AdultPediatricGeriatricDosage Forms & Strengths tablet 2.5mg 5mg 7.5mg 10mg 15mg 20mg tablet, orally disintegrating 5mg 10mg 15mg 20mg IM injection, short-acting 10mg IM injection, extended-release suspension 210mg/vial 300mg/vial 405mg/vial Schizophrenia PO 5-10 mg/day initially; if necessary, may be titrated upward in increments of 5 mg/day at intervals >1 week Maintenance: 10-20 mg/day; not to exceed 20 mg/day Recommended IM, extended-release dose based on oral dosage Oral dosage 10 mg/day: 210 mg IM every 2 weeks or 405 mg IM every 4 weeks for 1st 8 weeks, then 150 mg every 2 weeks or 300 mg every 4 weeks Oral dosage 15 mg/day: 300 mg IM every 2 weeks for 1st 8 weeks, then 210 mg every 2 weeks or 405 mg every 4 weeks Oral dosage 20 mg/day: 300 mg IM every 2 weeks for 1st 8 weeks, then 300 mg every 2 weeks Bipolar Mania Indicated for acute/maintenance treatment of manic or mixed episodes associated with bipolar 1 disorder; may be used adjunctively to valproate or lithium in the treatment of manic or mixed episodes associated with bipolar disorder Monotherapy: 10-15 mg/day PO initially; may be titrated upward in increments of 5 mg/day at intervals >24 hr Adjunct to lithium or valproate: 10 mg/day PO initially Maintenance: 5-20 mg/day PO; not to exceed 20 mg/day Agitation Associated with Schizophrenia and Bipolar I Mania IM, short-acting: 2.5-10 mg/dose; additional doses (up to 10 mg) may be considered; administer subsequent doses 2 hr after initial dose and 4 hr after 2nd dose if necessary; not to exceed 30 mg/day See Dosing Considerations Bipolar Depression Indicated for depressive episodes associated with bipolar I disorder in combination with fluoxetine 5 mg PO in evening; adjusted to range of 5-12.5 mg/day Safety of coadministered doses greater than olanzapine 18 mg with fluoxetine 75 mg have not been evaluated Chemotherapy Associated Nausea or Vomiting (Off-label) Off-label use for prevention of chemotherapy associated nausea or vomiting in combination with 5-HT3 antagonist and dexamethasone (N Engl J Med 2016;375[2]:134-42) Breakthrough nausea and vomiting: 5-10 mg PO qDay for 3 days, when not used for acute and delayed emesis prevention Acute and delayed emesis prevention Off-label use for prevention of chemotherapy associated nausea or vomiting in combination with 5-HT3 antagonist and dexamethasone In combination with dexamethasone and a 5-HT3 antagonist (eg, palonosetron, aprepitant) High emetic risk IV chemotherapy: 10 mg PO the day of chemotherapy (day 1), followed by 10 mg PO qDay (days 2-4) Moderate emetic risk IV chemotherapy: 10 mg PO the day of chemotherapy (day 1), followed by 10 mg PO qDay (days 2-3) References J Clin Oncol 2017 Jul 31 (ASCO clinical practice guideline update) Support Care Cancer 2017;25(2):607-613 N Engl J Med 2016;375(2):134-42 Dosing Modifications Renal impairment: Dose adjustment not necessary Hepatic impairment: Dose adjustment may be necessary; use caution Slow metabolism, initial dose for schizophrenia Initiate with 5 mg PO qDay for patients with risk factors which may slow olanzapine metabolism (eg, nonsmoking females ≥65 yr) Dose escalation should performed with caution Dosing Considerations Dosage adjustments, if necessary, should be made at intervals >24 hrDosage Forms & Strengths tablet 2.5mg 5mg 7.5mg 10mg 15mg 20mg tablet, orally disintegrating 5mg 10mg 15mg 20mg Bipolar I Disorder (Manic or Mixed Episodes) <13 years: Safety and efficacy not established 13-17 years: 2.5-5 mg/day PO initially; target dosage, 10 mg/day; adjust by increments/decrements of 2.5-5 mg; dosage range, 2.5-20 mg/day Schizophrenia <13 years: Safety and efficacy not established 13-17 years: 2.5-5 mg/day PO initially; target dosage, 10 mg/day; adjust by increments/decrements of 2.5-5 mg; dosage range, 2.5-20 mg/day Bipolar Depression Indicated for depressive episodes associated with bipolar I disorder in combination with fluoxetine <10 years: Safety and efficacy not established 10-17 years: 2.5 mg PO qPM and fluoxetine 20 mg PO qPM initially; dosage adjustments, if indicated, should be made to individual components according to efficacy and tolerability Safety of coadministered doses greater than olanzapine 12 mg with fluoxetine 50 mg have not been in pediatric clinical studies Stuttering (Off-label) ≤12 years: 1.25 mg PO at bedtime for 4 weeks, then 2.5 mg at bedtime >12 years: 2.5 mg PO at bedtime for 4 weeks, then 5 mg at bedtimeNot approved for dementia-related psychosis, because of increased risk of cardiovascular or infection-related mortality (see Black Box Warnings) Consider lower starting dosage Schizophrenia 2.5-5 mg/day PO initially IM (extended-release): 150 mg every 4 weeks in patients who are debilitated or predisposed to hypotensive episodes; not studied in patients with renal or hepatic impairment; requires deep IM administration (muscle mass in elderly may be sufficient) Schizophrenia or Bipolar-Related Agitation IM (short-acting): 5 mg; consider 2.5 mg if patient is predisposed to hypotensive reactionsInteraction CheckerEnter a drug name and olanzapineNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (4)amisulprideamisulpride, olanzapine. