What is the initial dosing for olanzapine (Zyprexa) in agitation?

From the Guidelines

The initial dose of olanzapine (Zyprexa) for agitation is typically 5-10 mg administered intramuscularly (IM) or orally, with a lower dose of 2.5-5 mg recommended for elderly patients or those with medical comorbidities. When considering the management of acute agitation, it's crucial to prioritize the patient's safety and the efficacy of the treatment. According to the study by Breier et al 1, IM olanzapine was found to be superior to placebo in reducing agitation in patients with schizophrenia, with no significant difference noted between IM olanzapine and haloperidol based on the PANSS-EC scores.

Key considerations for dosing include:

• Starting with a lower dose for vulnerable populations, such as the elderly or those with medical comorbidities, to minimize the risk of adverse effects.
• The dose may be repeated after 2-4 hours if needed, with a maximum daily dose of 20 mg, as indicated by the study by Meehan et al 1.
• Oral disintegrating tablets (Zyprexa Zydis) are available for patients who have difficulty swallowing pills or who refuse medication, offering an alternative administration route.
• Monitoring for respiratory depression is essential, especially if the patient has received other CNS depressants, due to the potential for excessive sedation and cardiorespiratory depression.

Common side effects of olanzapine include sedation, orthostatic hypotension, and anticholinergic effects, as reported in the study by Wright et al 1. It's also important to avoid combining IM olanzapine with parenteral benzodiazepines due to the risk of excessive sedation and cardiorespiratory depression. By considering these factors and following the recommended dosing guidelines, healthcare providers can effectively manage acute agitation while minimizing the risk of adverse effects.

From the FDA Drug Label

Dose Selection for Agitated Adult Patients with Schizophrenia and Bipolar I Mania — The efficacy of intramuscular olanzapine for injection in controlling agitation in these disorders was demonstrated in a dose range of 2.5 mg to 10 mg. The recommended dose in these patients is 10 mg. A lower dose of 5 or 7.5 mg may be considered when clinical factors warrant

The initial dosing for olanzapine (Zyprexa) in agitation is 10 mg. However, a lower dose of 5 mg or 7.5 mg may be considered when clinical factors warrant 2.

From the Research

Initial Dosing for Olanzapine (Zyprexa) in Agitation

• The initial dosing for olanzapine (Zyprexa) in agitation can vary depending on the specific clinical context and the patient's condition.
• According to a study published in the Annals of Emergency Medicine 3, the initial dose of intramuscular olanzapine used to treat agitation in the emergency department was 10 mg.
• Another study published in the Journal of Clinical Psychopharmacology 4 compared the efficacy and safety of intramuscular olanzapine, orally disintegrating olanzapine tablets, oral risperidone solution, and intramuscular haloperidol in the management of acute agitation, and found that a 10-mg dose of intramuscular olanzapine was effective in reducing agitation.
• A postmarketing surveillance study in Japan 5 also used an initial dose of 10 mg of intramuscular olanzapine to treat acute agitation associated with schizophrenia, and found it to be safe and effective.

Oral Dosing

• For oral dosing, a study published in the Journal of Clinical Psychopharmacology 6 investigated the effectiveness of rapid initial dose escalation of up to 40 mg per day of oral olanzapine in acute agitation, and found that this approach was superior to usual clinical practice in reducing agitation.
• Another study published in the Journal of Clinical Psychopharmacology 7 compared the efficacy of oral haloperidol, risperidone, and olanzapine in reducing psychotic agitation in severely agitated patients with schizophrenia or schizophreniform or schizoaffective disorder, and used a daily dose of 20 mg of olanzapine.

Key Findings

• The initial dosing for olanzapine (Zyprexa) in agitation can be 10 mg intramuscularly or 20 mg orally, depending on the specific clinical context and the patient's condition.
• Rapid initial dose escalation of up to 40 mg per day of oral olanzapine may be effective in reducing agitation, but this approach should be used with caution and under close medical supervision 6.
• Olanzapine has been shown to be safe and effective in reducing agitation in patients with schizophrenia or bipolar disorder, and can be used as part of a comprehensive treatment plan to manage agitation and improve patient outcomes 3, 7, 5, 4, 6.