From the Guidelines
Olanzapine is not recommended for the treatment of insomnia due to its significant side effect profile and the availability of safer, more effective alternatives. Olanzapine is an atypical antipsychotic medication primarily used to treat schizophrenia, bipolar disorder, and other psychiatric conditions. While it can cause sedation as a side effect, which might help with sleep, its use for insomnia is not supported by recent guidelines, such as the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines 1. These guidelines advise against the use of antipsychotics, including olanzapine, for the treatment of chronic insomnia disorder due to the lack of evidence supporting their efficacy and the potential for harm.
Instead, healthcare providers typically recommend starting with sleep hygiene improvements, cognitive behavioral therapy for insomnia (CBT-I), or if medication is needed, options like short-term use of melatonin, low-dose doxepin, or other sleep medications specifically approved for insomnia 1. The American College of Physicians guideline for the management of chronic insomnia disorder in adults also recommends CBT-I as the initial treatment intervention, with pharmacotherapy considered only after a shared decision-making approach with the patient 1.
Key points to consider when evaluating treatment options for insomnia include:
- The potential benefits and harms of each treatment option
- The availability of safer, more effective alternatives
- The importance of individualized treatment planning and shared decision-making with the patient
- The need for close medical supervision when using medications like olanzapine for sleep difficulties.
In summary, olanzapine should not be used as a first-line treatment for insomnia, and patients struggling with sleep problems should consult with a healthcare provider to determine the best course of treatment based on their specific situation, taking into account the latest evidence and guidelines 1.
From the FDA Drug Label
Nervous System Somnolence2913 Insomnia1211 The FDA drug label does mention insomnia as a treatment-emergent adverse reaction, but it does not indicate that olanzapine is used for insomnia. In fact, the label suggests that olanzapine may cause somnolence (drowsiness) in a significant percentage of patients, which is the opposite of insomnia.
- Key points:
- Olanzapine is associated with somnolence (drowsiness) in 29% of patients.
- Insomnia is listed as a treatment-emergent adverse reaction, occurring in 12% of patients.
- Clinical decision: Olanzapine is not indicated for the treatment of insomnia, and may actually exacerbate sleepiness due to its somnolent effects 2.
From the Research
Olanzapine for Insomnia
- There is no direct evidence to suggest that olanzapine is primarily used for the treatment of insomnia 3, 4, 5, 6, 7.
- Olanzapine is an atypical antipsychotic that has been approved for the treatment of schizophrenia, bipolar I disorder, and other conditions 3, 4, 5, 7.
- However, one study mentions that the sedative effect of a low dose of trazodone may be useful for some patients with insomnia, implying that sedative effects can be leveraged to manage insomnia, but this is not specific to olanzapine 6.
- The primary uses of olanzapine include the treatment of psychotic symptoms, manic episodes, and depressive symptoms, with common side effects including somnolence, dry mouth, dizziness, and bodyweight gain 3, 4, 5, 7.
- One study found that olanzapine improved appetite, weight, and quality of life in patients with locally advanced or metastatic cancer treated with chemotherapy, but this is not directly related to the treatment of insomnia 6.