Microplastics and Misinformation: What Science Really Says
November 12, 2025
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Brand Name :
Zyprexa, Zyprexa Zydis
Synonyms :
olanzapine
Class :
Atypical antipsychotics
Brand Name :
Zyprexa, Zyprexa Zydis
Synonyms :
olanzapine
Class :
Atypical antipsychotics
Dosage Forms & Strengths
tablet
20mg
15mg
10mg
7.5mg
5mg
2.5mg
5-10 mg/day starting; if required, may be titrated to 5 mg/day at >1 week
Maintenance dose: 10-20 mg/day; should not to exceed more than 20 mg/day
Recommended IM, extended-release dose based on oral dosage
Oral dosage 10 mg/day: 210 mg intramuscular every two weeks or 405 mg intramuscular every four weeks for 1st 8 weeks, then 150 mg every two weeks or 300 mg every four weeks
Oral dosage 15 mg/day: 300 mg intramuscular every two weeks for first 8 weeks, following 210 mg every two weeks or 405 mg every four weeks
Oral dosage 20 mg/day: 300 mg intramuscular every two weeks for first 8 weeks, following 300 mg every two weeks
Bipolar Mania
Monotherapy: 10-15 mg/day orally starting; may be titrated to 5 mg/day at >24 hr
lithium or valproate: starting dose of 10 mg/day orally
Maintenance dose: 5-20 mg/day orally; should not to exceed more than 20 mg/day
Agitation Associated with Schizophrenia and Bipolar I Mania
intramuscular, short-acting: 2.5-10 mg/dose; should not to exceed more than 30 mg/day
Bipolar Depression
5 mg orally in evening; adjusted between 5-12.5 mg/day
Chemotherapy Associated Nausea or Vomiting
5-10 mg orally every Day for 3 days
Acute and delayed emesis prevention
Moderate emetic risk IV chemotherapy: 10 mg orally on the first the day of chemotherapy, then by 10 mg orally every Day
High emetic risk IV chemotherapy: 10 mg orally on the first the day of chemotherapy, then by 10 mg orally every Day
Dose Adjustments
Dosing Modifications
Renal impairment: adjusting the Dose not necessary
Hepatic impairment: adjusting the Dose is necessary but use caution
tablet
20mg
15mg
10mg
7.5mg
5mg
2.5mg
Tablet, orally disintegrating
20mg
15mg
10mg
5mg
Below <13 years: Safety and efficacy is not established
13-17 years: 2.5-5 mg/day orally starting; following 10 mg/day
Bipolar Depression
Below <10 years: Safety and efficacy is not established
10-17 years: 2.5 mg orally every PM and fluoxetine 20 mg orally every PM starting. Dose adjustments should be made according to individual
Stuttering
≤12 years: 1.25 mg oral at HS for four weeks, following 2.5 mg at HS
>12 years: 2.5 mg orally at HS for four weeks, following 5 mg at HS
Not approved in cases of dementia-related psychosis, because of the increased risk of infection related mortality
2.5-5 mg/day orally starting
Intramuscular (ER): 150 mg every four weeks in patients who have hypotensive episode
Schizophrenia or Bipolar-Related Agitation
intramuscular: 5 mg; reduce to 2.5 mg if patient is having hypotensive reactions
olanzapine: they may enhance the QTc-prolonging effect of QTc-prolonging Agents
olanzapine: they may enhance the QTc-prolonging effect of QTc-prolonging Agents
olanzapine: they may enhance the QTc-prolonging effect of QTc-prolonging Agents
olanzapine: they may enhance the QTc-prolonging effect of QTc-prolonging Agents
olanzapine: they may enhance the QTc-prolonging effect of QTc-prolonging Agents
CNS depressants may enhance the CNS depressant effect of methotrimeprazine
may have an increased QTc-prolonging effect when combined with domperidone
may have an increased QTc-prolonging effect when combined with astemizole
may have an increased QTc-prolonging effect when combined with bedaquiline
may have an increased QTc-prolonging effect when combined with chloroquine
may have an increased QTc-prolonging effect when combined with chlorpromazine
may have an increased QTc-prolonging effect when combined with cisapride
may have an increased QTc-prolonging effect when combined with clofazimine
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with clozapine
may have an increased QTc-prolonging effect when combined with dasatinib
May enhance the QTc-prolonging effect of each other when combined
escitalopram: they may increase the QTc-prolonging effect of QTc-prolonging Agents
imipramine: they may increase the QTc-prolonging effect of QTc-prolonging agents
inotuzumab: they may enhance the QTc-prolonging effect of QTc-prolonging agents
lofexidine: they may increase the QTc-prolonging effect of QTc-prolonging Agents
propafenone: they may increase the QTc-prolonging effect of QTc-prolonging Agents
vemurafenib: they may increase the QTc-prolonging effect of QTc-prolonging Agents
ceritinib: they may increase the QTc-prolonging effect of QTc-prolonging Agents
amiodarone: they may increase the QTc-prolonging effect of QTc-prolonging Agents
flecainide: they may increase the QTc-prolonging effect of QTc-prolonging Agents
pilsicainide HCL: they may increase the QTc-prolonging effect of QTc-prolonging Agents
darunavir: it may increase the risk or severity of QTc prolongation
may increase the QTc interval when combined
it increases the effect of CNS depressants
it increases the effect of CNS depressants
