What is the intramuscular (IM) dose of Zyprexa (olanzapine) for agitation?

From the Guidelines

Olanzapine (Zyprexa) IM for acute agitation is typically administered at a dose of 10 mg for adults. The provided evidence does not directly address the intramuscular dose of olanzapine for agitation, but based on general medical knowledge and clinical guidelines, the recommended dose is usually 10 mg for adults [no direct citation available from the provided evidence].

Important Considerations

• The onset of action is relatively rapid, usually within 15-30 minutes, and the calming effect can last for several hours.
• If needed, a second dose can be given, but only after waiting at least 2 hours from the first injection, with a maximum daily dose of 30 mg.
• Before administration, healthcare providers should assess for contraindications such as known hypersensitivity to olanzapine or risk factors for cerebrovascular events.
• Vital signs should be monitored after administration due to potential side effects including hypotension, sedation, and rarely QT prolongation, as noted in a study on antipsychotics and QTc interval prolongation 1.

Mechanism of Action

• Olanzapine works by blocking multiple neurotransmitter receptors including dopamine and serotonin, which helps reduce agitation across various psychiatric conditions.
• The IM formulation is particularly useful when oral medication is refused or impractical during acute agitation episodes.

Comparison with Other Treatments

• While the provided evidence discusses the efficacy of ziprasidone IM and droperidol in treating acute agitation, olanzapine remains a commonly used and effective option for managing agitation in clinical practice.

From the FDA Drug Label

2.4 Olanzapine for Injection: 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

The recommended intramuscular (IM) dose of Zyprexa (olanzapine) for agitation is 10 mg. However, a lower dose of 5 mg or 7.5 mg may be considered when clinical factors warrant 2. Key considerations for dosing include:

• Dose range: 2.5 mg to 10 mg
• Recommended dose: 10 mg
• Lower doses: 5 mg or 7.5 mg may be considered
• Special populations: a dose of 5 mg/injection should be considered for geriatric patients or when other clinical factors warrant; a lower dose of 2.5 mg/injection should be considered for patients who otherwise might be debilitated, be predisposed to hypotensive reactions, or be more pharmacodynamically sensitive to olanzapine.

From the Research

Intramuscular Dose of Zyprexa (Olanzapine) for Agitation

• The intramuscular (IM) dose of Zyprexa (olanzapine) for agitation is not explicitly stated in the provided studies 3, 4, 5, 6.
• However, a study from 2004 5 mentions the use of a 20-mg initial dose of olanzapine to control agitation in hospitalized patients with schizophrenia and schizoaffective and schizofreniform disorders.
• Another study from 2006 3 discusses the efficacy of IM olanzapine in reducing acute agitation in patients with schizophrenia, bipolar mania, and Alzheimer and vascular dementia, but does not specify the dose.
• It is essential to note that the dosage of olanzapine for agitation may vary depending on the specific clinical guidelines and patient population, and should be determined by a qualified healthcare professional.

Safety and Efficacy of IM Olanzapine

• Studies have shown that IM olanzapine is effective in reducing acute agitation in patients with schizophrenia and bipolar disorder 3, 5.
• However, the use of IM olanzapine, especially in combination with parenteral benzodiazepines, requires caution due to the potential risk of adverse events, such as cardiac or respiratory compromise 4, 6.
• A retrospective review from 2024 6 found that the coadministration of IM olanzapine and parenteral benzodiazepines was not associated with a high risk of serious adverse events, but emphasized the importance of appropriate patient monitoring.