What is the typical dosing for Zyprexa (Olanzapine) ODT (Orally Disintegrating Tablet)?

Zyprexa ODT (Olanzapine) Dosing Guidelines

The typical starting dose for Zyprexa ODT (olanzapine orally disintegrating tablet) is 5-10 mg once daily, with a recommended dosage range of 2.5-20 mg per day depending on the clinical indication and patient characteristics.

Dosing by Indication

Schizophrenia and Related Psychoses

• Initial dose: 5-10 mg once daily
• Maintenance dose: 10-20 mg once daily
• Maximum dose: 20 mg daily
• Efficacy: Onset typically within 1-2 weeks 1

Delirium Management

• Initial dose: 2.5-5 mg ODT once daily (usually at bedtime)
• Dose adjustment: Can be increased as needed for symptom control
• Special populations: Reduce dose in older patients and those with hepatic impairment 2

Acute Agitation

• Initial dose: 5-10 mg ODT
• Dosing interval: Can be repeated as needed (clinical trials have used doses ranging from 2.5-10 mg) 2

Dosing Considerations for Special Populations

Elderly Patients

• Starting dose: 2.5-5 mg once daily
• Titration: Slower titration recommended
• Rationale: Increased sensitivity to medication effects and higher risk of adverse events 2

Hepatic Impairment

• Dose reduction: Start with lower doses (2.5-5 mg)
• Monitoring: More frequent monitoring for side effects recommended 2

Administration Guidelines

1. ODT formulation:

   • Place tablet on tongue
   • Allow to dissolve completely
   • No water needed
   • Can be taken with or without food

2. Timing:

   • Often administered at bedtime to minimize daytime sedation
   • For scheduled dosing, consistent timing improves efficacy

Monitoring and Side Effect Management

Common Side Effects

• Sedation/somnolence (most common)
• Weight gain (occurs in approximately 40% of patients) 3
• Dry mouth
• Increased appetite

Serious Adverse Effects to Monitor

• Metabolic effects (long-term use)
• Risk of oversedation when combined with benzodiazepines 2
• Transient increases in liver enzymes (usually clinically insignificant) 4

Clinical Pearls

• The ODT formulation is particularly useful for patients with difficulty swallowing or those who might try to "cheek" standard tablets
• Unlike clozapine, olanzapine does not cause agranulocytosis and does not require blood monitoring 4
• Unlike some other antipsychotics, olanzapine has minimal effect on QTc interval 3
• Efficacy has been demonstrated for treatment periods up to 1 year 1

Common Pitfalls to Avoid

1. Starting with too high a dose in elderly patients - can lead to excessive sedation and falls
2. Combining with benzodiazepines without caution - increased risk of oversedation and respiratory depression 2
3. Inadequate monitoring for weight gain - significant weight gain can occur, especially with higher starting doses 3
4. Failure to reduce dose in hepatic impairment - can lead to increased side effects

Olanzapine ODT provides the same efficacy as standard olanzapine tablets but with the advantage of rapid dissolution for patients who have difficulty swallowing or when compliance is a concern.