may have an increased QTc-prolonging effect when combined with flupentixol
may have an increased QTc-prolonging effect when combined with levoketoconazole
QT-prolonging Agents (Highest Risk) may increase Citalopram's ability to prolong QTc
QT-prolonging agents (Highest Risk) may increase clarithromycin's ability to prolong QTc
thiazide and it’s like diuretics increase the effect of QTc prolongation
May enhance the QTc-prolonging effect of QT-prolonging Class IA Antiarrhythmics
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
entrectinib: they may increase the QTc-prolonging effect of QTc-prolonging Agents
moxifloxacin: they may increase the QTc-prolonging effect of QTc-prolonging Agents
nilotinib: they may increase the QTc-prolonging effect of QTc-prolonging Agents
piperaquine: they may increase the QTc-prolonging effect of QTc-prolonging Agents
May increase the QTc-prolonging effect of each other when combined
May increase the QTc-prolonging effect of each other when combined
May increase the QTc-prolonging effect of each other when combined
May increase the QTc-prolonging effect of each other when combined
May increase the QTc-prolonging effect of each other when combined
may have an increased adverse effect when combined with olanzapine.
may have an increased adverse effect when combined with olanzapine.
may have an increased adverse effect when combined with olanzapine.
may have an increased adverse effect when combined with olanzapine.
may have an increased adverse effect when combined with olanzapine.
may have an increased risk of adverse effects when combined with olanzapine
It may diminish the effects when combined with chasteberry by pharmacodynamic antagonism
olanzapine: they may enhance the serum concentration of CYP1A2 Inhibitors
olanzapine: they may enhance the serum concentration of CYP1A2 Inhibitors
olanzapine: they may enhance the serum concentration of CYP1A2 Inhibitors
olanzapine: they may enhance the serum concentration of CYP1A2 Inhibitors
olanzapine: they may enhance the serum concentration of CYP1A2 Inhibitors
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
It may enhance the QTc interval when combined with efavirenz
The potential for increased CNS depression risk or seriousness occurs when olanzapine is used together with pipecuronium
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
adverse or side effects associated with olanzapine can be increased with benzodiazepines
adverse or side effects associated with olanzapine can be increased with benzodiazepines
ascorbigen, when used in combination with olanzapine, the efficacy of olanzapine is lowered
when both drugs are combined, there may be an increased risk or severity of QTC prolongation  
when both drugs are combined, there may be an increased risk or severity of QTC prolongation  
CNS depressants increase the CNS depressing effect of brexanolone
it increases the effect of CNS depressants
may increase the CNS depressant effect
may increase the QTc prolonging effect of QTc prolonging agents
may have an increased QTc-prolonging effect when combined with QT-prolonging antipsychotics
may diminish the serum concentration when combined with CYP1A2 substrates
may have an increased risk of adverse effects when combined with olanzapine
may have an increased QTc-prolonging effect when combined with olanzapine
may increase the QTc-prolonging effect when combined
may increase the QTc-prolonging effect of each other when combined
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with dabrafenib
may have an increased QTc-prolonging effect when combined with fluorouracil products
may have an increased QTc-prolonging effect when combined with haloperidol
may have an increased QTc-prolonging effect when combined with ondansetron
may have an increased QTc-prolonging effect when combined with pentamidine
hydroxyzine: they may increase the QTc-prolonging effect of QTc-prolonging Agents
pacritinib: they may increase the QTc-prolonging effect of QTc-prolonging Agents
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
adverse effects or toxic effects of lacosamide are increased by antiarrhythmic agents when used in combination
the rate of metabolism may be altered
When olanzapine is used together in combination with profenamine, this leads to reduction in therapeutic effectiveness of profenamine
amitriptyline: it may increase the risk or severity of QTc prolongation agents
benserazide: it may increase the risk or severity of QTc prolongation agents
it increases the effect of CNS depressants
CNS depressants increase the effect of suvorexant
Actions and spectrum:
olanzapine is an atypical antipsychotic medication used to treat certain mental and mood disorders. It exerts its actions through its effect on several neurotransmitter systems, including dopamine, serotonin, norepinephrine, and histamine.
olanzapine is primarily used to treat schizophrenia and bipolar disorder, which are thought to be caused by imbalances in brain chemicals. It is also used off-label for treating anxiety disorders, depression, and agitation associated with dementia.
