What is the recommended dosing for Zyprexa (olanzapine)?

Olanzapine (Zyprexa) Dosing Recommendations

For adults with schizophrenia or bipolar disorder, the recommended starting dose of olanzapine is 5-10 mg once daily, with a target dose of 10 mg daily and a maximum recommended dose of 20 mg daily. 1

Adult Dosing Guidelines

Schizophrenia

• Initial dose: 5-10 mg once daily
• Target dose: 10 mg once daily
• Maximum dose: 20 mg once daily
• Administration: Can be taken without regard to meals 1

Bipolar I Disorder (Manic or Mixed Episodes)

• Initial dose: 10-15 mg once daily
• Dosage adjustments: In increments of 5 mg at intervals of at least 24 hours
• Effective dose range: 5-20 mg daily
• Maximum dose: 20 mg daily (safety of doses above 20 mg not evaluated) 1

Agitation Associated with Schizophrenia and Bipolar I Mania (Intramuscular)

• Recommended dose: 10 mg IM
• Alternative dose: 5-7.5 mg when clinically warranted
• Subsequent doses: Up to 10 mg if agitation persists
• Timing: At least 2 hours after initial dose and 4 hours after second dose
• Maximum daily dose: 30 mg 1

Special Populations

Elderly Patients

• Intramuscular dosing: 5 mg/injection recommended
• Starting oral dose: Consider lower starting doses (2.5-5 mg) 1
• Caution: Monitor for orthostatic hypotension, sedation, and extrapyramidal symptoms 2

Patients with Dementia

• Initial dose: 2.5-5 mg once daily (usually at bedtime)
• Caution: FDA black box warning regarding increased mortality risk in elderly patients with dementia 2
• Monitoring: Regular assessment for extrapyramidal symptoms, QT prolongation, sedation 2

Adolescents with Bipolar I Disorder

• Initial dose: 2.5-5 mg once daily
• Target dose: 10 mg daily (mean modal dose in clinical trials: 10.7 mg/day)
• Effective dose range: 2.5-20 mg daily
• Dosage adjustments: In increments of 2.5 or 5 mg 1, 3

Administration Options

Oral Tablets

• Can be taken with or without food 1

Orally Disintegrating Tablets (Zyprexa Zydis)

• Remove tablet with dry hands
• Place entire tablet in mouth
• Tablet disintegrates rapidly in saliva
• Can be swallowed with or without liquid 1

Clinical Considerations and Precautions

• Weight gain: Monitor weight regularly as approximately 40% of patients experience weight gain 4
• Sedation: Somnolence and excessive sedation are common side effects (23% vs 14% for placebo) 5
• Orthostatic hypotension: Particularly with intramuscular administration or in elderly patients 1
• Drug interactions: Use caution with cytochrome P450 2D6 and 3A4 inhibitors or inducers 2
• Metabolic effects: Monitor for hyperglycemia and dyslipidemia 2

Important Monitoring Parameters

• Efficacy: Assess response to treatment regularly
• Side effects: Monitor for sedation, weight gain, metabolic changes
• Vital signs: Check for orthostatic hypotension, especially with IM administration
• Laboratory: Consider baseline and follow-up metabolic panels

Common Pitfalls to Avoid

1. Exceeding maximum recommended doses: While some studies suggest higher doses may benefit treatment-resistant patients, doses above 20 mg/day are associated with increased risk of side effects 6
2. Rapid dose escalation: Allow at least 24 hours between dose adjustments 1
3. Combining with benzodiazepines: Use caution as this combination increases risk of oversedation and respiratory depression 2
4. Inadequate monitoring: Regular assessment for metabolic effects and weight gain is essential

Olanzapine is an effective antipsychotic with established efficacy in schizophrenia and bipolar disorder when used at appropriate doses with careful monitoring for side effects.