Acute and chronic psychosis and acute manic episode, in the event of intolerance or treatment failure with other antipsychotics (preferably use haloperidol for these indications)
Forms and strengths
2.5 mg, 5 mg and 10 mg tablets
Dosage
Adult: 10 mg once daily. Increase up to 15 mg daily if necessary (max. 20 mg daily).
Reduce the dose by half in older patients (max. 10 mg daily).
Duration
Acute psychosis: at least 3 months
Chronic psychosis: at least one year
Manic episode: 8 weeks after remission of symptoms
Discontinue treatment gradually (over 4 weeks). If signs of relapse occur, increase the dose then decrease it more gradually.
Contra-indications, adverse effects, precautions
Do not administer to patients with cardiac disorders (heart failure, recent myocardial infarction, conduction disorders, bradycardia, etc.), dementia (e.g. Alzheimer's disease), Parkinson's disease,history of neuroleptic malignant syndrome and closed-angle glaucoma.
Administer with caution and carefully monitor use in older patients and patients with hypokalaemia, hypotension, prostate disorders, renal or hepatic impairment, history of seizures.
May cause: orthostatic hypotension, drowsiness (caution when driving/operating machinery), extrapyramidal symptoms, hyperprolactinaemia, weight gain, hyperlipidaemia, hyperglycaemia, anticholinergic effects (constipation, dry mouth), headache, insomnia, dizziness, sexual dysfunction; neuroleptic malignant syndrome(unexplained hyperthermia with neuromuscular disorders), rare but requiring immediate treatment discontinuation.
In case of extrapyramidal symptoms, try reducing the dose of olanzapine or, if the extra pyramidal symptoms are severe, add biperiden or trihexyphenidyl.
Avoid or monitor combination with:
central nervous system depressants (opioid analgesics, sedatives, H1 antihistamines, etc.);
ciprofloxacin (increased plasma concentrations of olanzapine);
carbamazepine, rifampicin, phenobarbital, phenytoin, ritonavir(decreased plasma concentrations of olanzapine);
antihypertensive drugs (risk of hypotension); drugs that prolong the QT interval (amiodarone, chloroquine, erythromycin, fluconazole, mefloquine, pentamidine, quinine, etc.).
Avoid alcohol during treatment(increased risk of adverse effects).
Pregnancy: re-evaluate whether the treatment is still necessary; if it is continued, use the lowest effective dose. Observe the neonate the first few days (risk of agitation, tremors,hypertonia/hypotonia, respiratory difficulties, sleeping disorders, etc.) if the mother was under treatmentin the 3rd trimester. If treatment starts during pregnancy, preferably use haloperidol.
Breast-feeding: if absolutely necessary,do not exceed 10 mg daily.