Buy Zyprexa Online

Zyprexa (olanzapine)

BOXED WARNING

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death; most deaths appeared to be cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature. Not approved for the treatment of patients with dementia-related psychosis. When used with fluoxetine, refer to the Boxed Warning section of the PI for Symbyax.

OTHER BRAND NAMES

Zyprexa Zydis

THERAPEUTIC CLASS

Atypical antipsychotic

DEA CLASS

RX

INDICATIONS

(PO) Treatment of schizophrenia, acute treatment of manic or mixed episodes associated with bipolar I disorder, and maintenance treatment of bipolar I disorder. Adjunct to lithium or valproate for the treatment of manic or mixed episodes associated with bipolar I disorder. In combination with fluoxetine for the treatment of depressive episodes associated with bipolar I disorder. In combination with fluoxetine for the treatment of treatment-resistant depression in adults. (IM) Treatment of acute agitation associated with schizophrenia and bipolar I mania in adults.

ADULT DOSAGE

Bipolar I Disorder

PO:
Manic or Mixed Episodes (Monotherapy):

Initial: 10mg or 15mg qd
Titrate: Adjust by increments/decrements of 5mg qd at intervals of not <24 hrs
Maint: 5-20mg/day
Max: 20mg/day

Manic or Mixed Episodes (w/ Lithium or Valproate):
Initial: 10mg qd
Max: 20mg/day

Depressive Episodes (w/ Fluoxetine):
Initial: 5mg w/ 20mg fluoxetine qpm
Range:
5-12.5mg w/ 20-50mg fluoxetine
Max:
18mg w/ 75mg fluoxetine

Agitation

Acute Agitation Associated w/ Schizophrenia and Bipolar I Mania:
IM:
10mg; consider 5mg or 7.5mg when clinical factors warrant
Range: 2.5-10mg. Assess for orthostatic hypotension prior to subsequent dosing
Max: 3 doses of 10mg 2-4 hrs apart

May initiate PO therapy in a range of 5-20mg/day when clinically appropriate

Depression

Treatment-Resistant Depression (w/ Fluoxetine):
PO:
Initial: 5mg w/ 20mg fluoxetine qpm
Range: 5-20mg w/ 20-50mg fluoxetine
Max: 18mg w/ 75mg fluoxetine

Schizophrenia

PO:
Initial: 5-10mg qd
Target Dose: 10mg/day w/in several days. Adjust dose by increments/decrements of 5mg qd at intervals of not <1 week
Max: 20mg/day
Maint: 10-20mg/day

PEDIATRIC DOSAGE

Schizophrenia

13-17 Years:
PO:

Initial: 2.5mg or 5mg qd
Target Dose: 10mg/day. Adjust dose by increments/decrements of 2.5mg or 5mg
Max: 20mg/day
Maint: Use lowest dose needed to maintain remission

Bipolar I Disorder

PO:
Manic or Mixed Episodes:

13-17 Years:
Initial: 2.5mg or 5mg qd
Target Dose: 10mg/day. Adjust dose by increments/decrements of 2.5mg or 5mg
Max: 20mg/day
Maint: Use lowest dose needed to maintain remission

Depressive Episodes (w/ Fluoxetine):
10-17 Years:
Initial: 2.5mg w/ 20mg fluoxetine qpm
Max: 12mg w/ 50mg fluoxetine

DOSING CONSIDERATIONS

Hepatic Impairment
Zyprexa and Fluoxetine in Combination: Starting dose of oral olanzapine 2.5-5mg w/ fluoxetine 20mg

Elderly
IM Dosing: 5mg/inj

Other Important Considerations
Debilitated/Predisposed to Hypotensive Reactions/Slower Metabolism/Sensitive to Olanzapine:
Schizophrenia: 5mg as a starting dose
IM Dosing: 2.5mg/inj

Predisposed to Hypotensive Reactions/Slow Metabolizers of Zyprexa or Fluoxetine Combination/Sensitive to Olanzapine:
Zyprexa and Fluoxetine in Combination: Starting dose of oral olanzapine 2.5-5mg w/ fluoxetine 20mg

ADMINISTRATION

Oral/IM routes

Tab, Zydis
Can be taken w/ or w/o food

Inj
Do not administer IV or SQ. Inject slowly, deep into the muscle mass
Dissolve the contents of the vial using 2.1mL of sterile water for inj to provide approx 5mg/mL of olanzapine
Immediately use (w/in 1 hr) after reconstitution

Zydis
After opening sachet, peel back foil on blister
Do not push tab through foil
Upon opening the blister, remove tab and place entire tab in the mouth using dry hands

HOW SUPPLIED

Inj: 10mg; Tab: 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg; Tab, Disintegrating: (Zydis) 5mg, 10mg, 15mg, 20mg

CONTRAINDICATIONS

When used with fluoxetine, refer to the Symbyax monograph. When used with lithium or valproate, refer to the individual monographs.

