Olanzapine anxiety (A complete guide)

In this blog, we will discuss olanzapine for anxiety, benefits, side effects, dosages, some precautions and considerations and a few reviews of people that have started the treatment. 

Olanzapine for Anxiety

It has been said that olanzapine for anxiety may be prescribed for anxiety, agitation, even to treat dysphoria and racing thoughts, especially for bipolar disorder.

It has been indicated that it can start working between 20 to 30 minutes of the intake and it seems to have a profound calming effect.

Since Olanzapine can be used to treat mood symptoms and psychotic symptoms it may be prescribed by your doctor, for people where the diagnosis is still not clear (bipolar disorder, schizophrenia or depression with psychotic features).

Additionally, it is believed that this medication can be quite effective and have remarkably a few side effects, however, even in doses of 10 to 20 mg, it can cause a lot of weight gain and some people may develop diabetes. 

This can be backed up by science, a study from 2004, a group of patients treated with olanzapine, mostly diagnosed with bipolar disorder and who demonstrated treatment resistance to antidepressant and/or mood stabilizers showed a significant improvement and sustained improvement.

However, as we mentioned, for all patients the observed adverse effects included weight gain, sedation, and dry mouth. 

What is Olanzapine?

Olanzapine (Zyprexa, brand name) is a thienobenzodiazepine chemical compound that has been classed as an atypical antipsychotic similar to antidepressants mirtazapine, nefazodone and trazodone.

It is prescribed to treat mental/mood conditions such as schizophrenia and bipolar disorder and in some cases, it can be combined with other medications to treat depression. 

All of them are said to work by increasing neurotransmitter serotonin in the brain and as researchers have identified “this increase in serotonergic tone is thought to explain olanzapine’s antidepressant and anxiolytic qualities and enhanced dopamine activity in the frontal cortex” (Jackson et al, 2004).

Another study from 2012, researchers studied the effects of atypical antipsychotics Olanzapine, risperidone, and quetiapine in a sample of people with a diagnosis of Generalized Anxiety Disorder and bipolar anxiety. 

Other brand names are  Zyprexa Relprevv and Zyprexa Zydis.

Overall, they found that atypical antipsychotics were relatively tolerated with somnolence and sedation reported as side effects.

However, in contrast to antidepressant medication and benzodiazepines, there was still information needing to be determined about the long-term risks and benefits of using antipsychotics in the treatment of GAD.

Dosages for Olanzapine

Here are the available dosage forms and strengths of olanzapine (rxlist.com), however, remember always to follow the instructions provided by your doctor. 

Adult Dosage Forms & Strengths

Tablet

• 2.5 mg
• 5 mg
• 7.5 mg
• 10 mg
• 15 mg
• 20 mg

Tablet, orally disintegrating

• 5 mg
• 10 mg
• 15 mg
• 20 mg

Intramuscular (IM) injection, short-acting

• 10 mg

Intramuscular (IM), extended-release suspension

• 210 mg/vial
• 300 mg/vial
• 405 mg/vial

Pediatric Dosage Forms & Strengths

Tablet

• 2.5 mg
• 5 mg
• 7.5 mg
• 10 mg
• 15 mg
• 20 mg

Tablet, orally disintegrating

• 5 mg
• 10 mg
• 15 mg
• 20 mg

For the treatment of schizophrenia in adults, dosage considerations (should be given as follows)

Taken orally

• 5-10 mg per day initially; if necessary, may be titrated upward in increments of 5 mg per day at intervals greater than 1 week
• Maintenance: 10-20 mg per day; not to exceed 20 mg per day

Intramuscular (IM), extended-release

• Recommended dosing based on oral dosing
• Oral dosage 10 mg per day: Give 210 mg IM every 2 weeks or 405 mg IM every 4 weeks for 1st 8 weeks, then 150 mg every 2 weeks or 300 mg every 4 weeks
• Oral dosage 15 mg per day: Give 300 mg IM every 2 weeks for 1st 8 weeks, then 210 mg every 2 weeks or 405 mg every 4 weeks
• Oral dosage 20 mg per day: Give 300 mg IM every 2 weeks for 1st 8 weeks, then 300 mg every 2 weeks

