Olimelt
Olimelt (Olanzapine 2.5–20 mg ODT) — orodispersible atypical for schizophrenia and bipolar mania. mouth-disintegrating tablet — useful in covert non-adherence.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer
Olimelt (Olanzapine 2.5 / 5 / 7.5 / 10 / 20 mg ODT) is an atypical antipsychotic for schizophrenia, bipolar mania and maintenance, treatment-resistant depression (with fluoxetine), and acute agitation. The most robust antipsychotic effect of the atypicals — but the heaviest metabolic burden.
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What Olimelt is and how it works
Olimelt is an olanzapine orodispersible (ODT) tablet supplied by Sun Pharma. Available strengths: 2.5 / 5 / 7.5 / 10 / 20 mg ODT. Olanzapine is a thienobenzodiazepine atypical antipsychotic with strong D2 antagonism, strong 5-HT2A antagonism, and substantial H1 (sedation, weight gain), M1 (anticholinergic), and α1 (orthostasis) blockade. The H1+M1 receptor profile is responsible both for its calming/sedative effect (useful in acute agitation) and for its metabolic burden.
The ODT formulation dissolves on the tongue without water — useful in patients with covert non-adherence or swallowing difficulty (acutely psychotic patients, geriatric patients with dysphagia). Bioequivalent to swallowed tablets.
Indications and dosing
| Indication | Starting | Target | Max |
|---|---|---|---|
| Schizophrenia (adult) | 5–10 mg OD | 10–20 mg OD | 20 mg |
| Schizophrenia (adolescent ≥ 13 y) | 2.5–5 mg OD | 10 mg OD | 20 mg |
| Bipolar mania (adult) | 10–15 mg OD | 10–20 mg OD | 20 mg |
| Acute agitation (IM) | 10 mg IM | — | 3 doses/24h |
| Treatment-resistant depression (with fluoxetine) | 5 mg + 20 mg fluoxetine | 5–18 mg | 18 mg |
| Older adults | 2.5–5 mg OD | 5–10 mg OD | by tolerability |
Important safety considerations
All atypical antipsychotics carry an FDA black-box warning for increased mortality (mostly cardiovascular and infectious) when used to treat behavioural disturbance in older adults with dementia. Atypicals are not approved for dementia-related psychosis or agitation. Use in this population is off-label, last-resort, time-limited, and requires explicit risk-benefit conversation.
Olanzapine produces the most weight gain (typically 4–10 kg in the first 6 months, sometimes far more), the most insulin resistance, and the most lipid disturbance of any commonly-used antipsychotic. Patients can develop type 2 diabetes within months of initiation. Mandatory monitoring: weight at every visit; fasting glucose / HbA1c and fasting lipids at baseline, 12 weeks, then 6-monthly. Counsel about diet and exercise from initiation.
Strong sedation in the first 1–2 weeks. Anticholinergic effects (dry mouth, constipation, urinary hesitancy) are universal. Both lessen but do not disappear.
Combining IM olanzapine with parenteral benzodiazepines has produced cases of severe hypotension, respiratory depression, and death. If both are clinically necessary in acute agitation, separate by ≥ 1 hour and monitor closely.
Common side effects
- Weight gain and metabolic syndrome — the dominant long-term concern.
- Sedation — universal at initiation.
- Orthostatic hypotension — common at initiation; titrate slowly in older adults.
- Anticholinergic — dry mouth, constipation, urinary hesitancy.
- Akathisia, EPS — less common than risperidone, more common than aripiprazole.
- Prolactin — modest rise; less than risperidone.
- Hepatic — transient AST/ALT rises common.
Drug interactions
- CYP1A2 inhibitors (fluvoxamine, ciprofloxacin) — raise olanzapine levels markedly.
- Smoking — induces CYP1A2; smokers have lower levels and need higher doses; smoking cessation can produce toxicity.
- Carbamazepine — strong CYP1A2 induction; raises olanzapine clearance.
- CNS depressants — additive sedation.
- Anticholinergics — additive burden.
Pregnancy, breastfeeding, paediatric
Pregnancy: limited data; weigh against untreated illness; late-pregnancy exposure can produce neonatal EPS or withdrawal. Breastfeeding: passes into milk; usually requires alternative or close monitoring. Paediatric: licensed from 13 (schizophrenia, bipolar).
Storage
Store at 15–30 °C in original packaging.
Frequently Asked Questions
Why does Olimelt cause so much weight gain?
Olanzapine’s combined H1 antihistamine, 5-HT2C antagonism, and other receptor effects produce strong appetite stimulation, slowed satiety, and shifted carbohydrate preference. Weight gain is dose-related but real even at low doses. Counselling about diet and exercise from week 1, plus regular weight monitoring, is mandatory.
How is Olimelt different from risperidone or aripiprazole?
Olanzapine has the strongest acute antipsychotic effect and the fastest calming action — useful in acute agitation. The trade-off is the heaviest metabolic burden. Risperidone is more efficacious for some positive symptoms but raises prolactin substantially. Aripiprazole is metabolically cleanest but produces more akathisia.
Should I monitor my blood sugar on Olimelt?
Yes — fasting glucose or HbA1c at baseline, 12 weeks, and then 6-monthly. Olanzapine can produce diabetes within months of initiation, sometimes presenting with diabetic ketoacidosis. Don’t skip the monitoring.
Can Olimelt be used long-term?
Yes — particularly for schizophrenia maintenance where olanzapine often outperforms other atypicals on relapse rate. The metabolic burden is the main reason long-term use requires careful weight, glucose, and lipid monitoring, plus active management of cardiometabolic risk.
How long until Olimelt works?
Calming effect within 1–2 hours of the first oral dose. Antipsychotic effect builds over 1–2 weeks; full antipsychotic and mood-stabilising effect at 4–6 weeks.
What about driving on Olimelt?
Avoid driving in the first 1–2 weeks of titration. Most patients on stable doses drive normally, but the sedation can be persistent at higher doses.
Is the orodispersible form different?
Bioequivalent to swallowed tablets — same kinetics, same dose, same effect. The ODT form is useful when adherence is in question (visible administration), in dysphagia, and in acutely psychotic patients who refuse to swallow tablets.
Can Olimelt be combined with fluoxetine?
Yes — the olanzapine-fluoxetine combination (OFC, Symbyax) is FDA-approved for treatment-resistant depression and bipolar depression. The fluoxetine partly addresses olanzapine’s lack of antidepressant effect; olanzapine adds a strong mood-stabilising component.
Why does smoking matter?
Smoking strongly induces CYP1A2, which is olanzapine’s main metabolic enzyme. Smokers metabolise olanzapine faster and need higher doses; abrupt cessation of smoking (e.g. hospital admission) can produce olanzapine toxicity if the dose isn’t adjusted. Tell the prescriber if smoking status changes.
Can Olimelt be stopped abruptly?
Generally not — taper over 2–4 weeks. Abrupt cessation can produce cholinergic rebound (nausea, sweating, insomnia) and an antipsychotic relapse. Never stop without prescriber agreement.
Other Mental Health Medications
- Aripicon (Aripiprazole — D2 partial agonist)
- Olanzap (Olanzapine — robust antipsychotic)
- Risdone (Risperidone)
- Seroquit (Quetiapine — bipolar depression)
- Atlura (Lurasidone — metabolically clean)
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| Strength | 2.5 mg, 7.5 mg, 10 mg, 20 mg |
|---|---|
| Quantity | 30 Tablet/s, 60 Tablet/s, 90 Tablet/s, 180 Tablet/s |
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