WARNINGS/PRECAUTIONS

Supervision should accompany therapy in patients at high risk of attempted suicide. Neuroleptic malignant syndrome (NMS) reported; d/c and instill intensive symptomatic treatment and monitoring. Associated with metabolic changes including hyperglycemia, dyslipidemia, and weight gain; may be associated with increased cardiovascular/cerebrovascular risk. Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, reported; caution in patients with diabetes mellitus or borderline increased blood glucose levels. Dose-related hyperprolactinemia reported. Tardive dyskinesia (TD) may develop; consider discontinuation if signs/symptoms develop unless treatment is required despite the presence of the syndrome. May induce orthostatic hypotension; caution with known cardiovascular disease (CVD), cerebrovascular disease, and conditions that would predispose to hypotension. Leukopenia, neutropenia, and agranulocytosis reported; consider discontinuing at 1st sign of a clinically significant decline in WBC count in the absence of other causative factors. D/C if severe neutropenia (absolute neutrophil count <1000/mm3) develops. May cause esophageal dysmotility and aspiration, and disruption of body temperature regulation. Seizures reported; caution with history of seizures or with conditions that potentially lower the seizure threshold. Not approved for treatment of patients with Alzheimer's disease. May impair mental/physical abilities. Caution in patients with clinically significant prostatic hypertrophy, narrow-angle glaucoma, history of paralytic ileus or related conditions, cardiac patients, and in the elderly.

ADVERSE REACTIONS

Postural hypotension, constipation, dry mouth, weight gain, somnolence, dizziness, personality disorder, akathisia, asthenia, dyspepsia, tremor, increased appetite, abdominal pain, headache, insomnia.

DRUG INTERACTIONS

May potentiate orthostatic hypotension with diazepam and alcohol. Increased clearance with carbamazepine (CYP1A2 inducer), and omeprazole and rifampin (CYP1A2 inducers or glucuronyl transferase inducers). Decreased clearance with fluoxetine (CYP2D6 inhibitor) and fluvoxamine (CYP1A2 inhibitor); consider lower dose of olanzapine with concomitant fluvoxamine. Caution with other centrally acting drugs, alcohol, and drugs whose effects can induce hypotension, bradycardia, or respiratory/CNS depression. May enhance effects of certain antihypertensives. May antagonize effects of levodopa and dopamine agonists. Caution with anticholinergic drugs; may contribute to an elevation in core body temperature. (IM) Not recommended with parenteral benzodiazepines. IM lorazepam may potentiate somnolence. (PO) Decreased levels with activated charcoal.

PREGNANCY AND LACTATION

Category C, not for use in nursing.

MECHANISM OF ACTION

Thienobenzodiazepine; not established. Proposed that efficacy in schizophrenia is mediated through a combination of dopamine and serotonin type 2 (5HT2) antagonism.

PHARMACOKINETICS

Absorption: (PO) Well-absorbed, Tmax=6 hrs; (IM) Rapid, Tmax=15-45 min. Distribution: Found in breast milk. (PO) Vd=1000L; plasma protein binding (93%). Metabolism: Via direct glucuronidation and CYP450-mediated oxidation; 10-N-glucuronide and 4'-N-desmethyl olanzapine (major metabolites). Elimination: (PO) Urine (57%, 7% unchanged), feces (30%); T1/2=21-54 hrs.

ASSESSMENT

Assess for CVD, cerebrovascular disease, risk of hypotension, history of seizures or conditions that could lower the seizure threshold, prostatic hypertrophy, narrow-angle glaucoma, history of paralytic ileus, hepatic impairment, history of drug abuse, risk factors for leukopenia/neutropenia, pregnancy/nursing status, and possible drug interactions. Assess for dementia-related psychosis and Alzheimer's disease in the elderly. Obtain baseline lipid profile, CBC, and FPG levels.

MONITORING

Monitor for signs/symptoms of NMS, TD, orthostatic hypotension, seizures, disruption of body temperature regulation, hyperprolactinemia, and other adverse reactions. Periodically monitor FPG, lipid levels, CBC, and weight of patient. In patients with clinically significant neutropenia, monitor for fever or other symptoms/signs of infection. Periodically reassess to determine the need for maintenance treatment.

PATIENT COUNSELING

Advise of potential benefits and risks of therapy. Counsel about the signs and symptoms of NMS. Inform of potential risk of hyperglycemia-related adverse events. Inform that medication may cause dyslipidemia and weight gain. Inform that medication may cause orthostatic hypotension; instruct to contact physician if dizziness, fast or slow heartbeat, or fainting occurs. Inform that medication may impair judgment, thinking, or motor skills; instruct to use caution when operating hazardous machinery, including automobiles. Instruct to avoid overheating and dehydration and to contact physician if severely ill and have symptoms of dehydration. Instruct to notify physician if taking, planning to take, or have stopped taking any prescription or OTC products, including herbal supplements. Instruct to avoid alcohol. Inform that orally disintegrating tab contains phenylalanine. Advise to notify physician if pregnant or planning to become pregnant during treatment. Advise to avoid breastfeeding during therapy.

STORAGE

Tab, Zydis, and Inj (Before Reconstitution): 20-25°C (68-77°F); excursions permitted between 15-30°C (59-86°F). Reconstituted Inj: 20-25°C (68-77°F) for up to 1 hr; excursions permitted between 15-30°C (59-86°F). Tab/Zydis: Protect from light and moisture. Inj: Protect from light. Do not freeze.

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