olanzapine

Black Box Warnings .

Adult Dosing .

Dosage forms:  TAB: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg; ODT: 5 mg, 10 mg, 15 mg, 20 mg; INJ: 5 mg per mL

schizophrenia

[10 mg PO qd]

Start: 5-10 mg PO qd, may incr. 5 mg/day qwk; Max: 20 mg/day; Info: start 2.5-5 mg PO qd in non-smoker, elderly, debilitated or female patients or if hypotension risk; doses >10 mg/day rarely more effective; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC

agitation, schizophrenia or bipolar I disorder-associated

[10 mg IM x1]

Max: 30 mg/day; Info: may repeat dose 2h after initial dose x1, then 4h after 2nd dose x1 prn; may give lower doses of 2.5-7.5 mg; consider 5 mg/dose in elderly and 2.5 mg/dose in non-smoker, debilitated or female patients or if hypotension risk; switch to PO ASAP; D/C if ANC <1000; consider D/C if unexplained decr. in WBC

bipolar I disorder, manic/mixed

[monotherapy]

Dose: 5-20 mg PO qd; Start: 10-15 mg PO qd, may adjust by 5 mg/day prn; Max: 20 mg/day; Info: for acute and maintenance tx; start 5 mg PO qd in non-smoker, elderly, debilitated or female patients or if hypotension risk; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC

[valproate or lithium adjunct]

Dose: 5-20 mg PO qd; Start: 10 mg PO qd, may adjust by 5 mg/day prn; Max: 20 mg/day; Info: for acute tx; start 5 mg PO qd in non-smoker, elderly, debilitated or female patients or if hypotension risk; D/C if ANC <1000; consider D/C if unexplained decr. in WBC

bipolar I disorder, acute depressive

[combo with fluoxetine]

Dose: 5-12.5 mg PO qpm; Start: 5 mg PO qpm; Max: 12.5 mg/day; Info: may start 2.5 mg PO qpm in non-smoker, elderly or female patients or if hypotension risk; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC

major depressive disorder, tx-resistant

[combo with fluoxetine]

Dose: 5-20 mg PO qpm; Start: 5 mg PO qpm; Max: 20 mg/day; Info: may start 2.5 mg PO qpm in non-smoker, elderly or female patients or if hypotension risk; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC

nausea/vomiting prevention, chemo-related (off-label)

[highly-emetogenic parenteral chemo]

Dose: 2.5-10 mg PO qd on days 1-4; Info: part of multi-drug regimen; consider lower doses in elderly/debilitated patients or if poorly tolerated; give before chemo or at bedtime; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool

[moderately-emetogenic parenteral chemo]

Dose: 2.5-10 mg PO qd on days 1-3; Info: part of multi-drug regimen; consider lower doses in elderly/debilitated patients or if poorly tolerated; give before chemo or at bedtime; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool

[moderately- or highly-emetogenic oral chemo]

Dose: 2.5-10 mg PO qd; Info: consider lower doses in elderly/debilitated patients or if poorly tolerated; give before chemo or at bedtime; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool

breakthrough nausea/vomiting, chemo-related (off-label)

[2.5-10 mg PO qhs]

Info: for patients in whom olanzapine not used as part of nausea/vomiting prevention regimen; consider lower doses in elderly/debilitated patients or if poorly tolerated; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool

anticipatory nausea/vomiting, chemo-related (off-label)

[2.5-5 mg PO x1]

Start: night before chemo; Info: consider lower doses in elderly/debilitated patients or if poorly tolerated; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool

renal dosing

[no adjustment]

renal impairment: no adjustment

HD/PD: no adjustment; no supplement

hepatic dosing

[bipolar I disorder, acute depressive]

hepatic impairment: start 2.5-5 mg qpm, titrate with caution

[major depressive disorder, tx-resistant]

hepatic impairment: start 2.5-5 mg qpm, titrate with caution

[all other indications]

hepatic impairment: not defined, caution advised

Peds Dosing .

Dosage forms:  TAB: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg; ODT: 5 mg, 10 mg, 15 mg, 20 mg

schizophrenia

[13-17 yo]

Dose: 10 mg PO qd; Start: 2.5-5 mg PO qd; Max: 20 mg/day; Info: not first-line tx due to incr. in weight gain, hyperlipidemia; may adjust dose in 2.5-5 mg increments; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC

bipolar I disorder, acute manic/mixed

[13-17 yo]

Dose: 10 mg PO qd; Start: 2.5-5 mg PO qd; Max: 20 mg/day; Info: not first-line tx due to incr. in weight gain, hyperlipidemia; may adjust dose in 2.5-5 mg increments; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC

bipolar I disorder, acute depressive

[combo with fluoxetine, 10-17 yo]

Dose: 5-12.5 mg PO qpm; Start: 2.5 mg PO qpm; Max: 12.5 mg/day; Info: periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC

renal dosing

[no adjustment]

renal impairment: no adjustment

HD/PD: no adjustment; no supplement

hepatic dosing

[see below]

hepatic impairment: not defined, caution advised