation.
Sources: FDA label (DailyMed): ZYPREXA (OLANZAPINE) TABLET ZYPREXA ZYDIS (OLANZ
- Take it every day even when you feel well. Do not stop suddenly.
- It can make you dizzy when you stand up – rise slowly.
- Weight gain and changes in blood sugar and cholesterol can happen. You will have regular weight and blood tests.
- Report muscle stiffness, restlessness (can’t sit still), shaking, or unusual movements of the face or tongue.
- Avoid alcohol and street drugs; they add to drowsiness and can worsen symptoms.
- It can make you feel hot more easily – drink fluids and avoid overheating.
- You may feel very hungry and gain weight – plan healthy snacks, regular activity; weight is checked often.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Schizophrenia
- Bipolar I – acute mania/mixed; maintenance
- Agitation associated with schizophrenia/bipolar mania (IM)
- Treatment-resistant depression (with fluoxetine – Symbyax)
Dosing
- Schizophrenia: 5–10 mg/day start; usual 10–20 mg/dayMax 20 mg/day (higher not well studied).
- Bipolar mania: 10–15 mg/day start; 5–20 mg/day
- IM agitation: 10 mg IM (5–7.5 mg if debilitated)Up to 3 doses 2–4 h apart; max 30 mg/day total (all routes).
Sources: FDA label (DailyMed): ZYPREXA (OLANZAPINE) TABLET ZYPREXA ZYDIS (OLANZ
Prescriber-oriented details; limited in this beta.
hepatic Adjustment
- Use caution; ↑ transaminases common.
geriatric
- Start 2.5–5 mg/day.
cyp Notes
- CYP1A2 substrate (smoking induces).
Sources: FDA label (DailyMed): ZYPREXA (OLANZAPINE) TABLET ZYPREXA ZYDIS (OLANZ
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): ZYPREXA (OLANZAPINE) TABLET ZYPREXA ZYDIS (OLANZAPINE) TABLET, ORALLY DISINTEGRATING ZYPREXA INTRAMUSCULAR …
- ADA/APA Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes (Diabetes Care 2004) - metabolic monitoring schedule
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified