ZYPREXA OLANZAPINE 5MG TABLETS 28S

Indications and dosage 1. Schizophrenia PO 5-10 mg/day initially; if necessary, may be titrated upward in increments of 5 mg/day at intervals >1 week Maintenance: 10-20 mg/day; not to exceed 20 mg/day   2. Bipolar Mania Indicated for acute/maintenance treatment of manic or mixed episodes associated with bipolar 1 disorder; may be used adjunctively to valproate or lithium in the treatment of manic or mixed episodes associated with bipolar disorder Monotherapy: 10-15 mg/day PO initially; may be titrated upward in increments of 5 mg/day at intervals >24 hr Adjunct to lithium or valproate: 10 mg/day PO initially Maintenance: 5-20 mg/day PO; not to exceed 20 mg/day 3. Bipolar Depression Indicated for depressive episodes associated with bipolar I disorder in combination with fluoxetine 5 mg PO in evening; adjusted to range of 5-12.5 mg/day 4. Chemotherapy Associated Nausea or Vomiting (Off-label) Off-label use for prevention of chemotherapy associated nausea or vomiting in combination with 5-HT3 antagonist and dexamethasone (N Engl J Med 2016;375[2]:134-42) Breakthrough nausea and vomiting: 5-10 mg PO qDay for 3 days, when not used for acute and delayed emesis prevention Acute and delayed emesis prevention Off-label use for prevention of chemotherapy associated nausea or vomiting in combination with 5-HT3 antagonist and dexamethasone In combination with dexamethasone and a 5-HT3 antagonist (eg, palonosetron, aprepitant) High emetic risk IV chemotherapy: 10 mg PO the day of chemotherapy (day 1), followed by 10 mg PO qDay (days 2-4) Moderate emetic risk IV chemotherapy: 10 mg PO the day of chemotherapy (day 1), followed by 10 mg PO qDay (days 2-3)   ???? PEDIATRICS 1. Bipolar I Disorder (Manic or Mixed Episodes) <13 years: Safety and efficacy not established 13-17 years: 2.5-5 mg/day PO initially; target dosage, 10 mg/day; adjust by increments/decrements of 2.5-5 mg; dosage range, 2.5-20 mg/day 2. Schizophrenia <13 years: Safety and efficacy not established 13-17 years: 2.5-5 mg/day PO initially; target dosage, 10 mg/day; adjust by increments/decrements of 2.5-5 mg; dosage range, 2.5-20 mg/day 3. Bipolar Depression Indicated for depressive episodes associated with bipolar I disorder in combination with fluoxetine <10 years: Safety and efficacy not established 10-17 years: 2.5 mg PO qPM and fluoxetine 20 mg PO qPM initially; dosage adjustments, if indicated, should be made to individual components according to efficacy and tolerability Safety of coadministered doses greater than olanzapine 12 mg with fluoxetine 50 mg have not been in pediatric clinical studies 4. Stuttering (Off-label) ?12 years: 1.25 mg PO at bedtime for 4 weeks, then 2.5 mg at bedtime   GERIATRIC Not approved for dementia-related psychosis, because of increased risk of cardiovascular or infection-related mortality Consider lower starting dosage 1. Schizophrenia 2.5-5 mg/day PO initially IM (extended-release): 150 mg every 4 weeks in patients who are debilitated or predisposed to hypotensive episodes; not studied in patients with renal or hepatic impairment; requires deep IM administration (muscle mass in elderly may be sufficient) 2. Schizophrenia or Bipolar-Related Agitation IM (short-acting): 5 mg; consider 2.5 mg if patient is predisposed to hypotensive reactions.   INTERACTIONS Click on here for interactions.   ADVERSE EFFECTS Adverse Effects >10% Orthostatic hypotension (?20%) Weight gain, dose dependent (5-40%) Hypertriglyceridemia (?39%) Hypercholesterolemia (?39%) Somnolence, dose dependent (6-39%) Extrapyramidal symptoms (EPS), dose dependent (15-32%) Xerostomia (9-22%) Weakness (2-20%) Dizziness (4-18%) Accidental injury (12%) Insomnia (12%) Elevated alanine aminotransferase (ALT) level (5-12%) Constipation (9-11%) Dyspepsia (7-11%) Hyperprolactinemia (30%) Hyperglycemia (12.8%) 1-10% Hypotension (2%) Postural hypotension (1%) Tremor (1%) Asthenia (2%) Akathisia reactions (2%) Parkinsonism reactions (4%) <1% Syncope Sudden cardiac death Hyperglycemia Diabetic coma with ketoacidosis Diabetic ketoacidosis Acute hemorrhagic pancreatitis Venous thromboembolism Immune hypersensitivity reaction Cerebrovascular disease Seizure, status epilepticus Suicidal intent Pulmonary embolism Death Neuroleptic malignant syndrome (NMS) Tardive dyskinesia

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