Antipsychotic Drugs (Module 5)
What is some information about depot antipsychotics?
A depot is an intramuscular injection which lasts in the system for two to four weeks. Two examples of depot antipsychotics include: Fluphenazine Deconoate Haloperidol Deconoate For some individuals, depot antipsychotics are convenient. They offer round-the-clock protection without the bother of having to remember to take pills. However, there are a great number of people who are prescribed antipsychotics but do not take them. They are designated as being non-compliant. The most important factor affecting compliance is thought to be the quality of the relationship between client and caretakers. An additional reason is the unpleasant side effects of the prescribed drug. This is particularly true in clinics where dosages have been too high and drugs continued for too long. Too frequently the client is blamed rather than the drug itself. This noncompliance led to the introduction and use of the depot drugs.
What is a potentially fatal adverse effect associated with antipsychotics?
A potentially fatal symptom complex referred to as neuroleptic malignant syndrome has been reported as being associated with the antipsychotic drugs. It is thought to be related to the length of drug use and the type of drug prescribed. More than 60% of the clients affected are men. If signs of this syndrome become evident, the drug should be stopped immediately. Manifestations of this serious adverse effect include: Hyperthermia Muscle rigidity Altered mental status (including catatonic signs) Autonomic instability, such as irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmias Acute renal failure
What are 7 commonly prescribed atypical antipsychotics?
Abilify (aripiprazole) Clozaril (clozapine) Geodon (ziprasidone) Invega (paliperidone) Risperdal (risperidone) Seroquel (quetiapine) Zyprexa (olanzapine)
What are common adverse effects of antipsychotic medications?
Anticholinergic effects: Dry mouth (the most common) Nasal drying Blurred vision Upset stomach, nausea, vomiting Constipation or diarrhea Urinary retention Agitation and confusion in some individuals Mild anticholinergic side effects usually wear off after a few days of being on the drug. If they make a client clearly uncomfortable and do not disappear within a few days, the drug should be changed or discontinued. The high potency antipsychotics, such as Haldol and Prolixin, are more likely to cause neuromuscular side effects. During early treatment, two adverse extrapyramidal reactions may occur: akathisia and acute dystonia. Characteristics of akathisia include: Restlessness Trouble standing still Pacing Feet in constant motion Characteristics of acute dystonia include: Facial grimacing Involuntary upward eye movement Muscle spasms of the tongue, face, neck, and back Laryngeal spasm A deficit of the neurotransmitter dopamine may create the extrapyramidal symptoms of pseudoparkinsonism. Characteristics include: Stooped posture Shuffling gait Rigidity Bradykinesia Tremors at rest Pill-rolling motion of the hand A serious adverse reaction which may occur in clients who have taken an antipsychotic drug for longer than a year is tardive dyskinesia. The syndrome may be irreversible. Characteristics include: Protrusion and rolling of the tongue Sucking and smacking movements of the lips Chewing motion Facial dyskinesia Involuntary movements of the body and extremities
How does dopamine act in relation to schizophrenia?
Dopamine has been implicated more than any other chemical substance in the neurotransmitter studies related to schizophrenia. It has long been known that mind altering drugs, such as cocaine, increase the levels of dopamine in the brain and produce psychosis. It has also been well established that the traditional antipsychotic drugs exert their therapeutic effects by blocking dopamine receptors. Dopamine is synthesized from the precursor tyrosine to L-dopa and then to dopamine. Dopamine plays an important role in the stress response and has many connections with the limbic system which help to regulate emotional behavior.
What are the 7 commonly prescribed typical antipsychotics?
Haldol (haloperidol) Loxitane (loxapine) Mellaril (thioridazine) Navane (thiothixene) Orap (pimozide) Prolixin (fluphenazine) Thorazine (chlorpromazine)
What are common uses, dosages, and important information for Geodon (ziprasidone)?
