Olanzapine IM
ZYPREXA INTRAMUSCULAR
Pronunciation: oe-LAN-za-peen (zye-PREX-a)
“Owl lands upon (cra)Zy pretzel”
What it isInjectable second-generation antipsychotic (ZYPREXA INTRAMUSCULAR, 2004) with D2, 5-HT2A, histamine, muscarinic, and alpha-1 blockade; acute agitation.
Why this oneIt controls agitation with less acute dystonia than haloperidol while preserving olanzapine’s sedative effect.
What limits itAvoid close use with parenteral benzodiazepines because cardiorespiratory depression can occur; hypotension and oversedation limit use.
FDA-approved for
- acute agitation (schizophrenia, bipolar I mania) (2004)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Acute agitation associated with schizophrenia and bipolar I mania | Adults | 10 mg IM (5 or 7.5 mg when clinically warranted) | May repeat up to 10 mg; assess orthostatic hypotension before subsequent doses | 3 doses given 2–4 h apart; total 30 mg/day |
Renal Undefined.
Hepatic Undefined.
Instructions
- Intramuscular use only; do not administer IV or SC; inject slowly deep into muscle
- Reconstitute only with 2.1 mL Sterile Water for Injection (~5 mg/mL); use within 1 hour
- Do not combine in a syringe with diazepam, lorazepam, or haloperidol injection
- Geriatric: consider 5 mg; debilitated/hypotension-prone: consider 2.5 mg
Available strengths
- inj 10 mg/vial
Cautions
- Orthostatic hypotension/bradycardia (with maximal dosing)
- Neuroleptic malignant syndrome
- DRESS
- Metabolic changes (hyperglycemia, dyslipidemia, weight gain)
- Tardive dyskinesia
- Suicide risk
Adverse reactions
- Somnolence
Pregnancy No established drug-associated malformation risk; third-trimester exposure risks neonatal extrapyramidal/withdrawal symptoms.
Lactation Present in human milk; monitor infant for sedation, irritability, poor feeding, extrapyramidal symptoms.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 10 mg/vial | inj | per unit | $20.92/ea | not offered |
Other forms: Olanzapine (ZYPREXA)
Available combined with: Samidorphan (in LYBALVI) · olanzapine / fluoxetine · olanzapine / samidorphan
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Classes and tags
Clinical profile
Open Olanzapine IM in the interactive console ↗
Memory aids: interaction avatars
