Olanzapine Tablet Dosing
For adults with schizophrenia or bipolar disorder, initiate olanzapine at 5-10 mg once daily, with a target dose of 10 mg/day for schizophrenia and 10-15 mg/day for bipolar disorder; the maximum recommended dose is 20 mg/day, though doses up to 30 mg/day may be considered in treatment-resistant cases.
Standard Dosing for Schizophrenia
- Starting dose: Begin with 5-10 mg once daily, typically administered at bedtime to minimize daytime sedation 1
- Target dose: 10 mg/day has demonstrated efficacy in controlled trials 1
- Dose range: 5-20 mg/day is the FDA-approved range, with most patients responding within this window 1, 2
- Titration: Dose adjustments can be made in 5 mg increments, allowing at least 24 hours between changes 1
Dosing for Bipolar Disorder
- Acute mania: Start at 10-15 mg once daily 1
- Maintenance treatment: Continue at the effective dose established during acute treatment, typically 10-20 mg/day 1
Maximum Dosing Considerations
- Standard maximum: 20 mg/day is the regulatory-approved maximum dose 2
- Higher doses in clinical practice: Evidence suggests that 40-50% of hospitalized patients receive doses exceeding 20 mg/day, with the average dose increasing to 22.5 mg/day in long-term care settings 2
- Treatment-resistant patients: Doses up to 40-60 mg/day have been used in case reports and observational studies for patients with severe, persistent symptoms or treatment resistance 2
- Risk-benefit at higher doses: While higher doses may provide additional benefit in selected patients, they carry increased risk of weight gain and elevated prolactin levels 2
Elderly Patients
- Starting dose: 2.5-5 mg once daily, typically at bedtime 3
- Dose range: 5-20 mg/day has been studied in elderly patients (ages 60-85 years) with good tolerability 4
- Titration: Use slower, more cautious titration in geriatric patients 3
- Common concerns: Monitor for orthostatic hypotension and drowsiness, which are more pronounced in elderly populations 3, 4
Hepatic Impairment
- Dose reduction required: Start with lower doses (2.5-5 mg daily) in patients with hepatic impairment 3
- Monitoring: While routine liver enzyme monitoring is not required, baseline assessment is prudent 3
Optimal Maintenance Dosing
- Therapeutic range: Maintenance doses of 2.5-30 mg/day have demonstrated comparable continuation rates in long-term studies 5
- Lower doses preferred: When possible, maintaining patients on the lower end of the effective dose range (10-15 mg/day) optimizes the tolerability profile 5
Plasma Concentration Considerations
- Therapeutic threshold: A 12-hour post-dose plasma concentration ≥23.2 ng/mL predicts therapeutic response in acute schizophrenia 6
- Gender differences: Males require higher doses than females to achieve the same plasma concentrations 6
- Clinical application: While therapeutic drug monitoring is not routinely performed, these data support dose optimization in partial responders 6
Common Pitfalls to Avoid
- Premature dose escalation: Allow adequate time (2-4 weeks) at each dose to assess response before increasing 1
- Combining with benzodiazepines: Exercise caution when co-administering olanzapine with benzodiazepines due to risk of oversedation and respiratory depression 3
- Metabolic monitoring: Weight gain and metabolic effects are dose-dependent; regular monitoring of weight, glucose, and lipids is essential 1, 2