It is believed that Geodon (ziprasidone) antagonizes dopamine, serotonin, histamine, and alpha 1-adrenergic receptors. It also appears to inhibit the reuptake of serotonin and norepinephrine. Ziprasidone's therapeutic effect it to diminish schizophrenic behavior and relieve the mood and anxiety symptoms that sometimes accompany schizophrenia. Capsules: 20 mg, 40 mg, 60 mg, 80 mg Injection: 20 mg/mL Dosages: Adults: PO: Initially, 20 mg twice daily with food. Increased at intervals not less than 2 days. Maximum dose: 80 mg twice daily. IM: 10 to 20 mg up to a maximum of 40 mg daily. Tell the client to take Geodon with food. This increases absorption. EKG and blood chemistry should be done before the drug is started and routinely thereafter. Tell the client to report dizziness, fainting, irregular heart beat, or relevant heart problems to prescriber. Tell the client that symptoms may not improve for 4 to 6 weeks. Tell the client to avoid performing tasks requiring alertness and coordination until the effects of the drug are known. This drug is relatively free of extrapyramidal side effects. Observe the client for evidence of neuroleptic malignant syndrome which is rare but potentially fatal.
What are common uses, dosages, and important information for Risperdal (risperidone)?
It is believed that Risperdal (risperidone) blocks dopamine and serotonin receptors in the brain and also has antiadrenergic properties. It is used both in the short-term (6 to 8 weeks) treatment of schizophrenia and also to delay relapses in long term (1 to 2 years) treatment. It is now one of the most frequently prescribed antipsychotics and is 95th on Mosby's Top 200 Drugs of 2003. Tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg Oral Disintegrating Tablets: 0.5 mg, 1 mg, 2 mg Solution: 1 mg/mL Dosages: Adults: Short Term: Initially, 1 mg PO bid. Increased by 1 mg bid on days 2 and 3 of treatment. Maximum dose: 8 mg daily. To Delay Relapses: Initially, 1 mg PO on day 1. Increase to 2 mg on day 2 and 4 mg on day 3. Dosage Range: 2 to 8 mg daily. Obtain blood pressure measurements before starting therapy and monitor pressure regularly. Watch for orthostatic hypotension. Risperdal is not safe or effective for elderly clients with dementia. It may cause cerebrovascular adverse effects, such as TIA or stroke. Monitor the client for weight gain. Dosages above 6 mg per day may cause extrapyramidal symptoms, such as akathisia, dystonia, and pseudoparkinsonism. The client also needs to be monitored for tardive dyskinesia, which may occur after prolonged use. It may disappear spontaneously or persist for life. Observe the client for evidence of neuroleptic malignant syndrome, which is rare but potentially fatal.
What is some general information about antipsychotic drugs?
The antipsychotic drugs are the primary ones used in the treatment of schizophrenia. These medications reduce hallucinations and delusions and generally improve the client's ability to function. They seem to be effective in reducing symptoms for approximately 80% of clients. The antipsychotic drugs can be classified as the traditional (typical) drugs and the atypical drugs.
What is the action of atypical antipsychotics in the body?
The atypical antipsychotics are believed not only block D2 receptors but other dopamine receptors as well. In addition, they are believed to block the receptors of other neurotransmitters such as serotonin, norepinephrine, and histamine. This enables them to be more effective for diminishing the negative as well as positive symptoms of schizophrenia. Negative symptoms refer to the loss of normal behaviors or functions usually performed by mentally healthy adults.
What is some general information about atypical antipsychotics?
The atypical antipsychotics help control the symptoms of schizophrenia by blocking more than one type of receptor in the postsynaptic neurons and by regulating the levels of key neurotransmitters in the brain. The atypical antipsychotics, such as clozapine, have helped reduce symptoms in more than 50% of clients who did not find relief with traditional antipsychotics. They significantly improve negative as well as positive symptoms and are less likely to cause tardive dyskinesia than the traditional antipsychotics.
What is an important safety consideration when giving antipsychotic medications?
The atypical or second generation antipyschotics are sometimes used to treat behavior disorders in elderly dementia patients. According to a recent advisory issued by the FDA, this practice increases these patients' risk of death. Drugs covered by this advisory include Abilify (aripiprazole), Clozaril (clozapine), Geodin (ziprasidone), Risperdal (risperidone), Seroquel (quetiapine), and Zyprexa (olanzapine). Based on an analysis of 17 studies that included more than 5,100 patients, the death rate of elderly dementia patients who took one of the above-mentioned drugs was 1.6 times higher than that of patients who took a placebo. The majority of deaths were cardiac-related or due to infection. The FDA has asked manufacturers of these drugs to add a black box warning that highlights this risk.
What are common uses, dosages, and important information for Abilify (aripiprazole)?
