Olanzap
Olanzap (Olanzapine 2.5–20 mg) — thienobenzodiazepine atypical for schizophrenia, bipolar mania, treatment-resistant MDD. strongest acute antipsychotic — heaviest metabolic burden.
✓ Medicinskt granskad av Morgan Ellis — Apoteksforskare · 8 års erfarenhet · Senast granskad: maj 2026
⚡ Snabbt svar
Olanzap (Olanzapine 2.5 / 5 / 7.5 / 10 / 15 / 20 mg) 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 Olanzap is and how it works
Olanzap is an olanzapine tablet supplied by Sun Pharma. Available strengths: 2.5 / 5 / 7.5 / 10 / 15 / 20 mg. 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.
Indikationer och dosering
| Indikation | Startdos | Målgrupp | 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 |
Viktiga säkerhetsöverväganden
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.
Vanliga biverkningar
- 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.
Läkemedelsinteraktioner
- 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.
Graviditet, amning, pediatrisk användning
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).
Förvaring
Förvara vid 15–30 °C i originalförpackning.
Vanliga frågor
Why does Olanzap 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 Olanzap 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 Olanzap?
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 Olanzap 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 Olanzap 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 Olanzap?
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?
Yes — orodispersible (ODT) versions of olanzapine exist (Zyprexa Zydis, Olimelt) and dissolve on the tongue without water. Bioequivalent to standard tablets but useful in adherence-uncertain or dysphagia patients.
Can Olanzap 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 Olanzap 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.
Andra läkemedel för psykisk hälsa
- Aripicon (Aripiprazole — D2 partial agonist)
- Olanzap (Olanzapine — robust antipsychotic)
- Risdone (Risperidone)
- Seroquit (Quetiapine — bipolar depression)
- Atlura (Lurasidone — metabolically clean)
Fler alternativ inom psykisk hälsa och psykiatriska läkemedel
Rangerade efter senaste ordervolym på MedsBase — vad andra kunder i denna kategori väljer.
| Styrka | 5 mg, 10 mg |
|---|---|
| Kvantitet | 30 tabletter, 60 tabletter, 90 tabletter, 180 tabletter |
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