Does Zyprexa (Olanzapine) Come in IV Formulation?
No, Zyprexa (olanzapine) does not come in an intravenous (IV) formulation—it is available only as intramuscular (IM) injection for parenteral use, along with oral formulations. 1
Available Formulations
Olanzapine is available in the following forms:
- Intramuscular (IM) injection: Approved for acute agitation in schizophrenia and bipolar mania 1, 2
- Oral tablets: Standard immediate-release formulation 1
- Orally disintegrating tablets: For patients who have difficulty swallowing or compliance issues 3, 4
Critical Safety Warning About IV Administration
The FDA label explicitly states that olanzapine for injection is intended for intramuscular use only and must NOT be administered intravenously or subcutaneously. 1 This is a critical safety consideration that clinicians must observe.
Why IM is Preferred Over IV for Antipsychotics
Guidelines from the American Academy of Pediatrics recommend that intramuscular dosing of antipsychotics in the emergency department is the preferred parenteral route of administration rather than IV. 5 This recommendation stems from safety concerns, particularly regarding:
- Cardiac risks: While IV haloperidol has been studied, it carries an FDA warning due to deaths associated with high doses and IV administration 5
- QT prolongation: Olanzapine causes minimal QT prolongation (mean 2 ms), but the IV route could theoretically increase cardiac risks 5
IM Olanzapine Dosing for Acute Agitation
When parenteral olanzapine is indicated for acute agitation:
- Standard dose: 10 mg IM 1, 5
- Lower doses: 5 mg or 7.5 mg may be considered when clinical factors warrant 1
- Geriatric/debilitated patients: 5 mg IM (or 2.5 mg for those predisposed to hypotension) 1
- Repeat dosing: Subsequent doses up to 10 mg may be given, but not more frequently than 2 hours after the initial dose and 4 hours after the second dose 1
- Maximum daily dose: Total daily doses greater than 30 mg have not been evaluated in clinical trials 1
Onset of Action and Efficacy
IM olanzapine demonstrates rapid effectiveness:
- Onset: Significant reduction in agitation occurs within 15-30 minutes after injection 6, 4
- Peak effect: Maximum benefit typically seen at 2 hours post-injection 6, 7
- Efficacy: Comparable to or superior to IM haloperidol for acute agitation, with a more favorable side effect profile 5, 2, 6, 7
Reconstitution and Administration
The IM formulation requires proper preparation:
- Reconstitution: Dissolve with 2.1 mL of Sterile Water for Injection to provide approximately 5 mg/mL 1
- Use immediately: Must be used within 1 hour after reconstitution 1
- Injection technique: Inject slowly, deep into the muscle mass 1
Critical Drug Incompatibilities
Do not combine IM olanzapine in a syringe with:
- Diazepam injection: Causes precipitation 1
- Haloperidol injection: Results in low pH that degrades olanzapine over time 1
- Lorazepam injection: Should not be used for reconstitution as it causes delayed reconstitution time 1
Common Pitfall to Avoid
The most common error is attempting to administer olanzapine intravenously. This is contraindicated and potentially dangerous. 1 Always verify the route of administration before preparing any antipsychotic injection, as only the IM route is approved and safe for olanzapine.