Olanzapine belongs to atypical antipsychotics class of drugs. Other members of this class include clozapine (Clozaril), risperidone (Risperdal), aripiprazole (Abilify) and ziprasidone (Geodon). Olanzapine/Fluoxetine is marketed in the United States as Symbyax by Eli Lilly and Company.
Abstract
Olanzapine belongs to atypical antipsychotics class of drugs. Other members of this class include clozapine (Clozaril), risperidone (Risperdal), aripiprazole (Abilify) and ziprasidone (Geodon). The exact mechanism of action of olanzapine is not known.
[2]
Brand Names
Zyprexa,
Zydis,
Relprevv
Symbyax
[3]
Manufacturers
AMER. REGENT
SANDOZ
TEVA USA
MYLAN
TORRENT PHARMA
DR.REDDY'S LAB
GREENSTONE LLC
SUN PHARMA
APOTEX CORP ELI LILLY & CO
AUROBINDO PHARMA
QUALITY CARE
PHYSICIANS TC
[1]
History
Olanzapine/Fluoxetine is marketed in the United States as Symbyax by Eli Lilly and Company. The drug combination was approved by the FDA in December, 2003.
[5]
Uses
Olanzapine is used to treat the symptoms of psychotic conditions such as schizophrenia and bipolar disorder (manic depression) in adults and children who are at least 13 years old. It is sometimes used together with other antipsychotic medications or antidepressants.
[3]
Pharmacology
Olanzapine is a potent antagonist of the muscarinic M3 receptor, which may underlie its diabetes side-effects. Additionally olanzapine also exhibits a relatively low affinity for serotonin 5-HT1, GABAA, beta-adrenergic receptors, and benzodiazepine binding sites. The mode of action of olanzapine's antipsychotic activity is unknown. It may involve antagonism of dopamine and serotonin receptors. Antagonism of dopamine receptors is associated with extrapyramidal effects such as tardive dyskinesia, and with therapeutic effects. Antagonism of muscarinic acetylcholine receptors is associated with anticholinergic side effects such as dry mouth and constipation, in addition it may suppress or reduce the emergence of extrapyramidal effects for the duration of treatment, however it offers no protection against the development of tardive dyskinesia. Antagonizing H1 histamine receptors causes sedation and may cause weight gain, although antagonistic actions at serotonin 5-HT2C and dopamine D2 receptors have also been associated with weight gain and appetite stimulation.
[4]
Schedule
It is not a controlled substance in the US.
Dosage
The dosage depends on the reason why it is prescribed for an individual. In general,
Start at lower dose of 5 mg PO qDay.
IM, extended-release (Zyprexa Relprevv): 150 mg IM q4wks in debilitated patients or predisposed to hypotensive episodes; not studied in patients with renal or hepatic impairment; requires deep IM administration.
Adolescents: 2.5-5 mg PO qDay initially; target dose is 10 mg/day; adjust by dose increments/decrements of 2.5-5 mg.
Not to exceed 20 mg qDay.
[6]
Drug Interactions
Contraindicated interactions with:
None
Serious interactions with:
acarbose
aclidinium
albuterol
alfentanil
cigarette smoking
cimetidine
cinnarizine
ciprofloxacin
deferasirox
desflurane
desipramine
dexchlorpheniramine
dexfenfluramine
morphine
motherwort
moxonidine
nabilone
nalbuphine
nalidixic acid
nateglinide
zileuton
ziprasidone
zotepine
Significant interactions with:
abobotulinumtoxina
acarbose
aclidinium
albuterol
benzphetamine
benztropine
biperiden
clemastine
clobazam
clobetasone
clofedanol
dantrolene
darifenacin
darunavir
dasatinib
ethanol
ethchlorvynol
ethotoin
insulin lispro
insulin nph
methadone
methamphetamine
methocarbamol
methoxamine
methscopolamine
zafirlukast
ziconotide
ziprasidone
[7]
Adverse Effects
Xerostomia (9-22%)
Weakness (2-20%)
Dizziness (4-18%)
Accidental injury (12%)
Insomnia (12%)
Elevated ALT (5-12%)
Constipation (9-11%)
Dyspepsia (7-11%)
Hyperprolactinemia
Hyperglycemia
[8]
Contraindications
Documented hypersensitivity
Breastfeeding
[9]
Cautions
Increased risk of hyperglycemia and diabetes; in some cases, hyperglycemia concomitant with use of atypical antipsychotics has been associated with ketoacidosis, hyperosmolar coma, or death
Monitor blood glucose of high-risk patients
Irreversible, involuntary, dyskinetic movements may develop with antipsychotic drugs; although prevalence appears to be highest among elderly individuals, especially elderly women
Neuroleptic malignant syndrome has been reported
Increased potential for weight gain
May induce orthostatic hypotension associated with dizziness, tachycardia, bradycardia and, in some patients, syncope, especially during the initial dose-titration period, probably reflecting its alpha-1-adrenergic antagonistic properties
Do not reconstitute with lorazepam injection; do not mix with diazepam or haloperidol in syringe
FDA Warning regarding off-label use for dementia in elderly.
[9]
Pricing
The pricing varies depending on what form one would like to buy, and the brand.
The 10mg tablet is priced in between $16.05 to $170.81. The prices for 15mg tablet vary from
$22.67 to $170.21. The 2.5mg tablet would cost in the range of $9.29 to $144.81. The prices of 20mg tablet may vary from $49.15 to $170.21.
[1]
Referenecs
[1] http://reference.medscape.com/drug/zyprexa-relprevv-olanzapine-342979#90
[2] http://www.medicinenet.com/olanzapine/article.htm
[3] http://www.drugs.com/mtm/olanzapine.html
[4] http://diabetes.diabetesjournals.org/content/54/5/1552.full.pdf
[5] http://ps.psychiatryonline.org/data/Journals/PSS/3474/1137.pdf
[6] http://reference.medscape.com/drug/zyprexa-relprevv-olanzapine-342979#13
[7] http://reference.medscape.com/drug/zyprexa-relprevv-olanzapine-342979#3
[8] http://reference.medscape.com/drug/zyprexa-relprevv-olanzapine-342979#4
[9] http://reference.medscape.com/drug/zyprexa-relprevv-olanzapine-342979#5
