Drug reference

Olanzapine embonate

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 444, 445, 446

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Maintenance in schizophrenia in patients tolerant to olanzapine by mouth (patients taking 10 mg oral olanzapine daily) ▶BY DEEP INTRAMUSCULAR INJECTION ▶Adult 18–75 years: Initially 210 mg every 2 weeks, alternatively initially 405 mg every 4 weeks, then maintenance 150 mg every 2 weeks, alternatively maintenance 300 mg every 4 weeks, maintenance dose to be started after 2 months of initial treatment, dose to be administered into the gluteal muscle, consult product literature if supplementation with oral olanzapine required Maintenance in schizophrenia in patients tolerant to olanzapine by mouth (patients taking 15 mg oral olanzapine daily) ▶BY DEEP INTRAMUSCULAR INJECTION ▶Adult 18–75 years: Initially 300 mg every 2 weeks, then maintenance 210 mg every 2 weeks, alternatively maintenance 405 mg every 4 weeks, maintenance dose to be started after 2 months of initial treatment, dose to be administered into the gluteal muscle, consult product literature if supplementation with oral olanzapine required Maintenance in schizophrenia in patients tolerant to olanzapine by mouth (patients taking 20 mg oral olanzapine daily) ▶BY DEEP INTRAMUSCULAR INJECTION ▶Adult: Initially 300 mg every 2 weeks, then maintenance 300 mg every 2 weeks (max. per dose 300 mg every 2 weeks), adjusted according to response, dose to be administered into the gluteal muscle, consult product literature if supplementation with oral olanzapine required

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Cautions

Bone-marrow depression. hypereosinophilic disorders. low leucocyte count. low neutrophil count. myeloproliferative disease. paralytic ileus. when transferring from oral to depot therapy, the dose by mouth should be reduced gradually

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Safety

Important Safety Information

When prescribing, dispensing or administering, check that this is the correct preparation—this preparation is used for maintenance treatment and should not be used for the rapid control of an acute episode.

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Interactions

→Appendix 1: olanzapine

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Side Effects

▶Common or very common Anticholinergic syndrome. appetite increased. arthralgia. asthenia. eosinophilia. fever. glycosuria. oedema. sexual dysfunction ▶Uncommon Abdominal distension. alopecia. breast enlargement. diabetes mellitus. diabetic coma. dysarthria . epistaxis. ketoacidosis. memory loss. oculogyration. photosensitivity reaction. urinary disorders ▶Rare or very rare Drug reaction with eosinophilia and systemic symptoms (DRESS). hepatic disorders. hypothermia. pancreatitis. rhabdomyolysis. thrombocytopenia ▶Frequency not known Erythema. gait abnormal. increased risk of fall. pneumonia. visual hallucinations SIDE-EFFECTS, FURTHER INFORMATION Side-effects may persist until the drug has been cleared from its depot site. Overdose Post-injection reactions have been reported leading to signs and symptoms of overdose.

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Pregnancy

Use only if potential beneﬁt outweighs risk; neonatal lethargy, tremor, and hypertonia reported when used in third trimester.

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Breast Feeding

Avoid—present in milk.

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Hepatic Impairment

Manufacturer advises caution. Dose adjustments Manufacturer advises consider initial dose of 150 mg every 4 weeks.

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Renal Impairment

Dose adjustments Initially 150 mg every 4 weeks.

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Monitoring Requirements

▶Observe patient for at least 3 hours after injection. ▶Treatment requires careful monitoring for optimum effect. ▶Blood lipids and weight should be measured at baseline, at 3 months (weight should be measured at frequent intervals during the ﬁrst 3 months), and then yearly with antipsychotic drugs. Patients taking olanzapine require more frequent monitoring of these parameters: every 3 months for the ﬁrst year, then yearly. ▶Fasting blood glucose should be measured at baseline, at 4–6 months, and then yearly. Patients taking olanzapine should have fasting blood glucose tested at baseline, after one months’ treatment, then every 4–6 months.

