From the FDA Drug Label
2.4 Olanzapine for Injection: Agitation Associated with Schizophrenia and Bipolar I Mania The efficacy of intramuscular olanzapine for injection in controlling agitation in these disorders was demonstrated in a dose range of 2.5 mg to 10 mg. The recommended dose in these patients is 10 mg. A lower dose of 5 or 7.5 mg may be considered when clinical factors warrant If agitation warranting additional intramuscular doses persists following the initial dose, subsequent doses up to 10 mg may be given.
The recommended dose of olanzapine depot is 10 mg, with a possible lower dose of 5 or 7.5 mg when clinically warranted. The dosing frequency is not explicitly stated for depot administration, but for intramuscular injections, subsequent doses can be given if agitation persists, with a maximum of 10 mg per dose, and no more frequently than 2 hours after the initial dose, and 4 hours after the second dose 1.
From the Research
Olanzapine long-acting injectable (depot) is typically administered as 150-300 mg every 2-4 weeks, with the recommended starting dose being 210 mg every 2 weeks for the first two injections, followed by 150 mg every 2 weeks as maintenance, as supported by the study published in 2013 2.
Key Considerations
- The dosing should be individualized based on clinical response and tolerability, with oral olanzapine supplementation (5-20 mg daily) recommended for the first 2 weeks after initiating depot treatment to ensure adequate plasma levels 3.
- Olanzapine depot must be administered by healthcare professionals via deep gluteal intramuscular injection using the specialized needle provided in the kit, with patients monitored for post-injection delirium/sedation syndrome for at least 3 hours after each injection, which occurs in approximately 0.1% of injections 4.
- This formulation provides steady plasma levels, improving adherence in patients with schizophrenia or bipolar I disorder who have difficulty with daily oral medication, as noted in the study published in 2010 4.
Dosing Frequency and Amount
- The most common doses are 300 mg and 405 mg, accounting for 92.9% of injections, with the most common time intervals between injections being about 14 days for 150 mg, 210 mg, and 300 mg, and about 28 days for 405 mg, as reported in the study published in 2013 5.
- Patients can be switched directly from oral to olanzapine LAI without the need for oral supplementation and with a low risk of relapse when initiated on an appropriate LAI dose, as found in the study published in 2011 3.
Safety and Efficacy
- The safety profile of olanzapine LAI is comparable to that of oral olanzapine, except for injection site-related adverse events, with significant mean weight gain and treatment-emergent changes in nonfasting glucose observed, as noted in the study published in 2013 2.
- Olanzapine remains a useful antipsychotic, but requires careful monitoring, with further research needed to compare the different options available to mitigate olanzapine-induced weight gain and to evaluate potential synergism between pharmacological and non-pharmacological treatments, as discussed in the review published in 2020 6.