What are the inpatient indications for use of Zyprexa (olanzapine)?

From the Guidelines

Olanzapine (Zyprexa) is indicated for inpatient treatment of acute agitation in schizophrenia, bipolar mania, psychotic disorders, and delirium. The typical inpatient dosing ranges from 5-20 mg daily, with initial doses often starting at 5-10 mg and titrated based on response and tolerability. For acute agitation requiring rapid control, the intramuscular formulation can be administered at 2.5-10 mg, with doses potentially repeated after 2 hours (maximum 30 mg daily) 1. Olanzapine is also used for treatment-resistant psychosis and as an adjunct for depression with psychotic features in inpatient settings. Some key points to consider when using olanzapine in inpatient settings include:

• Monitoring for metabolic side effects (weight gain, hyperglycemia, dyslipidemia), sedation, orthostatic hypotension, and QTc prolongation, particularly in the inpatient setting where higher doses may be used 1.
• Baseline and follow-up monitoring of weight, blood glucose, lipids, and EKG are important, especially for patients with cardiovascular risk factors.
• The medication works primarily by blocking dopamine D2 receptors and serotonin 5-HT2A receptors, helping to control positive symptoms like hallucinations and delusions while also addressing negative symptoms.
• Delirium management with olanzapine should focus on identifying and treating reversible causes, maximizing nonpharmacologic interventions, and using the medication at the lowest effective dose to manage symptoms 1. In terms of specific inpatient indications, olanzapine can be used for:
• Acute agitation in schizophrenia and bipolar mania
• Psychotic disorders, including treatment-resistant psychosis
• Delirium, particularly in patients with advanced cancer and limited life expectancy
• Depression with psychotic features, as an adjunct to other treatments.

From the FDA Drug Label

As ZYPREXA IntraMuscular for the: Treatment of acute agitation associated with schizophrenia and bipolar I mania. (1. 4) Efficacy was established in three 1-day trials in adults. (14.3)

The inpatient indications for use of Zyprexa (olanzapine) are:

• Treatment of acute agitation associated with schizophrenia and bipolar I mania 2. Note that the other indications are for oral formulation and may not be specific to inpatient use.

From the Research

Inpatient Indications for Use of Zyprexa (Olanzapine)

The inpatient indications for use of Zyprexa (olanzapine) include:

• Treatment of acute agitation associated with schizophrenia or bipolar mania 3
• Treatment of acute manic episodes in patients with bipolar I disorder 4, 5, 6
• Treatment of schizophrenia, including the management of positive and negative symptoms 7
• Prevention of relapse in patients with bipolar I disorder who have responded to olanzapine treatment 4, 5, 6
• Treatment of patients with agitation associated with schizophrenia or bipolar mania, where intramuscular olanzapine may be used as a rapid-acting alternative to oral therapy 3

Specific Patient Populations

Olanzapine may be used in the following specific patient populations:

• Patients with acute mania who have not responded to other treatments 4, 5, 6
• Patients with bipolar I disorder who are at risk of relapse 4, 5, 6
• Patients with schizophrenia who have negative and depressive symptoms 7
• Patients with agitation associated with schizophrenia or bipolar mania who require rapid control of symptoms 3

Administration and Dosage

Olanzapine may be administered orally or intramuscularly, depending on the specific indication and patient population 3, 4, 5, 6, 7. The dosage and administration of olanzapine should be individualized based on the patient's response to treatment and tolerability of the medication.