From the Guidelines
Olanzapine is classified as an atypical antipsychotic, also known as a second-generation antipsychotic. This classification is based on its mechanism of action, which involves blocking dopamine D2 receptors and serotonin 5-HT2A receptors in the brain, resulting in fewer extrapyramidal side effects compared to older antipsychotics 1. The most recent and highest quality study supporting this classification is from 2018, which lists olanzapine as a second-generation antipsychotic 1.
Key Characteristics of Olanzapine
- Works by blocking dopamine D2 receptors and serotonin 5-HT2A receptors in the brain
- FDA-approved for treating schizophrenia, bipolar disorder (manic or mixed episodes), and treatment-resistant depression (when combined with fluoxetine)
- Typical dosage range is 5-20 mg daily for schizophrenia and 10-20 mg daily for bipolar mania
- Carries significant metabolic risks, including weight gain, hyperglycemia, and dyslipidemia
- Requires regular monitoring of weight, blood glucose, and lipid levels during treatment
Comparison to Other Antipsychotics
- Differs from first-generation antipsychotics by having a broader receptor binding profile and lower risk of movement disorders
- Compared to other atypical antipsychotics, such as risperidone and quetiapine, olanzapine has a similar efficacy profile but may have a higher risk of metabolic side effects 1
Clinical Considerations
- Due to its metabolic profile, olanzapine requires careful consideration in patients with diabetes, obesity, or cardiovascular risk factors
- Common side effects include sedation, dry mouth, constipation, and increased appetite
- Regular monitoring and careful dose adjustment are necessary to minimize the risk of adverse effects and optimize treatment outcomes.
From the FDA Drug Label
ZYPREXA (olanzapine) is an atypical antipsychotic that belongs to the thienobenzodiazepine class. The class of Olanzapine is atypical antipsychotic, specifically belonging to the thienobenzodiazepine class 2, 2, 2.
- Key points:
From the Research
Class of Olanzapine
- Olanzapine is classified as a second-generation (atypical) antipsychotic agent 3, 4, 5, 6
- It is a thienobenzodiazepine derivative, which is a class of compounds with a distinct chemical structure 3, 5
- Olanzapine has a unique pharmacological profile, with a greater affinity for serotonin 5-HT2A receptors than for dopamine D2 receptors 3
Characteristics of Olanzapine
- Olanzapine has proven efficacy against the positive and negative symptoms of schizophrenia 3, 4, 5, 6
- It has a rapid onset of action, with clinical benefits apparent within 1-2 weeks of treatment 5
- Olanzapine is associated with a lower risk of extrapyramidal symptoms compared to conventional antipsychotics 3, 5
- However, it is also associated with a higher risk of weight gain and metabolic side effects compared to some other atypical antipsychotics 4, 6
Comparison to Other Antipsychotics
- Olanzapine has been compared to other atypical antipsychotics, including amisulpride, aripiprazole, clozapine, quetiapine, risperidone, and ziprasidone 4
- The results of these comparisons suggest that olanzapine may be more efficacious than some of these agents, but also has a higher risk of weight gain and metabolic side effects 4