Olanzapine
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
| ID | DRUG-OLANZAPINE |
|---|---|
| Type | Drug |
| Aliases | ZyprexaZyprexa Zydis (ODT)Оланзапін |
| Status | reviewed 2026-04-27 | pending_clinical_signoff |
| Diseases | None declared |
| Sources | SRC-ESMO-DLBCL-2024 SRC-NCCN-BCELL-2025 |
Drug Facts
| Class | Atypical (second-generation) antipsychotic; multireceptor antagonist (D2, 5-HT2A/2C, H1, M1, α1) |
|---|---|
| Mechanism | Thienobenzodiazepine atypical antipsychotic with high-affinity antagonism at multiple receptors implicated in nausea and vomiting: dopamine D2 (mesolimbic), serotonin 5-HT2A/2C, histamine H1, muscarinic M1, and α1-adrenergic. Multi-receptor blockade in the vomiting center, area postrema, and chemoreceptor trigger zone produces broad-spectrum antiemetic effect across acute, delayed, and breakthrough CINV phases. Adding olanzapine 10 mg PO days 1-4 to triple antiemetic prophylaxis (NK1 + 5-HT3 + dex) improves complete-response rate by ~10% absolute for HEC (Navari, NEJM 2016). Particularly effective for refractory or breakthrough nausea where single-receptor antagonists have failed. Approved by FDA September 1996 (psychiatric indications); CINV use is guideline-supported off-label / on-label depending on jurisdiction. |
| Typical dosing | CINV adjunct: 10 mg PO once daily on days 1-4 of HEC; or 5 mg PO once daily in elderly (≥65 yrs), frail patients, or to limit sedation. Single oral dose 30-60 minutes before chemo on day 1 works adequately if 4-day course not feasible. Some protocols use 5 mg PO daily × 4 days as standard to reduce sedation while preserving efficacy (Navari 2016 used 10 mg). Breakthrough CINV rescue: 10 mg PO once, then 10 mg daily × 3 days. Bedtime dosing preferred to align peak sedation with sleep. Renal: no adjustment. Hepatic impairment: start lower (5 mg) and titrate. Pediatric ≥6 yrs: 0.1 mg/kg up to 10 mg. |
| Ukraine registered | True |
| NSZU reimbursed | False |
| Ukraine last verified | 2026-04-27 |
Warnings
- Increased mortality in elderly patients with dementia-related psychosis (cerebrovascular events, infection)
- Post-injection delirium / sedation syndrome with long-acting IM (Zyprexa Relprevv) — not relevant to oral CINV use
Notes
Adding olanzapine 10 mg PO d1-4 to triple antiemetic prophylaxis (NK1 + palonosetron + dex) improves complete-response rate from ~66% to ~74% in HEC (Navari NEJM 2016 — pivotal). Equivalent efficacy seen with 5 mg dose with substantially less sedation (Yanai 2018, Lancet Oncol). Particularly valuable for: AC chemo (breast), high-dose cisplatin, BEACOPP, and breakthrough nausea refractory to standard triple therapy. Sedation is the principal patient-experience barrier — bedtime dosing and 5 mg dose mitigate. Avoid combining with metoclopramide (additive EPS) and IM benzodiazepines (cardiopulmonary depression). Available as ODT for patients with active vomiting. Ukraine: registered, NOT NSZU- reimbursed for CINV — patient self-pay (~UAH 200-400 per 4-day course); affordable adjunct that materially improves CINV control.
Used By
No reverse references found in the YAML corpus.