Olanzapine

About Olanzapine

Olanzapine is an atypical antipsychotic that blocks dopamine D2 and serotonin 5-HT2A receptors among others. Oral olanzapine is labeled for schizophrenia and for manic or mixed episodes of bipolar I disorder, including maintenance, in adults and adolescents aged 13 to 17; as an add-on to lithium or valproate; and with fluoxetine for bipolar depression and treatment-resistant depression. The usual adult dose is 5 to 20 mg once a day.

Every olanzapine product carries the boxed warning that elderly patients with dementia-related psychosis treated with antipsychotics have an increased risk of death; it is not approved for that use. Its main long-term effects are metabolic: weight gain, raised blood sugar that can progress to diabetes, and raised cholesterol and triglycerides, so the label calls for fasting blood sugar and lipid tests at the start and periodically, with regular weighing. Sleepiness, dizziness on standing, constipation, dry mouth, increased appetite and tremor are common; tardive dyskinesia, neuroleptic malignant syndrome, seizures, trouble swallowing and the severe drug reaction DRESS are rarer serious risks.

The orally disintegrating tablet (Zyprexa Zydis and generics) is also taken once a day: peeled from its blister with dry hands, it dissolves on the tongue and is swallowed with or without liquid. A short-acting intramuscular injection treats acute agitation. Zyprexa Relprevv, an extended-release injection every two or four weeks for schizophrenia, is given only through its REMS program at a registered facility, where the patient is watched for at least three hours for post-injection delirium or sedation and then must be accompanied home and not drive that day.

Taking Olanzapine

How to take it

Once a day, with or without food. Swallow tablets whole. For the orally disintegrating tablet, peel back the foil with dry hands rather than pushing the tablet through it, put the whole tablet in your mouth straight away, let it dissolve, and swallow with or without liquid.

If you miss a dose

Take it as soon as you remember. If it is almost time for the next dose, skip the missed dose. Do not take a double dose.

Storage

At room temperature, tightly closed, out of reach of children; keep orally disintegrating tablets in the blister until you take them.

Interactions to know about

Carbamazepine and tobacco smoking speed its breakdown, so levels fall; fluvoxamine raises them. Alcohol and diazepam add to the drop in blood pressure on standing, and it strengthens blood pressure medicines and works against levodopa. Injected olanzapine is not given with an injected benzodiazepine because of excessive sedation and slowed breathing. Take care with driving, and avoid overheating.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Olanzapine differs from pharmacy to pharmacy

Generic olanzapine tablets come from many makers and cost pharmacies little, so most of a quote is dispensing fee and markup, and strengths are not priced evenly. The orally disintegrating tablets come from fewer makers and are usually quoted higher. A prescription that names Zyprexa and blocks substitution is priced as a brand; the injections are bought and given by clinics rather than picked up at a counter.

Ways to pay less for Olanzapine without insurance

• Ask the prescriber to allow generic substitution, or to write for olanzapine rather than Zyprexa.
• If the orally disintegrating tablet was chosen for convenience, ask whether the plain tablet would suit you; it is usually quoted lower.
• Ask the pharmacy to quote your dose as one tablet and as two lower strengths.
• Once the dose is stable, ask for a ninety-day supply.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Olanzapine

1. 1.How do I take the orally disintegrating tablet?
2. 2.When are my blood sugar, cholesterol and weight checks due?
3. 3.Does smoking, or stopping smoking, change my dose?
4. 4.Is it safe with my other medicines, alcohol or sleeping tablets?
5. 5.Which movements, fever or stiffness should I report straight away?

Related medications