From the Guidelines
Olanzapine is contraindicated in patients with known hypersensitivity to the medication or any of its components, and it should be used with caution in patients with a history of QT interval prolongation, recent myocardial infarction, uncompensated heart failure, or cardiac arrhythmias, as well as in elderly patients with dementia-related psychosis due to increased mortality risk. The medication should not be used in patients with a history of QT interval prolongation, recent myocardial infarction, uncompensated heart failure, or cardiac arrhythmias. Caution is warranted in patients with a history of seizures, cardiovascular disease, cerebrovascular disease, conditions predisposing to hypotension, hepatic impairment, history of paralytic ileus, prostatic hypertrophy, narrow-angle glaucoma, or a history of neuroleptic malignant syndrome. Some key points to consider when prescribing olanzapine include:
- Monitoring for hyperglycemia in patients with diabetes or risk factors for diabetes, as olanzapine can cause significant weight gain and metabolic changes, including dyslipidemia, as noted in studies such as 1 and 1.
- Careful monitoring of patients with pre-existing metabolic disorders, as olanzapine can exacerbate these conditions, as seen in 1 and 1.
- Avoiding use in pregnant women unless the potential benefit justifies the potential risk to the fetus, as safety during pregnancy has not been established, and being aware of potential interactions with other medications, such as those noted in 1.
- Being cautious when using olanzapine in elderly patients, as they may be more susceptible to its side effects, including orthostatic hypotension and metabolic effects, as mentioned in 1 and 1.
- Considering alternative treatments for patients with a history of neuroleptic malignant syndrome, as olanzapine can increase the risk of this condition, and being aware of the potential for rare but serious side effects, such as drug reaction with eosinophilia and systemic symptoms (DRESS), as noted in 1.
From the FDA Drug Label
ZYPREXA is not approved for the treatment of patients with dementia-related psychosis. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.
The contraindications to olanzapine include:
- Dementia-related psychosis: Olanzapine is not approved for the treatment of patients with dementia-related psychosis, as it may increase the risk of death in elderly patients with this condition 2 2.
From the Research
Contraindications to Olanzapine
The following are contraindications to olanzapine:
- Diabetes patients, as olanzapine is contraindicated in these patients due to its potential to worsen glucose control 3
- Patients with a history of hypersensitivity syndrome, as olanzapine has been reported to cause this condition 4
- Patients with severe liver impairment, as olanzapine has been associated with elevations in liver enzymes 5
- Patients with a history of neuroleptic malignant syndrome, as olanzapine has been reported to cause this condition 6
Special Considerations
The following are special considerations for olanzapine use:
- High-dose olanzapine therapy (> 40 mg daily) is associated with an increased risk of adverse events, including extrapyramidal symptoms, sedation, weight gain, hypotension, neuroleptic malignant syndrome, and QTc prolongation 6
- Olanzapine should be used with caution in patients with a history of cardiovascular disease, as it has been associated with an increased risk of stroke and transient ischemic attack 5
- Olanzapine should be used with caution in patients with a history of seizures, as it has been associated with an increased risk of seizures 5
Warnings and Precautions
The following are warnings and precautions for olanzapine use:
- Olanzapine has been associated with an increased risk of diabetic ketoacidosis, particularly in patients with a history of diabetes 7
- Olanzapine has been associated with an increased risk of weight gain and metabolic changes, including hyperglycemia and dyslipidemia 3, 7
- Olanzapine has been associated with an increased risk of orthostatic hypotension, particularly in patients with a history of cardiovascular disease 5