Olanzapine is an antipsychotic medication. It is mostly used for psychotic disorders like schizophrenia and in bipolar disorder, it can be very effective in treating mania and as maintenance treatment. I love olanzapine for many reasons but I also hate it for a few. I'm feeling positive today so I will stay more on the positive side.
I use olanzapine a lot in my work since I mostly treat patients with psychotic disorders. These days I also mostly treat acutely ill patients and then olanzapine in my "go-to" in the beginning of treatment. Often later on in the admission I try to switch to another antipsychotic, usually because of possible (or happening) side effects of olanzapine. I also use olanzapine a lot when I'm on call to treat patients coming to the ER. Many of those patients have psychotic symptoms, sometimes due to worsening of their psychotic disorder but many times also related to drug use. Olanzapine works really well in those cases. I often see patients who have been taking stimulants, like amphetamines or cocaine, the past few days, slept little and present with paranoia and delusions. Olanzapine works like a charm because what these patients need is a break from the drugs and a long sleep.
The usual starting dose of olanzapine is 10mg. I rarely start with a lower dose when treating psychotic or manic patients. I would maybe consider 7,5mg for someone young with first episode psychosis. But if a young, first episode psychosis patient came in and was calm and not lacking sleep I would probably start him off with another antipsychotic, usually aripiprazole. If a patients was really agitated or manic and had a history of taking olanzapine before I would probably prescribe 15-20mg as a starting dose.
Reasons for loving olanzapine:
#1 It tends to help patients feel better fast.
Olanzapine is sedating and also has anxiolytic effects, so it reduces anxiety. This calming effect can be seen after just one dose but usually you have to wait a lot longer for the antipsychotic effect.
#2 Helps with sleep.
Sleep is so important for everyone. Sometimes just getting one good nights sleep can be a total game changer.
Very important in mania. Those patients often have been sleeping little or not at all for days. They seem to get better so much faster if they get their sleep.
#3 It is a very effective antipsychotic.
Probably the best antipsychotic after clozapine. It works fast and well and most patients respond to it, at least partly.
Reasons for hating olanzapine:
#1 Weight gain is a very common side effect.
The weight gain can be very much and fast.
You have to be careful, inform about the possible side effect, weight your patients regularly and preferably switch medications sooner than later if there is a substantial increase in weight.
I don't hate olanzapine for this reason but would prefer it if it wasn't like this:
#1 After giving the long-acting injection of olanzapine (Zypadhera) the patients have to be observed for 3 hours.
Long-acting injections give the patients the best chances of continued recovery and remission and lower the risk of relapse and re-admission. Therefore it is the best possible treatment in psychotic disorders.
Many patients don't like having to stay in hospital for 3 hours after getting their monthly injection so they can be less likely to accept this treatment with long-acting injections of olanzapine than they would if being treated with another antipsychotic.
Zypadhera is also very very very yellow so it looks a bit radioactive. It can be difficult to get paranoid patients to accept an injection medication looking like that.
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