The exact action of Abilify (aripiprazole) is unknown. It is believed to exert its antipsychotic effect through partial agonistic activity at dopamine (D2) and serotonin 1 A receptors and antagonist activity at serotonin 2 A receptors. The drug is used in the treatment of schizophrenia. Tablets: 10 mg, 15 mg, 20 mg, 30 mg Dosages: Adults: Initially, 10 to 15 mg PO daily. If needed, may be increased to a maximum daily dose of 30 mg daily after at least 2 weeks. Abilify may be taken without regard for meals. Tell the client to avoid hazardous activities because this drug may impair thinking, judgment, and motor skills. Grapefruit juice may interact with this drug. Tell the client to avoid or limit its use. Tell the client to avoid the use of alcohol. Inform the client that gradual improvement of symptoms will occur over several weeks rather than immediately. Observe the client for signs of tardive dyskinesia. The elderly, especially women, are at highest risk for developing this adverse effect. Observe the client for evidence of neuroleptic malignant syndrome which is rare but potentially fatal. If signs and symptoms occur, stop the drug immediately and notify the prescriber.
What are common uses, dosages, and important information for Clozaril (clozapine)?
The exact action of Clozaril (clozapine) is unknown. It is thought to interfere in the binding of dopamine to both D1 and D2 dopamine receptors. Clozapine's therapeutic effect it to diminish schizophrenic behavior. It significantly improves negative as well as positive symptoms and is less likely to produce tardive dyskinesia and the anticholinergic effects of the traditional antipsychotics. Tablets: 25 mg, 100 mg Dosages: Adults: Initially, 25 mg 1 - 2 times a day. May be increased by 25 to 50 mg per day over a period of 2 weeks. May be further increased by 50 - 100 mg per day no more frequently than 1 - 2 times a week. Maximum dose: 900 mg per day. Elderly: Initially, 25 mg per day. May be increased by 25 mg per day. Maximum dose: 450 mg per day. Clozapine may cause agranulocytosis, a potentially lethal disorder of the white blood cells. Clients are required to have a blood test once a week for the first six months, then biweekly for those with acceptable white blood cell counts. Monitor the client's blood pressure and pulse. Dizziness (39%) and tachycardia (25%) are common side effects. This drug causes seizures in up to 5% of clients. This side effect appears to be dose dependent. Tell the client to avoid the use of alcohol. Tell the client to avoid hazardous activities until the effects of the drug are known. Drowsiness generally subsides with continued treatment. This drug is relatively free of extrapyramidal side effects. Observe the client for evidence of neuroleptic malignant syndrome, which is rare but potentially fatal.
What are the common uses, dosages, and important information for Haldol (haloperidol)?
The exact action of Haldol (haloperidol) is unknown. It is believed to exert its antipsychotic effect by blocking dopamine receptors in the brain. The drug is used in the treatment of psychotic disorders including manic states, drug-induced psychosis, and schizophrenia. It is also prescribed to control tics and vocal utterances and used in the short term treatment of children with severe behavior disorders. Tablets: haloperidol: 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg Injections: haloperidol decanoate: 50 mg/mL, 100 mg/mL haloperidol lactate: 5 mg/mL Oral concentrate: 2 mg/mL Dosages: Adults and children older than 12: Initially 0.5 to 5 mg PO bid or tid or 2 to 5 mg IM q 4 to 8 hours. Hourly may be needed until the desired results are obtained. Maximum: 100 mg PO daily. Children (ages 3 to 12): 0.05 mg/kg to 0.15 mg/kg PO daily Haldol may cause dry mouth (anticholinergic effect). Tell clients that chewing sugarless gum or sucking on hard candy or ice chips may help alleviate the problem. Extreme drowsiness may occur if this drug is combined with alcohol, narcotics, pain killers, or sleep medications. Haldol should not be taken with certain other drugs. Tell clients to check with their prescribers before taking OTC or other prescription drugs. Haldol may cause tardive dyskinesia. This condition can be permanent and appears to be more common in the elderly, especially women. Observe the client for evidence of neuroleptic malignant syndrome which is rare but potentially fatal. IM decanoate is used for chronic therapy. Initial dosage is 10 to 15 times the daily PO dose but should not exceed 100 mg. The IM dose is repeated every 4 weeks.
What are common uses, dosages, and important information for Invega (paliperidone)?
