Introduction
Olanzapine is marketed under the trade name Zyprexa; there are also Alonzap, Bloonis, Clingozan, Oferta, Olzapine, and other generics (FDA, 2022).
FDA Application Statement
According to the FDA, Zyprexa is an atypical neuroleptic used to treat schizophrenia, bipolar disorders, and depression, proving its clinical effectiveness (2022).
Research for Use outside the FDA
Olanzapine is one of the most well-studied anti-schizophrenia drugs and is popularly prescribed by physicians. Studies prove the effectiveness of Olanzapine, despite the relatively frequent side effects (Citrome et al., 2019). Intramuscular injections of the drug have one of the fastest effects for stopping an acute attack (Prabhakar, Mahajan & Kapoor, 2020; Alastanos et al., 2022).
Classification
Olanzapine and its derivatives belong to psychotropic drugs, neuroleptics, and antipsychotics (FDA, 2022).
Mechanism of action
Pharmacokinetics
Absorption of Olanzapine is independent of food intake. After oral administration, Olanzapine is well absorbed, and its maximum plasma concentration is reached after 5-8 hours (FDA, 2022). Olanzapine binds to plasma proteins and is metabolized in the liver.
Pharmacodynamics
Zyprexa is an antipsychotic, antimanic, and mood-stabilizing agent with a broad pharmacological profile. The drug has a high affinity for serotonin, dopamine, muscarinic, and histamine receptors (FDA, 2022). Zyprexa enhances the anti-anxiety effect and reduces delusions and hallucinations.
Dosage, Route of Administration, Dosage Changes
The daily dose must be selected individually, depending on the patient’s clinical condition. The recommended starting dose of Zyprexa is 10 mg once daily (FDA, 2022). Increasing the dose above the standard is recommended only after an appropriate clinical examination. Gradual dose reduction should be considered if Zyprexa is discontinued. A reduction in the initial dose may be recommended for patients with a combination of factors that may slow down the metabolism of Olanzapine. The most common uses are tablets; in acute cases, intramuscular injections can be used.
Patients
Half-Life
The half-life of a substance is the time it takes to lose half of its effect. It generally refers to the cleansing of the body through the kidneys and liver function. The importance of understanding the half-life of drugs lies in the drug’s effectiveness, calculating the dosage and time of administration, and assessing addiction and interaction with other medications. In Zyprexa, the half-life reaches 33 hours; respectively, more than two days are needed for complete elimination (FDA, 2022). Such a long period of action is vital to achieving the drug’s effectiveness.
Side Effects
Adverse reactions from the use of the drug are pretty common and range from mild to severe. The most commonly reported reactions are drowsiness, weight gain, and increased appetite (FDA, 2022). Increases in prolactin, cholesterol, swelling, and general fatigue are also standard (FDA, 2022). The main side effects appear in the first days of use.
Adverse Potential Reactions
Often side effects from the use of the drug negatively affect the liver. Potential adverse reactions include eosinophilia, elevated hepatic aminotransferases, and elevated alkaline phosphatase levels (FDA, 2022). In addition, when taking the drug, cholesterol and glucose levels may increase (FDA, 2022). These adverse effects are often noted among patients at different stages of treatment.
Contraindications
Zyprexa should be used with caution in smoking patients. Zyprexa may reduce the effects of direct and indirect dopamine agonists (FDA, 2022). Fluoxetine causes an increase in the maximum concentration of Zyprexa (FDA, 2022). Fluvoxamine, a specific inhibitor, significantly reduces the clearance of Zyprexa (FDA, 2022). Taking ethanol with Zyprexa may increase the pharmacological effects of olanzapine, including sedation.
Overdose Issues
The first symptom of an overdose is tachycardia, overexcitation, and cognitive impairment. The minimum dose for acute fatal overdose was 450 mg (FDA, 2022). Standard overdose procedures, such as gastric lavage, may be prescribed. Symptomatic treatment is shown following and control over the functions of vital organs.
Diagnostics and Laboratory Monitoring
An overdose is diagnosed in the case of taking the medication and the presence of the above symptoms. It is necessary to monitor the cardiovascular system to identify possible arrhythmias. Careful medical supervision and monitoring should continue until the patient has recovered.
Concomitant Disease Considerations
Zyprexa has a severe number of restrictions for patients with comorbidities. Zyprexa is not recommended in elderly patients with dementia (FDA, 2022). Age over 75 years, vascular dementia, or mixed dementia have been identified as risk factors for developing cerebrovascular adverse reactions with Zyprexa therapy (FDA, 2022). In some cases, using Zyprexa may develop hyperglycemia (FDA, 2022). An increase in the patient’s body weight may predispose to developing these side effects. Therefore, drug use in people with existing diabetes is not recommended.
Legal and Ethical Considerations
Olanzapine has no ethical controversy and is widely used in various treatment regimens. The US FDA approved Olanzapine for the treatment of depressive episodes associated with bipolar disorder, bipolar disorder (2022). Olanzapine is also approved to treat schizotypal conditions (FDA, 2022). Olanzapine is approved for both long-term and short-term use in treating schemes.
Patient Education Recommendations
Since the prevalence of side effects is relatively high, teaching patients to watch for warning symptoms is necessary. First, it is required to demonstrate the principle of measuring blood pressure, which can indicate heart problems. Patients should be aware of the need to avoid alcohol and smoking, which increase the risk of complications. One of the main side effects is weight gain, so switching to a healthier diet may be the solution. Most importantly, patients should undergo regular medical examinations to monitor their health status.
References
Alastanos, J. N., Suri, D., DeLellis, H., & Mapugay, A. (2022). A case report and literature review of olanzapine-associated hyperglycemia with previous history of gestational diabetes.Mental Health Clinician, 12(1), 37-44.
Citrome, L., McEvoy, J. P., Todtenkopf, M. S., McDonnell, D., & Weiden, P. J. (2019). A commentary on the efficacy of olanzapine for the treatment of schizophrenia: the past, present, and future.Neuropsychiatric disease and treatment, 15, 2559-2569.
FDA.gov. (2022). Zyprexa.
Prabhakar, H., Mahajan, C., & Kapoor, I. (Eds.). (2020). Pharmacology in Clinical Neurosciences: A Quick Guide. Springer Singapore.