Frequency defined:
Orthostatic hypotension (≥20%)
Hypertriglyceridemia (≤39%)
Somnolence, dose dependent (6-39%)
Xerostomia (9-22%)
Dizziness (4-18%)
Insomnia (12%)
Constipation (9-11%)
Hyperprolactinemia (30%)
Weight gain, dose dependent (5-40%)
Hypercholesterolemia (≤39%)
Extrapyramidal symptoms (EPS), dose dependent (15-32%)
Weakness (2-20%)
Accidental injury (12%)
Elevated alanine aminotransferase (ALT) level (5-12%)
Dyspepsia (7-11%)
Hyperglycemia (12.8%)
Frequency undefined:
Hypotension (2%)
Tremor (1%)
Akathisia reactions (2%)
Postural hypotension (1%)
Asthenia (2%)
Parkinsonism reactions (4%)Â
Syncope
Hyperglycemia
Diabetic ketoacidosis
Venous thromboembolism
Cerebrovascular disease
Suicidal intent
Death
Tardive dyskinesia
Sudden cardiac death
Diabetic coma with ketoacidosis
Acute hemorrhagic pancreatitis
Immune hypersensitivity reaction
Seizure, status epilepticus
Pulmonary embolism
Neuroleptic malignant syndrome (NMS)Â
Postmarketing Reports
Eosinophilia and Systemic Symptoms (DRESS)
Restless legs syndrome
Falls
Salivary hypersecretion
Black Box Warning
Black box warning for olanzapine is related to an increased risk of death in older patients with dementia-related psychosis. This risk is not unique to olanzapine but applies to all antipsychotic medications.
Another black box warning for olanzapine is related to the risk of suicidal thoughts and behavior in children, adolescents, and young adults.
Contraindication/Caution
Contraindication
Caution
Comorbidities
Pregnancy consideration: pregnancy category C
Lactation: not recommended as drug enters breat milk.Â
Pregnancy category:
Pharmacology
olanzapine is a second-generation (atypical) antipsychotic medication with complex pharmacology. It works by antagonizing multiple neurotransmitter receptors in the brain, including dopamine, serotonin, and to a lesser extent, histamine, muscarinic, and alpha-adrenergic receptors. By blocking these receptors, olanzapine helps to regulate the activity of these neurotransmitters, which are involved in mood, behavior, and cognition.
Specifically, olanzapine is a potent antagonist of the dopamine type 2 (D2) receptor and the serotonin type 2 (5-HT2A) receptor. By blocking these receptors, olanzapine helps reduce dopamine and serotonin activity in specific brain regions. This is thought to be responsible for its antipsychotic and mood-stabilizing effects.
olanzapine also has some sedative and anticholinergic effects, which may contribute to its therapeutic effects in certain conditions. Its sedative effects are believed to be due to its antagonism of histamine H1 receptors, while its anticholinergic effects are due to its blockade of muscarinic acetylcholine receptors.
Pharmacodynamics
Pharmacokinetics
olanzapine is well absorbed after oral administration and reaches peak plasma concentration in 5-8 hours. The bioavailability of the orally disintegrating tablet is similar to that of the oral tablet. It is highly protein-bound, primarily to albumin, and undergoes extensive first-pass metabolism in the liver.
The hepatic cytochrome P450 (CYP) system metabolizes the drug, specifically CYP1A2 and CYP2D6. olanzapine has a long elimination half-life of approximately 21-54 hours and is primarily eliminated in the urine and feces. The drug is eliminated slowly, and it may take several weeks to clear the body completely.
Administration
olanzapine can be administered orally as tablets or orally disintegrating tablets (ODT). The tablets are typically taken once daily, with or without food, and should be administered whole. ODTs are designed to dissolve rapidly on the tongue and should not be swallowed whole.
The recommended dosage of olanzapine varies depending on the condition being treated and other individual factors and should be determined by a healthcare provider. Injections of olanzapine are also available for intramuscular use in certain situations, such as for rapid control of agitation and disturbed behavior in schizophrenia and bipolar mania.
Patient information leaflet
Generic Name: olanzapine
Pronounced: [ oh-LANZ-a-peen ]
Why do we use olanzapine?
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