olanzapine

Warnings and precautions

Black Box Warning: Increased mortality in elderly patients with dementia-related psychosis, postinjection delirium/seda- tion syndrome Black Box Warning: Available only through restricted distribution program (Zyprexa Relprevv Patient Care Program, 877-772-9390) due to postinjection de- lirium/sedation syndrome; given at a facil- ity with emergency services; continuous observation; monitor for 3 hr after injection • Use gloves to prepare; irritating to skin • Use deep IM gluteal inj only • Use only diluent provided in kit; give q2-4wk using 19-G, 1.5-inch needle in kit; for obese patients, use 19-G, 2-inch or larger needle Black Box Warning: Increase: respiratory depression—opioids Decrease: OLANZapine levels—CYP1A2 inducers: carBAMazepine, omeprazole, rifAMPin Decrease: antiparkinson activity— levodopa, bromocriptine, other DOPa- mine agonists Drug/Lab Test Increase: LFTs, prolactin, CPK Drug/Herb Increase: toxicity—kava Decrease: olanzapine effect—St. John’s wort; avoid concurrent use Black Box Warning: Postinjection de- lirium/sedation syndrome (ZyPREXA Relprevv):  monitor continuously for ≥3 hr after injection; patient must be accom- panied when leaving: assess for seda- tion, coma, delirium, EPS, slurred speech, altered gait, aggression, dizziness, weak- ness, hypertension, seizures; before leav- ing, confirm that patient is alert, oriented, and free of any other symptoms • Mental status: assess orientation, af- fect, LOC, reflexes, coordination, sleep pattern disturbances, mood, behavior, presence of hallucinations and type be- fore initial administration, monthly; EPS, including akathisia (inability to sit still, no pattern to movements), tardive dyski- nesia (bizarre movements of jaw, mouth, tongue, extremities), pseudoparkinson- ism (rigidity, tremors, pill rolling, shuf- fling gait), suicidal thoughts, behaviors • Renal status: I&O ratio; palpate blad- der if low urinary output occurs; urinary retention may be cause, especially in geri- atric patients; urinalysis recommended before, during prolonged therapy • Bilirubin, CBC, LFTs • B/P sitting, standing, lying: take pulse, respirations during initial treatment; establish baseline before starting treat- ment; report drops of 30 mm Hg; obtain baseline ECG • Dizziness, faintness, palpitations, tachycardia on rising Black Box Warning: Geriatric patients O for serious reactions: fatal pneumonia, heart failure, stroke leading to death (IM); do not use in dementia-related psychosis • Neuroleptic malignant syndrome: hy- perpyrexia, muscle rigidity, increased CPK, altered mental status, acute dystonia (cheek chewing, swallowing, eyes, pill rolling), stop drug immediately • EPS: May occur after long-term use • Hyperthermia: Monitor for excessive heat, worse with exercising • Constipation, urinary retention daily; increase bulk, water in diet • Weight gain, hyperglycemia, metabolic changes in diabetic patients • Supervised ambulation until patient stabilized on medication; do not involve patient in strenuous exercise program because fainting is possible; patient should not stand still for long periods • Hyperglycemia: increased in diabetic patient, monitor FBS baseline and peri- odically • Metabolic syndrome: large weight gain, increased B/P, FBS, cholesterol, and triglycerides, BMI • DRESS: may be fatal; fever, hepatitis, cutaneous reactions, eosinophilia, nephri- tis, pneumonia, myocarditis, discontinue immediately • Beers: avoid in older adults except for schizophrenia, bipolar disorder, or short-term use as an antiemetic during chemotherapy; increased risk of stroke • Pregnancy/breastfeeding:  use only if benefits outweigh fetal risk, may cause EPS in infant if used in 3rd trimester; those pregnant should enroll women in the National Pregnancy Registry for Atypi- cal Antipsychotics, 1-866-961-2388; ex- creted in breast milk, avoid breastfeeding Black Box Warning: About postinjection delirium/sedation syndrome: all symp- toms, not to drive or engage in hazardous activities after injection on that day • To use good oral hygiene; frequent rinsing of mouth; sugarless gum, hard candy, ice chips for dry mouth • To avoid hazardous activities until product response is determined • That orthostatic hypotension occurs often; to rise from sitting or lying position gradually • To avoid hot tubs, hot showers, tub baths because hypotension may occur • To avoid abrupt withdrawal of this product because EPS may result; product should be withdrawn slowly • To avoid OTC preparations (cough, hay fever, cold) unless approved by pre- scriber because serious product interac- tions may occur; to avoid use with alco- hol, CNS depressants, opioids because increased drowsiness may occur • Suicidal thoughts, behaviors: report immediately suicidal thoughts/behaviors • That in hot weather, heat stroke may occur; to take extra precautions to stay cool • To take PO without regard to food, how to use ODT • To notify prescriber if pregnancy is planned or suspected; not to breastfeed

Source pages 975, 976, 977, 978