How to switch a patient from Lybalvi (olanzapine and samidorphan) to olanzapine?

Switching from Lybalvi (Olanzapine/Samidorphan) to Olanzapine

When switching a patient from Lybalvi 15 mg to olanzapine, implement a direct substitution with olanzapine 10 mg, as the olanzapine component in Lybalvi 15 mg is equivalent to 10 mg of standalone olanzapine.

Understanding Lybalvi Composition

• Lybalvi is a combination medication containing olanzapine plus samidorphan (an opioid antagonist) that was FDA-approved in 2021 for schizophrenia and bipolar I disorder 1
• The samidorphan component in Lybalvi is specifically designed to mitigate olanzapine-induced weight gain while maintaining therapeutic efficacy 2
• Lybalvi 15 mg contains 10 mg of olanzapine and 10 mg of samidorphan 1

Switching Protocol

• Direct substitution approach: Replace Lybalvi 15 mg with olanzapine 10 mg daily 3, 4
• Begin olanzapine administration immediately upon discontinuation of Lybalvi to maintain therapeutic coverage 3
• No tapering of Lybalvi is required as the patient will continue receiving the same olanzapine dose 4

Monitoring Recommendations

• Monitor patient closely during the first week after switching for:
  • Changes in efficacy (symptom control) 3
  • Potential weight gain (as the protective effect of samidorphan will be lost) 2
  • Any withdrawal symptoms related to discontinuation of the samidorphan component 5

Special Considerations

• Be aware that removing the samidorphan component may lead to increased weight gain and metabolic effects that were previously mitigated 2
• If the patient is on any opioid medications (including buprenorphine), the switch to olanzapine will eliminate the risk of opioid antagonism that existed with Lybalvi 5
• Consider monitoring metabolic parameters more frequently after switching, as the patient may experience increased weight gain with olanzapine alone 2

Follow-up Recommendations

• Schedule a follow-up appointment within 2-4 weeks after switching to assess:
  • Therapeutic efficacy 3
  • Weight changes 2
  • Metabolic parameters (glucose, lipids) 2
  • Need for dose adjustments 4

Common Pitfalls to Avoid

• Avoid assuming that Lybalvi 15 mg equals olanzapine 15 mg (the correct equivalent is olanzapine 10 mg) 1
• Do not taper olanzapine dose when switching, as this may lead to symptom recurrence 4
• Be prepared to address potential weight gain concerns with the patient, as this is a common reason patients may have been prescribed Lybalvi initially 2