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndromeIncreases risk of neuroleptic malignant syndrome.dronedaroneolanzapine and dronedarone both increase QTc interval. Contraindicated.fezolinetantolanzapine will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitorsthioridazineolanzapine and thioridazine both increase QTc interval. Contraindicated.Serious - Use Alternative (112)abametapirabametapir will increase the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.adagrasibadagrasib, olanzapine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.amiodaroneolanzapine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.amisulprideamisulpride and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesanagrelideolanzapine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.apomorphineolanzapine decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.apomorphine and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesarsenic trioxideolanzapine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.artemetherartemether and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesartemether/lumefantrineolanzapine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.asenapineolanzapine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.benzhydrocodone/acetaminophenbenzhydrocodone/acetaminophen, olanzapine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.bromocriptineolanzapine decreases effects of bromocriptine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.buprenorphineolanzapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. If concurrent use of olanzapine and buprenorphine is necessary, consider dose reduction of one or both drugs.buprenorphine buccalbuprenorphine buccal and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesbuprenorphine subdermal implantbuprenorphine subdermal implant and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesbuprenorphine transdermalbuprenorphine transdermal and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesbuprenorphine, long-acting injectionbuprenorphine, long-acting injection and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancescabergolineolanzapine decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.calcium/magnesium/potassium/sodium oxybatesolanzapine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.ceritinibceritinib and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instanceschlorpromazineolanzapine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.ciprofloxacinolanzapine and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.citalopramcitalopram and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesclarithromycinclarithromycin and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesclozapineclozapine and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancescrizotinibcrizotinib and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesdegarelixdegarelix and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesdesfluranedesflurane and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesdisopyramideolanzapine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.dopamineolanzapine decreases effects of dopamine by pharmacodynamic antagonism. Contraindicated.droperidololanzapine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.eliglustatolanzapine and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.encorafenibencorafenib and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesentrectinibolanzapine and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.erdafitinibolanzapine will increase the level or effect of erdafitinib by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. If coadministration of a strong CYP2C9 inhibitors is unavoidable, closely monitor adverse reactions and modify dose of erdafitinib accordingly. If strong CYP2C9 inhibitor is discontinued, consider increasing erdafitinib dose in the absence of any drug-related toxicities.eribulineribulin and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instanceserythromycin baseolanzapine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.erythromycin ethylsuccinateolanzapine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.erythromycin lactobionateolanzapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.erythromycin stearateolanzapine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.fedratinibolanzapine will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.fexinidazolefexinidazole and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.fluvoxaminefluvoxamine will increase the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.olanzapine and fluvoxamine both increase QTc interval. Avoid or Use Alternate Drug.foscarnetolanzapine and foscarnet both increase QTc interval. Avoid or Use Alternate