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Olanzapine
, Action
I DrugNames
p 1, Zyprexa, Zyprexa Zydis
Antagonizes dopamine and serotonin type 2 in the CNS. Also has anticholinergic, antihistaminic, and anti-
I

alphaj-andrenergic effects.
Uses Psychotic disorders: acute manic episodes associated with bipolar disorder (may be used with lithium or
valproate), long-term maintenance therapy of bipolar disorder, long-term treatment/maintenance of
schizophrenia, agitation due to schizophrenia or mania (IM).
Unlabeled uses: Management of anorexia nervosa Treatment of nausea related to highly emetogenic
chemotherapy
Absorption, Distribution, Well absorbed but rapidly metabolized by first-pass effect, resulting in 60% bioavailability. Conventional
Metabolism, and Excretion tablets and orally disintegrating tablets (Zydis) are bioequivalent. IM administration results in significantly
higher blood levels (5 times that of oral). Extensively distributed (93% protein binding). Highly metabolized
(mostly by the hepatic P450 CYP lA2 system); 7% excreted unchanged in urine.
Half-Life 21-54 hours
Interactions Drug-Drug: Effects may decrease by concurrent carbamazepine, omeprazole, or rifampin. Increased
hypotension may occur with antihypertensives. Increased CNS depression may occur with concurrent use of
alcohol or other CNS depressants. May antagonize the effects oflevodopa or other dopamine agonists. Nicotine
can decrease olanzapine levels.
Nursing Implications Assess mental status (orientation, mood, behavior) before and periodically during therapy. Monitor blood
pressure, ECG, pulse, and respiratory rate before and frequently during dose adjustment. Assess weight, BM!,
fasting blood glucose, fluid intake and bowel function initially and throughout therapy. Make sure medication is
not hoarded or cheeked. Monitor for akathisia (restlessness or desire to keep moving) and extrapyramidal side
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effects (parkinsonian - difficulty speaking or swallowing, loss of balance, pill rolling of hands, mask-like face,
shuffling gait, rigidity, tremors and dystonic - muscle spasms, twisting motions, twitching, inability to move
eyes, weakness of arms or legs) every 2 months during therapy and 8-12 weeks after therapy is discontinued.
Monitor for tardive dyskinesia. Monitor for neuroleptic malignant syndrome (fever, respiratory distress,
tachycardia, seizures, diaphoresis, hyper or hypotension, pallor, tiredness, severe muscle stiffness, loss of
bladder control). Evaluate CBC, liver function tests, and ocular examinations. May cause decrease in platelets
and an increase in bilirubin, AST, AL T, GGT, CPIC, and alkaline phosphate. May be administered without
regard to meals. Peel back foil from blister packets and place on tongue with dry hands as the pill will
disintegrate with or without water on the tongue.
Effective Use Decrease in excitable, manic behavior. Decrease in positive symptoms (delusions, hallucinations) of
schizophrenia. Decrease in negative symptoms (social withdrawal, flatlblunted effect) ofschizopbrenia.
Side Effects CNS: neuroleptic malignant syndrome, seizures, agitation, dizziness, headache, restlessness, sedation,
weakness, dystonia, insomnia, mood changes, personality disorder, speech impairment, tardive dyskinesia
EENT: amblyopia, rhinitis, increased salivation, pharyngitis
CV: orthostatic hypotension (increased with IM), tachycardia, chest pain
Resp:cough,dyspnea
GI: constipation, dry mouth, abdominal pain, increased appetite, weight loss or gain, nausea, increased thirst
GU: decreased libido, urinary incontinence
Derm: photosensitivity
Endo: hyperglycemia, goiter
Metab: dyslipidema
MS: hypertonia, joint pain
Neuro: tremor
Mise: fever, flu-like syndrome
Teaching Needs Advise client to take as directed. Do not skip doses or double up on missed doses. May need to discontinue
gradually. Possibility of extrapyramidal symptoms and tardive dyskinesia. Instruct client to report these
symptoms immediately. Advise to change positions slowly. May cause drowsiness therefore take caution when
driving or doing other activities requiring alertness. Avoid taking alcohol and other eNS depressants. Talk to
health care professional before taking any Rx, OTC, or herbal products. Use sunscreen and protective clothing
when exposed to the sun. Extremes of temperature (exercise, hot weather, hot baths or showers) should also be
avoided - this drug impairs body temperature regulation. Instruct client to use saliva substitute, frequent mouth
rinses, good oral hygiene, and sugarless gum or candy to minimize dry mouth. Advise to notify health care
professional of medication before other treatment or surgery.
Route PO,IM
Pregnancy Category C
Classification Therapeutic: antipsychotics, mood stabilizers
Pharmacologic: thienobenzodiazenmes