Schizophrenia in Children

Less than 13 years: Safety and efficacy not established

• 13-17 years: 2.5-5 mg per day taken orally initially
• target dosage, 10 mg per day
• adjust by increments/decrements of 2.5-5 mg; dosage range, 2.5-20 mg per day

Bipolar Mania in Adults

Used as monotherapy or in combination with lithium or valproate

Monotherapy: 10-15 mg/day taken orally initially

Adjunct to lithium or valproate: 10 mg/day taken orally initially

Maintenance: 5-20 mg/day taken orally; not to exceed 20 mg/day

Depression in bipolar disorder

• Use in combination with fluoxetine
• 5 mg in the evening; adjusted to a range of 5-12.5 mg/day; may be increased up to 20 mg/day in resistant depression

Dosing considerations

• Dosage adjustments, if necessary, should be made at intervals greater than 24 hours

Schizophrenia or Bipolar-Related Agitation in Adults

• 10 mg IM (short-acting)
• Consider 5-7.5 mg for geriatric patients or if circumstances warrant
• Subsequent IM doses up to 10 mg may be administered 2 hours after 1st dose and 4 hours after 2nd dose; not to exceed 30 mg/day

Bipolar I Disorder (Manic or Mixed Episodes) in Children

Less than 13 years: Safety and efficacy not established

• 13-17 years: 2.5-5 mg/day taken orally initially
• target dosage, 10 mg/day
• Adjust by increments/decrements of 2.5-5 mg
• Dosage range, 2.5-20 mg/day

Stuttering (Off-label) in Children

Children 12 years of age or under

• 1.25 mg taken orally at bedtime for 4 weeks, then 2.5 mg at bedtime

Children older than 12 years of age

• 2.5 mg taken orally at bedtime for 4 weeks, then 5 mg at bedtime

Dosing Modifications

Renal impairment: Dose adjustment not necessary

Hepatic impairment: Dose adjustment may be necessary; use caution

Administration

IM administration

• Short-acting and extended-release IM preparations are not interchangeable
• Short-acting: Dissolve in 2.1 mL SWI to yield 5 mg/mL solution; inject deep and slow within 1 hour of reconstitution
• Extended-release: Reconstitute with supplied diluent (210-mg vial in 1.3 mL; 300-mg vial in 1.8 mL; 405-mg vial in 2.3 mL); inject deep in gluteal muscle
• Do not use lorazepam injection for reconstitution, and do not mix with haloperidol or diazepam in syringe

Geriatric Dosing Considerations

Not approved for dementia-related psychosis, because of increased risk of cardiovascular or infection-related mortality

Consider lower starting dosage

Schizophrenia

• 2.5-5 mg/day taken orally initially

IM (extended-release): 150 mg every 4 weeks in patients who are debilitated or predisposed to hypotensive episodes; not studied in patients with renal or hepatic impairment; requires deep IM administration (muscle mass in elderly may be sufficient)

Schizophrenia or Bipolar-Related Agitation

IM (short-acting):

• 5 mg; consider 2.5 mg if the patient is predisposed to hypotensive reactions

What are the side effects?

Side effects may include the following (rxlist.com):

• Dizziness/low blood pressure upon standing
• Weight gain, dose-dependent
• High levels of triglycerides in the blood
• High cholesterol
• Drowsiness, dose-dependent
• Extrapyramidal symptoms (EPS), dose-dependent (muscle spasms, jerky movements, slow movements)
• Dry mouth
• Weakness
• Dizziness
• Accidental injury
• Insomnia
• Elevated alanine aminotransferase (ALT) level
• Constipation
• Indigestion
• Elevated levels of prolactin in the blood
• High blood sugar
• Low blood pressure
• Tremor
• Weakness
• Restlessness
• Parkinsonism reactions

These list does not include all the possible side effects, please check with your physician for additional information.

Olanzapine drug interaction

As with any other drug, it is important to be aware of potential interactions with other drugs you may be taking simultaneously when starting your olanzapine treatment.

Let your doctor know the list of drugs you are taking and do not start, or stop the treatment unless indicated by your physician. 

