Formulary
Olanzapine embonate: Indications, Dosing, Side Effects and Interactions
Olanzapine embonate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Olanzapine embonate: Indications, Dosing, Side Effects and Interactions
Olanzapine embonate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Maintenance in schizophrenia in patients tolerant to olanzapine by mouth (patients taking 10 mg oral olanzapine daily)**
- **Adult** (By Deep Intramuscular Injection): 18-75 years Initially 210 mg every 2 weeks, alternatively initially 405 mg every 4 weeks, then maintenance 150 mg every 2 weeks, alternatively maintenance 300 mg every 4 weeks, maintenance dose to be started after 2 months of initial treatment, dose to be administered into the gluteal muscle, consult product literature if supplementation with oral olanzapine required.
**Maintenance in schizophrenia in patients tolerant to olanzapine by mouth (patients taking 15 mg oral olanzapine daily)**
- **Adult** (By Deep Intramuscular Injection): 18-75 years Initially 300 mg every 2 weeks, then maintenance 210 mg every 2 weeks, alternatively maintenance 405 mg every 4 weeks, maintenance dose to be started after 2 months of initial treatment, dose to be administered into the gluteal muscle, consult product literature if supplementation with oral olanzapine required.
**Maintenance in schizophrenia in patients tolerant to olanzapine by mouth (patients taking 20 mg oral olanzapine daily)**
- **Adult** (By Deep Intramuscular Injection): Initially 300 mg every 2 weeks, then maintenance 300 mg every 2 weeks (max. per dose 300 mg every 2 weeks), adjusted according to response, dose to be administered into the gluteal muscle, consult product literature if supplementation with oral olanzapine required.
Cautions
For all antipsychotic drugs Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes (may raise blood glucose); epilepsy; history of jaundice; myasthenia gravis; Parkinson's disease (may be exacerbated); photosensitisation (may occur with higher dosages); prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma Cautions, further information Cardiovascular disease An ECG may be required, particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: for all antipsychotics (other than quetiapine and clozapine) in patients with parkinsonism or Lewy Body Disease (risk of severe extrapyramidal symptoms) in behavioural and psychological symptoms of dementia (BPSD), unless symptoms are severe and other non-pharmacological treatments have failed (increased risk of stroke) for use as a hypnotic, unless sleep disorder is due to psychosis or dementia (risk of confusion, hypotension, extrapyramidal side-effects, and falls) in patients prone to falls (may cause gait dyspraxia, parkinsonism) if prescribed a phenothiazine (other than prochlorperazine for nausea, vomiting, or vertigo; chlorpromazine for relief of persistent hiccups; levomepromazine as an antiemetic in palliative care) as first-line treatment (sedative, significant antimuscarinic (anticholinergic) toxicity in older people, and safer and more efficacious alternatives exist) if prescribed an antipsychotic drug with moderate or marked antimuscarinic effects (e.g. chlorpromazine, clozapine, flupenthixol, fluphenazine, pipothiazine, promazine, and zuclopenthixol) in patients with a history of prostatism or urinary retention (high risk of urinary retention) Cautions For olanzapine embonate Bone-marrow depression; hypereosinophilic disorders; low leucocyte count; low neutrophil count; myeloproliferative disease; paralytic ileus; when transferring from oral to depot therapy, the dose by mouth should be reduced gradually
Side effects
For all antipsychotic drugs Common or very common Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; fatigue; galactorrhoea; gynaecomastia; hyperglycaemia; hyperprolactinaemia; hypersalivation; hypotension (dose-related); insomnia; leucopenia; movement disorders; muscle rigidity; neutropenia; parkinsonism; postural hypotension (dose-related); QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased Uncommon Agranulocytosis; confusion; neuroleptic malignant syndrome (discontinue-potentially fatal) Rare or very rare Sudden death; withdrawal syndrome neonatal Side-effects, further information For depot antipsychotics-side-effects may persist until the drug has been cleared from its depot site. Overdose Phenothiazines cause less depression of consciousness and respiration than other sedatives. Hypotension, hypothermia, sinus tachycardia, and arrhythmias may complicate poisoning. For details on the management of poisoning see Antipsychotics under Emergency treatment of poisoning . Side-effects For olanzapine embonate Common or very common Anticholinergic syndrome; appetite increased; arthralgia; asthenia; eosinophilia; fever; glycosuria; oedema; sexual dysfunction Uncommon Abdominal distension; alopecia; breast enlargement; diabetes mellitus; diabetic coma; dysarthria; embolism and thrombosis; epistaxis; ketoacidosis; memory loss; oculogyration; photosensitivity reaction; urinary disorders Rare or very rare Drug reaction with eosinophilia and systemic symptoms (DRESS); hepatic disorders; hypothermia; pancreatitis; rhabdomyolysis; thrombocytopenia Frequency not known Erythema; gait abnormal; increased risk of fall; pneumonia; visual hallucinations Side-effects, further information Side-effects may persist until the drug has been cleared from its depot site. Overdose Post-injection reactions have been reported leading to signs and symptoms of overdose.
Pregnancy
For all antipsychotic drugs Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. Pregnancy For olanzapine embonate Use only if potential benefit outweighs risk; neonatal lethargy, tremor, and hypertonia reported when used in third trimester.
Breast feeding
For all antipsychotic drugs There is limited information available on the short- and long-term effects of antipsychotic drugs on the breast-fed infant. Animal studies indicate possible adverse effects of antipsychotic medicines on the developing nervous system. Chronic treatment with antipsychotic drugs whilst breast-feeding should be avoided unless absolutely necessary. Phenothiazine derivatives are sometimes used in breast-feeding women for short-term treatment of nausea and vomiting. Breast feeding For olanzapine embonate Avoid-present in milk.
Hepatic impairment
Manufacturer advises caution. Dose adjustments Manufacturer advises consider initial dose of 150 mg every 4 weeks.
Renal impairment
Dose adjustments Consider initial dose of 150 mg every 4 weeks. M
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Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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