Conversion from Oral Olanzapine to Zyprexa Relprevv (Olanzapine Pamoate)
Use the established conversion table where oral olanzapine 10 mg daily converts to Zyprexa Relprevv 210 mg every 2 weeks or 405 mg every 4 weeks, with proportional adjustments for other oral doses. 1
Standard Conversion Algorithm
The conversion from oral olanzapine to the long-acting injectable formulation follows a structured dosing equivalence:
Conversion Table
- Oral olanzapine 10 mg/day → Zyprexa Relprevv 210 mg every 2 weeks OR 405 mg every 4 weeks 1
- Oral olanzapine 15 mg/day → Zyprexa Relprevv 300 mg every 2 weeks OR 405 mg every 4 weeks 1
- Oral olanzapine 20 mg/day → Zyprexa Relprevv 300 mg every 2 weeks 1
Key Conversion Principles
The long-acting injection is administered without oral supplementation once steady-state is achieved, as demonstrated in pivotal trials where OLAI efficacy was established without concurrent oral olanzapine. 1
For doses between standard conversions, round to the nearest available depot strength (150 mg, 210 mg, 300 mg, or 405 mg) based on clinical response. 1
Critical Safety Considerations
Post-injection syndrome occurs in <0.1% of injections but requires mandatory observation for at least 3 hours post-injection by qualified healthcare personnel in a healthcare facility. 1 This risk management plan is non-negotiable and must be followed for every injection. 1
Monitoring Requirements
- Observe patient for minimum 3 hours after each injection 1
- Monitor for sedation, delirium, extrapyramidal symptoms, dysarthria, ataxia, aggression, dizziness, weakness, hypertension, and convulsion 1
- Ensure patient does not drive or operate machinery for remainder of the day 1
Practical Implementation
Start with the equivalent depot dose based on the conversion table above, administered every 2 or 4 weeks depending on the selected formulation. 1 The every-2-week and every-4-week formulations have different pharmacokinetic profiles, so selection should be based on patient preference and adherence patterns. 1
Oral olanzapine supplementation is not required during the transition period or maintenance, as the depot formulation provides adequate therapeutic levels when dosed appropriately. 1
Common Pitfalls to Avoid
- Do not continue oral olanzapine supplementation indefinitely—the depot formulation alone is sufficient for maintenance therapy 1
- Do not discharge patients immediately after injection—the 3-hour observation period is mandatory 1
- Do not use in patients who cannot comply with the post-injection monitoring requirements 1