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Dose and formulations

Directions For Administration

Correct injection technique (including use of z-track technique) and rotation of injection sites are essential.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Powder and solvent for suspension for injection ▶Zypadhera (Eli Lilly and Company Ltd) Olanzapine (as Olanzapine embonate monohydrate) 210 mg Zypadhera 210mg powder and solvent for suspension for injection vials | 1 vial P £142.76 DT = £142.76 Olanzapine (as Olanzapine embonate monohydrate) 300 mg Zypadhera 300mg powder and solvent for suspension for injection vials | 1 vial P £222.64 DT = £222.64 Olanzapine (as Olanzapine embonate monohydrate) 405 mg Zypadhera 405mg powder and solvent for suspension for injection vials | 1 vial P £285.52 DT = £285.52 Movement disorders Cerebral palsy and spasticity Overview Cerebral palsy is a group of permanent, non-progressive abnormalities of the developing fetal or neonatal brain that lead to movement and posture disorders, causing activity limitation and functional impact. There can be accompanying clinical and developmental comorbidities. These include disturbances of sensation, perception, cognition, communication and behaviour, epilepsy, and secondary musculoskeletal problems (such as muscle contracture and abnormal torsion). Cerebral palsy is not curable and the comorbidities can impact on many areas of participation and quality of life, particularly eating, drinking, comfort, and sleep. There are an increasing number of adults now living with cerebral palsy. These patients have a wide range of abilities — from full independence in everyday life to requiring 24 hour care and attention. It is therefore important that patients and their family and carers are provided with information about the network of general and specialised adult services available, to ensure their changing needs are met. The management of adults with cerebral palsy is a continuation from childhood under the care of specialists. For guidance on the management of patients with cerebral palsy, see Cerebral Palsy and Spasticity in BNF for Children. Useful Resources Cerebral palsy in under 25s: assessment and management. National Institute for Health and Care Excellence. Clinical guideline 62. January 2017. www.nice.org.uk/guidance/ng62 Spasticity in under 19s: management. National Institute for Health and Care Excellence. Clinical guideline 145. July 2012 (updated November 2016). www.nice.org.uk/guidance/cg145 Cerebral Palsy in adults. National Institute for Health and Care Excellence. Clinical guideline 119. January 2019. www.nice.org.uk/guidance/ng119 Motor neurone disease Description of condition Motor neurone disease is a neurodegenerative condition affecting the brain and spinal cord. Degeneration of motor neurones leads to progressive muscle weakness; resulting Nervous system symptoms include muscle cramps, wasting and stiffness, loss of dexterity, reduced respiratory function and cognitive dysfunction. The most common form is amyotrophic lateral sclerosis. g Patients suspected of having developed motor neurone disease should be referred to a neurologist without delay. h Aims of treatment As there is no cure, treatment focuses on maintaining functional ability and managing symptoms. Non-drug treatment Non-drug treatment includes nutrition, psychosocial support, physiotherapy, exercise programmes and use of special equipment or mobility aids. Management of symptoms Muscular symptoms g Quinine p. 655 [unlicensed indication] is recommended as ﬁrst line treatment for muscle cramps. If quinine is ineffective, not tolerated or contra-indicated, baclofen p. 1190 [unlicensed indication] should be considered as second line treatment. Subsequent treatment options include tizanidine p. 1192 [unlicensed indication], dantrolene sodium p. 1417 [unlicensed indication] or gabapentin p. 331 [unlicensed indication]. Symptoms of muscle stiffness, spasticity or increased tone can be managed with baclofen, tizanidine, dantrolene sodium or gabapentin [unlicensed indication]. Treatment of severe spasticity may require specialist referral. h Saliva problems g A trial of an antimuscarinic drug [unlicensed indication] can be considered for excessive drooling of saliva. Glycopyrronium bromide p. 1405 is recommended in patients who have cognitive impairment as it has fewer central nervous system side-effects. If initial treatment is ineffective, not tolerated or contra-indicated, referral for specialist administration of botulinum toxin type A p. 425 [unlicensed indication] may be required. Humidiﬁcation, nebulisers and carbocisteine p. 306 can be used to treat patients with thick, tenacious saliva. h Respiratory symptoms g Reversible causes of worsening respiratory impairment (such as respiratory tract infections or secretion problems) should be treated before considering other options. Patients experiencing breathlessness can be treated with opioids [unlicensed indication], or benzodiazepines [unlicensed indication] if the patient’s symptoms are exacerbated by anxiety. Non-invasive ventilation should be considered in patients with respiratory impairment. h Amyotrophic lateral sclerosis Riluzole p. 1186 is licensed for use in patients with amyotrophic lateral sclerosis to extend life or to extend the time to mechanical ventilation—see National funding/access decisions under riluzole. Useful Resources Motor neurone disease: assessment and management. National Institute for Health and Care Excellence. Clinical guideline NG42. February 2016. www.nice.org.uk/guidance/ng42 4.1 Dystonias and other involuntary movements Essential tremor, chorea, tics, and Nervous system related disorders Drugs used in essential tremor, chorea, tics, and related disorders Tetrabenazine p. 425 is mainly used to control movement disorders in Huntington’s chorea and related disorders. Tetrabenazine can also be prescribed for the treatment of tardive dyskinesia if switching or withdrawing the causative antipsychotic drug is not effective. It acts by depleting nerve endings of dopamine. It is effective in only a proportion of patients and its use may be limited by the development of depression. Haloperidol p. 404 [unlicensed indication], olanzapine p. 416 [unlicensed indication], risperidone p. 421 [unlicensed indication], and quetiapine p. 419 [unlicensed indication], can also be used to suppress chorea in Huntington’s disease. Haloperidol can also improve motor tics and symptoms of Tourette syndrome and related choreas. Other treatments for Tourette syndrome include pimozide p. 406 [unlicensed indication] (important: ECG monitoring required), clonidine hydrochloride p. 156 [unlicensed indication], and sulpiride p. 408 [unlicensed indication]. Trihexyphenidyl hydrochloride p. 431 in high dosage can also improve some movement disorders; it is sometimes necessary to build the dose up over many weeks. Chlorpromazine hydrochloride p. 402 and haloperidol are used to relieve intractable hiccup. Propranolol hydrochloride p. 162 or another beta- adrenoceptor blocking drug may be useful in treating essential tremor or tremors associated with anxiety or thyrotoxicosis. Primidone p. 352 in some cases provides relief from benign essential tremor; the dose is increased slowly to reduce side- effects. Piracetam below is used as an adjunctive treatment for myoclonus of cortical origin. After an acute episode, attempts should be made every 6 months to decrease or discontinue treatment. Riluzole p. 1186 is used to extend life in patients with motor neurone disease who have amyotrophic lateral sclerosis. Torsion dystonia and other involuntary movements Treatment with botulinum toxin type A p. 425 can be considered after an acquired non-progressive brain injury if rapid-onset spasticity causes postural or functional difﬁculties. Other drugs used for Dystonias and other involuntary movements Clozapine, p. 414. Diazepam, p. 360. Orphenadrine hydrochloride, p. 430. Pericyazine, p. 406. Pramipexole, p. 442. Prochlorperazine, p. 407. Procyclidine hydrochloride, p. 431. Ropinirole, p. 444. Rotigotine, p. 445. Triﬂuoperazine, p. 408 ANTIPSYCHOTICS › FIRST-GENERATION eiiii F 401

