What is the recommended dosing of Zyprexa (olanzapine) for agitation?

From the Guidelines

For agitation, the recommended dosing of Zyprexa (olanzapine) is 2.5-5 mg orally or subcutaneously as a starting dose, with the possibility of adjusting based on patient response and tolerability, as indicated in the most recent guidelines 1. When considering the management of agitation, it's crucial to weigh the benefits and risks of olanzapine, taking into account its potential to cause drowsiness, orthostatic hypotension, and metabolic effects, especially with long-term use 1. Key points to consider in the dosing of olanzapine for agitation include:

• Starting with a lower dose, such as 2.5 mg, is recommended for older patients or those with hepatic impairment to minimize adverse effects 1.
• The medication can be administered orally or subcutaneously, with oral dosing typically starting at 2.5-5 mg and subcutaneous dosing following a similar range 1.
• Monitoring for common side effects like sedation, weight gain, and metabolic changes is essential, particularly with continued use 1.
• Caution is advised when combining olanzapine with benzodiazepines due to the risk of oversedation and respiratory depression 1. Given the potential risks and benefits, the initial dose of 2.5-5 mg of olanzapine for agitation, as suggested by recent clinical guidelines 1, appears to be a reasonable approach, balancing efficacy with the need to minimize adverse outcomes.

From the FDA Drug Label

2.4 ZYPREXA IntraMuscular: Agitation Associated with Schizophrenia and Bipolar I Mania 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 [see Clinical Studies (14.3)].

The recommended dosing of Zyprexa (olanzapine) for agitation is 10 mg intramuscularly, with a possible lower dose of 5 or 7.5 mg when clinically warranted 2.

From the Research

Zyprexa Dosing for Agitation

• The recommended dosing of Zyprexa (olanzapine) for agitation varies depending on the specific clinical context and patient population.
• According to a study published in 2023 3, intramuscular (IM) olanzapine 10 mg was effective in sedating 78.9% of patients with acute undifferentiated agitation within 20 minutes.
• Another study published in 2018 4 found that IM olanzapine 10 mg resulted in a greater proportion of patients adequately sedated at 15 minutes compared to haloperidol 5 mg and ziprasidone 20 mg.
• A review of the literature published in 2005 5 noted that IM olanzapine has shown faster onset of action, greater efficacy, and fewer adverse effects than haloperidol or lorazepam in the treatment of acute agitation associated with schizophrenia, schizoaffective disorder, bipolar mania, and dementia.
• The same review 5 also mentioned that IM olanzapine has distinct calming versus nonspecific sedative effects, and has been shown to have ease of transition to same-agent oral therapy once the episode of acute agitation has diminished.
• A study published in 2019 6 reviewed the off-label use of intravenous (IV) olanzapine for the management of agitation, and found that doses from 2.5 to 10 mg given as an IV bolus (maximum dose of 30 mg/d) have been administered, with efficacy similar to droperidol in achieving adequate sedation within 10 minutes.
• A review published in 2005 7 noted that IM olanzapine is at least as effective as IM haloperidol or lorazepam in the treatment of patients with acute agitation associated with schizophrenia or bipolar mania, and has a faster onset of action, with a low incidence of extrapyramidal symptoms (EPS).

Key Findings

• IM olanzapine 10 mg is effective in sedating patients with acute undifferentiated agitation within 20 minutes 3.
• IM olanzapine has a faster onset of action and greater efficacy than haloperidol or lorazepam in the treatment of acute agitation associated with schizophrenia, schizoaffective disorder, bipolar mania, and dementia 5, 7.
• IV olanzapine has been used off-label for the management of agitation, with doses from 2.5 to 10 mg given as an IV bolus (maximum dose of 30 mg/d) 6.