The exact action of Invega (paliperidone) is unknown. It is believed to exert its antipsychotic effect through partial agonistic activity at dopamine (D2) and serotonin type 2 receptors. The drug is used in the treatment of schizophrenia. Tablets (extended release): 1.5 mg, 3 mg, 6 mg, 9mg Injection (extended release): 39 mg, 78 mg, 117 mg, 156 mg, 234 mg Dosages: Adults: 6 mg PO once daily in the morning, max 12 mg/day; IM 234 mg on day 1 then 156 mg 1 wk later (in deltoid muscle). Recommended maintenance dosage is 117 mg/month (range 39-234 mg) Adolescents (ages 12-17): Initially, 3 mg PO daily. Dosage may be increased by 3mg/day every 5 days based upon clinical response, max is 12 mg/day for patients weighing 51 kg (112 lb) or more and 6 mg/daily for patients weighing less than 51 kg. Invega may be taken without regard for meals. Do not chew, crush or break tablets. Tell the client to avoid hazardous activities because this drug may impair thinking, judgment, and motor skills. Tell the client to avoid the use of alcohol. Drug may cause hyperglycemia. Monitor patient with diabetes regularly. Observe the client for signs of tardive dyskinesia. The elderly, especially women, are at highest risk for developing this adverse effect. Observe the client for evidence of neuroleptic malignant syndrome which is rare but potentially fatal. If signs and symptoms occur, stop the drug immediately and notify the prescriber.
What are common uses, dosages, and important information for Loxitane (loxapine)?
The exact action of Loxitane (loxapine) is unknown. It is believed to exert its antipsychotic effect by blocking postsynaptic dopamine receptors in the brain. Loxitane is used in psychotic disorders. It is also being investigated for use in anxiety disorders with depression. Capsules or Tablets (loxapine succinate): 5 mg, 10 mg, 25 mg, 50 mg Injections (loxapine hydrochloride): 50 mg/mL Oral Concentrate (loxapine hydrochloride): 25 mg/mL Dosages: Adults: Initially 10 mg PO bid to qid, increased rapidly to 60 to 100 mg daily until symptoms are controlled. If patients can't take oral dosages, then 12.5 to 50 mg IM q 4 to 6 hours. Maximum: 250 mg daily. Elderly Clients: Initially 5 mg PO bid, then dosages adjusted as needed and tolerated. Mix oral concentrate with orange or grapefruit juice to disguise the unpleasant taste. Tell the client to use sugarless gum or hard candy to relieve drug mouth. Warn the client to avoid activities that require alertness and good coordination until the effects of the drug are known. Drowsiness and dizziness usually subside after the first few weeks. Tell client to avoid alcohol while taking this drug. Tell the client to stand up slowly to avoid dizziness. Monitor the client for signs of tardive dyskinesia. It may disappear spontaneously or persist for life, even if drug is stopped. Observe the client for evidence of neuroleptic malignant syndrome, which is rare but potentially fatal.
What are common uses, dosages, and important information for Navane (thiothixene)?
The exact action of Navane (thiothixene) is unknown. It is believed to block dopamine receptors in the brain. Navane is used in the symptomatic management of psychotic disorders. Capsules: 1 mg, 2 mg, 5 mg, 10 mg, 20 mg Injections: 2 mg/mL, 5 mg/mL Oral Concentrate: 5 mg/mL Dosages: Adults and Children over 12: Initially, 2 mg three times a day. Increased gradually as needed. Maximum dosage: 60 mg daily. Children under 12: Safety and effectiveness have not been established. Dilute oral concentrate with fruit juice, milk, or semisolid food just before administration. Warn the client to avoid hazardous activities until the effects of the drug are known. Tell the client to watch for dizziness when standing quickly. Discourage the use of alcohol during therapy. Tell the client to report signs of urinary retention, constipation, or blurred vision (anticholinergic effects). Instruct the client to use sunblock and to wear protective clothing outdoors. May cause photosensitivity. Like the other antipsychotics, this drug may cause tardive dyskinesia, a syndrome which may be irreversible. Watch for evidence of neuroleptic malignant syndrome, which is rare but potentially fatal.
What are common uses, dosages, and important information for Orap (pimozide)?