PDF pages 445, 446

Dose text by age group

Adult 18–75 years

Initially 210 mg every 2 weeks,

First-line fragment. Read the complete Indications and Dose section above.

PDF page 444

Adult 18–75 years

Initially 300 mg every 2 weeks, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 444

Adult

Initially 300 mg every 2 weeks, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 444

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Olanzapine embonate

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 444, 445, 446

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 444

Cautions

PDF page 444

Safety

Important Safety Information

PDF page 444

Interactions

→Appendix 1: olanzapine

PDF page 444

Side Effects

PDF page 444

Pregnancy

Use only if potential beneﬁt outweighs risk; neonatal lethargy, tremor, and hypertonia reported when used in third trimester.

PDF page 444

Breast Feeding

Avoid—present in milk.

PDF page 444

Hepatic Impairment

Manufacturer advises caution. Dose adjustments Manufacturer advises consider initial dose of 150 mg every 4 weeks.

PDF page 444

Renal Impairment

Dose adjustments Initially 150 mg every 4 weeks.

PDF page 444

Monitoring Requirements

PDF pages 444, 445

Dose and formulations

Directions For Administration

Correct injection technique (including use of z-track technique) and rotation of injection sites are essential.

PDF page 445

Medicinal Forms

PDF pages 445, 446

Dose text by age group

Adult 18–75 years

Initially 210 mg every 2 weeks,

First-line fragment. Read the complete Indications and Dose section above.

PDF page 444

Adult 18–75 years

Initially 300 mg every 2 weeks, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 444

Adult

Initially 300 mg every 2 weeks, then

First-line fragment. Read the complete Indications and Dose section above.

PDF page 444

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.