According to rxlist.com, serious interactions of olanzapine include:

• apomorphine
• bromocriptine
• cabergoline
• dopamine
• fluvoxamine
• levodopa
• lisuride
• mefloquine
• methyldopa
• ondansetron
• pefloxacin
• pramipexole
• ropinirole
• sodium oxybate
• umeclidinium bromide/vilanterol inhaled
• vilanterol/fluticasone furoate inhaled

Moderate interactions:

Olanzapine has known moderate interactions with at least 293 different drugs.

Mild interactions:

• brimonidine
• chasteberry
• ethanol
• eucalyptus
• omeprazole
• ruxolitinib
• sage

This is not a complete list of drug interactions, always consult with your doctor before you start taking the medicine. 

What should I do if I overdose?

You need to seek immediate medical assistance by calling emergency services or going to a hospital.

If you or someone has overdose on olanzapine they may display symptoms such as agitation, heart palpitations, drowsiness, slurred speech, sudden uncontrollable movements, and even coma (pyscom.net).

Some Warnings/precautions

• Olanzapine is not approved for dementia-related psychosis and elderly patients with this condition can have an increased risk of death due to heart failure or pneumonia. 
• Some people are at risk for severe sedation or delirium after injecting olanzapine, this is why it is recommended to monitor for at least 3 hours in a facility that has access to emergency services. 
• If you have had an allergic reaction in the past or if you believe you could have one, talk to your doctor before starting the treatment.
• Olanzapine intake can increase the risk of developing hyperglycemia and diabetes. 
• Olanzapine intake can cause irreversible and involuntary dyskinetic movements, especially in elderly individuals.
• May cause anticholinergic effects including paralytic ileus, urinary retention, xerostomia, BPH, and visual problems.
• People taking Olanzapine can have a higher risk of cerebrovascular accidents such as stroke and transient ischemic attacks that can result in death. 

For additional information, consult with your physician any worries or questions you may have before starting the Olanzapine treatment. 

Reviews from Olanzapine treatment

Here are some reviews from rxlist.com about some of the benefits and side effects of using Olanzapine:

“Worst drug ever made! I put on 32 Kilos and I’m struggling even with good eating and daily exercise to remove it. Even after stopping the drug. Don’t take this drug. Don’t trust any doctor who is endorsing this drug is it dangerous deleterious to your health and should be recalled and removed from prescription immediately!”.

“I’ve been taking Zyprexa for four weeks now and recently added trazodone. Severe anxiety has decreased and I can now go outside by myself again. Severe depression has also decreased, but I am now experiencing a “blank” mood. Minor weight gain. I will try this for another week and speak to my doctor about “blank” feeling which is a real downside”. 

“It worked and it was good for sleeping but I had to stop it because I gained 10 pounds in a month”. 

Why is this blog about Olanzapine anxiety important?

We have discussed how Olanzapine is classed as an antipsychotic medication that can be used in the treatment of schizophrenia and bipolar disorder.

However, studies are still investigating the effect on the treatment of anxiety since there are many conflicting results. 

If you are starting to take olanzapine for anxiety most likely your doctor already assessed the potential benefits over the side effects and decided it was the best treatment for you.

However, always consult if there are any unwanted side effects or worsening of symptoms.  

Please feel free to leave any comments in the comments section below!

Frequently asked questions (FAQs) about olanzapine anxiety

Recommended reading

• Efficacy of Sodium Valproate and Olanzapine in BPD,Mania: at Tertiary Care Hospital in Nepal: A comparative study 
• The Zyprexa Papers
• Antiepileptic effects of Verapamil,Atorvastatin,L-Carnitine&Olanzapine: Effect of Verapamil, Atorvastatin, L-Carnitine, Olanzapine and their combinations in the Treatment of Epilepsy
• Olanzapine Pamoate; A Clear and Concise Reference
• Adverse Metabolic Effects of Conventional and Atypical Antipsychotics: Changes in Blood Glucose, Serum Cholesterol, BMI with Haloperidol, Risperidone and Olanzapine

References

Psycheducation.com 

Jackson, W.C, Manning, J.S, Connor, P.D and Deardorff, G.O (2004) Retrospective Study of Olanzapine in Depressive and Anxious States in Primary Care

Psycom.net

Rxlist.com