The exact action of Orap (pimozide) is unknown. It appears to have a selective ability to block central dopaminergic receptors. This drug has been found to be useful in the management of clients with chronic schziophrenia. It is relatively non-sedating and can be administered in a single daily dose. It is NOT indicated in clients with mania or acute schizophrenia. It is also used to suppress motor and phonic tics in patients with Tourette syndrome who are unresponsive to first-line therapy. Tablets: 2 mg, 4 mg, 10 mg Dosages: Adults and Children over 12: Initial dose: 1 to 2 mg PO daily, increased every other day until a satisfactory level of therapeutic effect is attained. Maintenance dose: Less than 0.2 mg/kg daily or 10 mg/day, whichever is less. Maximum dosage: 10 mg daily. Children under 12: Safety and effectiveness have not been established. A single morning dose is recommended for all clients. Orap is effective in clients with chronic schizophrenia. It is NOT indicated in the treatment of mania, acute schizophrenia, or chronic schizophrenia in which the main symptoms are agitation, excitement, and anxiety. Like the other antipsychotics, this drug may cause tardive dyskinesia, a syndrome which may be irreversible. The possibility of blood dyscrasias has not been ruled out for this drug. Therefore, clients should be observed closely for signs and symptoms of this adverse effect. Caution should be used if this drug is used for clients with cardiovascular disorders. Sudden, unexpected deaths have occurred with Orap, mainly at doses above 20 mg per day. An ECG should be obtained before treatment begins and periodically thereafter. Watch for evidence of neuroleptic malignant syndrome, which is rare but potentially fatal.
What are common uses, dosages, and important information for Prolixin (fluphenazine)?
The exact action of Prolixin (fluphenazine) is unknown. It is believed to exert its antipsychotic effect by blocking dopamine receptors in the brain. The drug is used in the treatment of psychotic disorders including schizophrenia. Fluphenazine decanoate is given by injection (depot) for prolonged therapy for chronic schizophrenia and to manage behavioral complications in mental retardation. Depot injections are useful for clients where compliance is sometimes an issue. The homeless population frequently benefit from depot injections. Tablets (fluphenazine hydrochloride): 1 mg, 2.5 mg, 5 mg, 10 mg Injections (fluphenazine hydrochloride): 2.5 mg/mL Depot Injections (fluphenazine decanoate): 25 mg/mL Dosages: Adults (Tablets): Initially, 2.5 to 10 mg PO per day in divided doses every 6 to 8 hours. Then, increased gradually to a maintenance dose of 1 to 5 mg per day. Maximum: 20 mg per day. Adults (Injections): 1/3 to 1/2 of oral doses. Usual IM dose 1.25 mg. Adults (Depot Injections): Initially, 12.5 mg to 25 mg IM or Sub-Q. Repeated or increased every 1 to 6 weeks. Usual maintenance dose 25 mg to 100 mg every 1 to 4 weeks. Maximum dose: 100 mg per dose. Prolixin has a high incidence of extrapyramidal symptoms and a low incidence of sedation, anticholinergic effects, and orthostatic hypotension. Many long term clients do better on the monthly injections (IM decanoate), especially those who demonstrate compliance problems. Tell the client to avoid hazardous activities until the effects of the drug are known. Review and provide written guidelines about side effects that need to be reported and when to return for followup care. This drug may cause tardive dyskinesia. This condition can be permanent and appears to be more common in the elderly, especially women. Observe the client for evidence of neuroleptic malignant syndrome, which is rare but potentially fatal.
What are common uses, dosages, and important information for Thorazine (chlorpromazine)?
The exact action of Thorazine (chlorpromazine) is unknown. It is a piperidine phenothiazide that most likely blocks postsynaptic dopamine receptors in the brain. Thorazine is used for the treatment of schizophrenia. It is also used to treat severe behavioral disorders in children and the manic phase of bipolar disorder. In addition, it is prescribed for nausea and vomiting, restlessness and apprehension before surgery, tetanus, and intractable hiccups. Tablets: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg Capsules (extended release): 30 mg, 75 mg, 150 mg Oral Concentrate: 30 mg/mL, 100 mg/mL Syrup: 10 mg/5 mL Injection: 25 mg/mL Suppository: 25 mg, 100 mg Dosages for psychosis: Adults: IM: For hospitalized patients with acute symptoms, 25 mg initially. May repeat in 1 to 4 hours as needed. May be increased over several days to 400 mg q 4 to 6 hours. Switch to oral as soon as possble. Oral: 25 mg PO tid initially then gradually increase to 400 mg daily in divided dosages. Maximum: 300 to 800 mg daily. Children (over 6 months): Oral: 0.55 mg/kg q 4 to 6 hours or IM q 6 to 8 hours. Thorazine causes the following common side effects: urinary retention, dizziness, dry mouth, sedation, constipation, nausea and vomiting, anorexia, weight gain, and orthostatic hypotension. Less common neuromuscular and neurological side effects include the following: mask-like expression. acute dystonia (involuntary muscle twitching and spasms). akathisia (severe restlessness, agitation, and anxiety). shuffling, unstable gait, pseudoparkinson's disease. tardive dyskinesia, which may be irreversible even if the drug is stopped. neuroleptic malignant syndrome, which is rare but potentially fatal. NOTE: prescription of Thorazine is not as common as it once was because of potential cardiovascular effects.
