SGA / Thienobenzodiazepine·Psychiatry - Antipsychotics

Olanzapine (wafer/ODT)

Schizophrenia, Bipolar I mania

Authority requiredPBSSGAZyprexa, Zypine ODT2.5 mg tablet+2

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At a glance

Max Dose

20 mg/day

Half-life

33 h

Caution: Metabolic

HIGH RISK

Caution: Sedation

SEVERE

Cautions

Avoid / Cautions

Concurrent use of IM Olanzapine and IM Benzodiazepines. Pregnancy Category C (High risk of gestational diabetes and macrosomia).

Where it stands

Rapid Summary

Overview

Second-Generation Antipsychotic (SGA). Highly sedating, rapidly acting agent. Excellent for acute agitation, but notorious for causing massive weight gain and metabolic syndrome.

Clinical Focus

Never administer IM Olanzapine within 1-2 hours of IM Benzodiazepines due to a severe risk of fatal respiratory depression and bradycardia.

Bottom Line

Olanzapine (wafer/ODT) is a highly effective rapidly-dissolving antipsychotic for acute agitation and psychosis, but causes significant metabolic syndrome including weight gain and diabetes with ongoing use.

Formulation & Access

Brand Names

Zyprexa, Zypine ODT

Oral Routes

Tablets (2.5 mg, 5 mg, 10 mg). Wafers/ODT (5 mg, 10 mg) - melt on tongue instantly.

Parenteral

Ampoules for IM injection (Short-acting) and IM Depot (Relprevv).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Schizophrenia, Bipolar I mania.

Off-Label

OFF

Acute severe agitation, severe refractory nausea, delirium.

Clinical Place

The go-to oral 'rescue' medication on wards (as a wafer) due to rapid absorption and intense sedation.

Quick reference

Class & Role

SGA / Thienobenzodiazepine — Second-Generation Antipsychotic (SGA).

Route / Formulation

Tablets (2.5 mg, 5 mg, 10 mg). Wafers/ODT (5 mg, 10 mg) - melt on tongue instantly. (Zyprexa, Zypine ODT)

Usual Dose & Max

PO 5-10 mg Wafer STAT. May repeat after 2 hours. Max 20 mg/day.

Key Indication Doses

Acute Agitation: PO 5-10 mg Wafer STAT. May repeat after 2 hours. Max 20 mg/day. Schizophrenia / Bipolar: PO 5-10 mg NOCTE. Titrate up to 20 mg/day. Elderly / Delirium: PO 2.5 mg Wafer STAT. Max 5 mg/day in elderly. Extremely sensitive to sedation and anticholinergic effects.

Best Uses

Key Risks

Metabolic: Massive weight gain, new-onset type 2 diabetes, severe hyperlipidemia. Neurological: Profound sedation, somnolence, anticholinergic delirium (in the elderly). Cardiovascular: Orthostatic hypotension, QTc prolongation.

Key Interactions

CNS Depressants (Opioids, Benzos). Massive risk of respiratory collapse. Smoking. Polycyclic aromatic hydrocarbons in cigarette smoke induce CYP1A2. If a patient stops smoking in hospital, their Olanzapine levels will artificially spike by up to 50%, causing heavy sedation.

Monitoring

Baseline and 3-monthly BSL, HbA1c, Lipids, and Weight. Baseline ECG for QTc assessment.

Clinical Pearl

Wafers dissolve in the mouth, preventing the patient from 'cheeking' the pill and spitting it out. However, they are NOT absorbed through the mouth; the dissolved saliva must still be swallowed to be absorbed in the gut.

Access

Authority requiredZyprexa, Zypine ODT2.5 mg tablet

Brand: Zyprexa, Zypine ODT
PBS status: Authority required
Formulation: Tablets (2.5 mg, 5 mg, 10 mg). Wafers/ODT (5 mg, 10 mg) - melt on tongue instantly.

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