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{{MedTemplate
{{MedTemplate
| generic           = Olanzapine
| generic           = Olanzapine
| brand             = Zyprexa
| brand             = Zyprexa (oral, IM acute), Zyprexa Zydis (ODT), Zyprexa Relprevv (LAI), Lybalvi (with samidorphan)
| structure         =  
| structure         =
| classes           = Antipsychotic, Neuroleptic
| classes           = [[:Category:Neuroleptics|Neuroleptic]], [[:Category:Atypical neuroleptics|Atypical neuroleptic (second-generation)]], [[:Category:Thienobenzodiazepines|Thienobenzodiazepine]], [[:Category:Mood stabilizers|Mood stabilizer]]
| mechanism          = Multi-receptor antagonist (D1-4, 5-HT2, H1, muscarinic)
| uses              = <vote slug="schizophrenia-use">Schizophrenia (FDA)</vote>, <vote slug="bipolar-mania-mixed-use">Bipolar I mania and mixed episodes (FDA)</vote>, <vote slug="bipolar-maintenance-use">Bipolar I maintenance (FDA)</vote>, <vote slug="bipolar-depression-combination-use">Bipolar depression (FDA, in combination with fluoxetine as Symbyax)</vote>, <vote slug="acute-agitation-im-use">Acute agitation in schizophrenia or bipolar disorder (FDA, IM)</vote>, <vote slug="treatment-resistant-depression-adjunct-use">Treatment-resistant depression adjunct (off-label)</vote>, <vote slug="anorexia-nervosa-use">Anorexia nervosa (off-label, evidence-supported)</vote>
| uses              =  
| starting_dose    = Schizophrenia / acute mania: 5-10 mg PO once daily, target 10-15 mg/day. Acute agitation IM: 10 mg, may repeat in 2 hours. Relprevv LAI: 150-300 mg every 4 weeks after oral overlap
| starting_dose     =  
| preparations     = Tablets 2.5, 5, 7.5, 10, 15, 20 mg; ODT (Zydis) 5, 10, 15, 20 mg; acute IM injection 10 mg/vial; Relprevv LAI 210, 300, 405 mg vials
| preparations      =  
| fda_max          = 20 mg/day (oral)
| fda_max           =  
| pill_id           =
| routes             =  
| routes           = Oral, intramuscular (acute and long-acting)
| onset             =  
| onset             = Sedation from first dose; neuroleptic effect emerges over days to weeks
| duration           =  
| duration         = 24 hours (oral); 2-4 weeks (LAI)
| halflife           =  
| halflife         = 21-54 hours<ref name="zyprexa-label">FDA Prescribing Information, Zyprexa (olanzapine), Eli Lilly, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020592s062,021086s041,021253s048lbl.pdf</ref>
| bioavailability   =  
| bioavailability   = ~60% (oral); ~100% (IM)<ref name="zyprexa-label" />
| pregnancy         =  
| pregnancy         = Signal for gestational diabetes and metabolic syndrome with maternal exposure; the metabolic load can be substantial during pregnancy.{{citation needed}}
| legal             =  
| legal             = [[USLegal:Prescription only|Rx-only]] in US. Carries the atypical-neuroleptic '''Boxed Warning''' for increased mortality in elderly patients with dementia-related psychosis. '''Zyprexa Relprevv LAI''' additionally carries a Boxed Warning for '''post-injection delirium/sedation syndrome''' requiring 3-hour monitored observation after each injection<ref name="zyprexa-label" />
| intro              =  
| mechanism        = <vote slug="olanzapine-mech-claim">Multi-receptor antagonist with broad activity at D1, D2, D3, D4 dopamine receptors (D2/D3 mediating the neuroleptic effect), 5-HT2A and 5-HT2C serotonin receptors (the atypical-neuroleptic feature, reducing extrapyramidal burden), H1 histamine (mediating sedation and weight gain), M1-M5 muscarinic (anticholinergic effects), and α1-adrenergic (orthostatic hypotension) receptors.</vote> The marquee tolerability concern is '''severe metabolic burden''': weight gain often exceeding 10 kg in the first year, insulin resistance, hyperlipidemia, and elevated type 2 diabetes risk, among the worst in the second-generation class. Routine metabolic monitoring (weight, fasting glucose, lipid panel) is standard. The Lybalvi formulation combines olanzapine with samidorphan, an opioid antagonist, to mitigate weight gain<ref name="zyprexa-label" />.
| pharmacokinetics  =  
| pharmacodynamics  =  
| indications        =
| dosing            =
| effects           =
| interactions      = <pharmaInteractions/>
| pregnancy_details  =
| monitoring         =
| counseling        =
| anecdotes          =
| seealso            =
| references        =  
}}
}}


