Zyprexa

Provider Level

RN/Paramedic

Class

Atypical antipsychotic

Mechanism of Action

Antagonizes dopamine D2 and serotonin 5-HT2 receptors in the central nervous system, leading to antipsychotic and sedative effects.

Indications

Severe agitation, acute psychosis, and acute behavioral emergencies where non-pharmacological interventions have failed.

Contraindications

Known hypersensitivity to olanzapine. Black box warning against use in elderly patients with dementia-related psychosis due to increased risk of death.

Routes

PO, IM

Onset / Duration

Onset: 15 to 45 minutes for IM, somewhat longer for PO. Duration: 24 to 30 hours.

Adverse Effects

Sedation, hypotension, orthostasis, extrapyramidal symptoms, QTc prolongation, respiratory depression, and anticholinergic effects.

Precautions & Interactions

Use with extreme caution when co-administered with benzodiazepines or other CNS depressants due to a significantly increased risk of severe respiratory depression and hypotension.

Special Considerations

Continuous monitoring of airway, breathing, and circulation is required. Obtain a baseline ECG when feasible to monitor for QTc prolongation. Not intended for IV administration.