OLANZAPINE oral

Prescription under medical supervision

Therapeutic action

– Atypical antipsychotic

Indications

– Chronic psychosis, in the event of intolerance or treatment failure with other antipsychotics

Forms and strengths

– 2.5 mg and 5 mg tablets

Dosage

– Adult: 5 mg once daily. Increase up to 10 mg daily if necessary (max. 20 mg daily).
– Reduce the dose by half in elderly patients (max. 10 mg daily).

Duration

– Minimum one year. The treatment should be discontinued gradually (over 4 weeks). If signs of relapse occur, increase the dose.

Contra-indications, adverse effects, precautions

– Do not administer to patients with cardiac disorders (heart failure, recent myocardial infarction, conduction disorders, bradycardia, etc.), dementia (e.g. Alzheimer's disease), Parkinson's disease, history of neuroleptic malignant syndrome and closed-angle glaucoma.
– Administer with caution and carefully monitor use in elderly patients and patients with hypokalaemia, hypotension, prostate disorders, renal or hepatic impairment, history of seizures. 
– May cause: orthostatic hypotension, drowsiness, extrapyramidal symptoms, hyperprolactinaemia, weight gain, hyperlipidaemia, hyperglycaemia, anticholinergic effects (constipation, dry mouth), headache, insomnia, dizziness, sexual dysfunction; neuroleptic malignant syndrome (unexplained hyperthermia with neuromuscular disorders), rare but requiring immediate treatment discontinuation. 
– In the event of extrapyramidal symptoms, combine with biperiden or trihexyphenidyl.
– Avoid or monitor combination with:
• central nervous system depressants (opioid analgesics, sedatives, H1 antihistamines, etc.); 
• ciprofloxacin (increased plasma concentrations of olanzapine);
• carbamazepine, rifampicin, phenobarbital, phenytoin, ritonavir (decreased plasma concentrations of olanzapine);
• antihypertensive drugs (risk of hypotension); drugs that prolong the QT interval (amiodarone, chloroquine, erythromycin, fluconazole, mefloquine, pentamidine, quinine, etc.). 
– Avoid alcohol during treatment.
– Pregnancy: re-evaluate whether the treatment is still necessary; if it is continued, monitor the neonate the first few days (risk of hypertonia, tremors, sedation). 
– Breast-feedingif absolutely necessary, do not exceed 10 mg daily. 

Remarks

– Storage: below 25 °C