== References ==
<references />


[[Category:Antipsychotics / Neuroleptics]]
[[Category:Second-Generation Antipsychotics (SGAs / Atypicals)]]
[[Category:Neuroleptics]]
[[Category:Neuroleptics]]
[[Category:Atypical neuroleptics]]
[[Category:Thienobenzodiazepines]]
[[Category:Mood stabilizers]]

Latest revision as of 07:12, 23 May 2026

Neuroleptic, Atypical neuroleptic (second-generation), Thienobenzodiazepine, Mood stabilizer
Olanzapine
Zyprexa (oral, IM acute), Zyprexa Zydis (ODT), Zyprexa Relprevv (LAI), Lybalvi (with samidorphan)

Experience

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Problems

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Titration strategies

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Effects

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Summary
Classes
Neuroleptic, Atypical neuroleptic (second-generation), Thienobenzodiazepine, Mood stabilizer
Common uses
Schizophrenia (FDA)0, Bipolar I mania and mixed episodes (FDA)0, Bipolar I maintenance (FDA)0, Bipolar depression (FDA, in combination with fluoxetine as Symbyax)0, Acute agitation in schizophrenia or bipolar disorder (FDA, IM)0, Treatment-resistant depression adjunct (off-label)0, Anorexia nervosa (off-label, evidence-supported)0
Pharmacy
Starting dose
Schizophrenia / acute mania: 5-10 mg PO once daily, target 10-15 mg/day. Acute agitation IM: 10 mg, may repeat in 2 hours. Relprevv LAI: 150-300 mg every 4 weeks after oral overlap
Preparations
Tablets 2.5, 5, 7.5, 10, 15, 20 mg; ODT (Zydis) 5, 10, 15, 20 mg; acute IM injection 10 mg/vial; Relprevv LAI 210, 300, 405 mg vials
US FDA Max
20 mg/day (oral)
Pharmacology
Routes
Oral, intramuscular (acute and long-acting)
Onset
Sedation from first dose; neuroleptic effect emerges over days to weeks
Duration
24 hours (oral); 2-4 weeks (LAI)
Half-life
21-54 hours[1]
Bioavailability
~60% (oral); ~100% (IM)[1]
Pregnancy
Signal for gestational diabetes and metabolic syndrome with maternal exposure; the metabolic load can be substantial during pregnancy.[citation needed]
Legal status
Rx-only in US. Carries the atypical-neuroleptic Boxed Warning for increased mortality in elderly patients with dementia-related psychosis. Zyprexa Relprevv LAI additionally carries a Boxed Warning for post-injection delirium/sedation syndrome requiring 3-hour monitored observation after each injection[1]
Purported mechanism
Multi-receptor antagonist with broad activity at D1, D2, D3, D4 dopamine receptors (D2/D3 mediating the neuroleptic effect), 5-HT2A and 5-HT2C serotonin receptors (the atypical-neuroleptic feature, reducing extrapyramidal burden), H1 histamine (mediating sedation and weight gain), M1-M5 muscarinic (anticholinergic effects), and α1-adrenergic (orthostatic hypotension) receptors.0 The marquee tolerability concern is severe metabolic burden: weight gain often exceeding 10 kg in the first year, insulin resistance, hyperlipidemia, and elevated type 2 diabetes risk, among the worst in the second-generation class. Routine metabolic monitoring (weight, fasting glucose, lipid panel) is standard. The Lybalvi formulation combines olanzapine with samidorphan, an opioid antagonist, to mitigate weight gain[1].

References

  1. ↑ 1.0 1.1 1.2 1.3 FDA Prescribing Information, Zyprexa (olanzapine), Eli Lilly, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020592s062,021086s041,021253s048lbl.pdf
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