What is the action of typical antipsychotics in the body?
The exact action of the typical antipsychotics is unknown. They are believed to act by blocking the effects of dopamine 2 (D2) receptors believed to be overactive in persons with schizophrenia. The suppression of dopamine seems to reduce schizophrenic symptoms, especially the positive ones, such as hallucinations, hyperactivity, and bizarre behaviors.
What are common uses, dosages, and important information for Mellaril (thioridazine)?
The mechanism for antipsychotic effects is unclear. Thioridazine is a piperidine phenothiazine blocks postsynaptic dopamine receptors in the brain. The drug is used in the treatment of psychotic disorders, schizophrenia and major depressive disorders. Tablets: 10 mg, 25 mg, 50mg, 100 mg Dosages: Adults and children older than 12: Initially 50 to 100 mg PO tid. May be increased gradually to 800 mg daily in divided doses as needed. Maximum: 800 mg PO daily Children (ages 2 to 12): Initially, 0.5 mg/kg PO daily in divided doses. Increase gradually to optimal therapeutic effect. Maximum: 3 mg/kg daily Thioridazine may cause dry mouth. Tell clients that chewing sugarless gum or sucking on hard candy or ice chips may help alleviate the problem. Orthostatic hypotension occurs frequently; client should be advised to change positions gradually and avoid activities that require alertness until stabilized on the medication. OTC preparations should be avoided (i.e. cough, hay fever, and cold) unless approved by prescriber, as serious product interactions may occur. Avoid use with alcohol. Observe the client for evidence of neuroleptic malignant syndrome which is rare but potentially fatal. Don't confuse thioridazine and Thorazine.
What are common uses, dosages, and important information for Seroquel (quetiapine)?
The pharmacologic profile of Seroquel (quetiapine) is similar to that of clozapine, but it does not cause agranulocytosis. The drug interacts with dopamine, serotonin, histamine, and alpha 1 adrenergic receptors. The drug is used to manage the signs and symptoms of psychotic disorders. It produces moderate sedation, few extrapyramidal effects, and no anticholinergic effects. Tablets: 25 mg, 100 mg, 200 mg, 300 mg Dosages: Adults: PO: Initially, 25 mg PO bid with increments of 25 mg to 50 mg bid or tid on days 2 and 3, as tolerated. Target range is 300 mg to 400 mg daily bid or tid by day 4. Safety of dosages over 800 mg has not been evaluated. Warn the client about the risk of dizziness upon standing up quickly. The risk is greatest during the 3 to 5 day period of first dosage adjustment. Tell the client to avoid becoming overheated or dehydrated. Tell the client to avoid the use of alcohol. Warn the client to avoid activites that require mental alertness until the effects of the drug are known, especially during periods of dosage adjustment. This drug may cause cataract formation. Tell the client to have an eye exam at the beginning of therapy and then every 6 months during therapy. Monitor the client for signs of tardive dyskinesia. Observe the client for evidence of neuroleptic malignant syndrome, which is rare but potentially fatal.
What are common uses, dosages, and important information for Zyprexa (olanzapine)?
Zyprexa (olanzapine) is similar to clozapine and thought to antagonize dopamine D1, serotonin 5HT2, muscarinic, histamine H1 and alpha-1 receptors. Studies indicate that it is an effective antipsychotic drug with few significant side effects. The drug is used in the long-term management of schizophrenia and for short-term treatment of acute manic episodes associated with bipolar I disorder. Tablets: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg Tablets (orally disintegrating): 5 mg, 10 mg, 15 mg, 20 mg Dosages: Adults (for long-term treatment of schizophrenia): PO: Initially, 5 to 10 mg PO once daily. Doses adjusted in 5 mg increments at intervals not less than 1 week. Most clients respond to 10 to 15 mg per day. Safety of dosages greater than 20 mg per day have not been evaluated. Warn the client not to engage in hazardous activities until the effects of the drug are known. Warn the client against exposure to extreme heat. The drug may impair the body's ability to reduce temperature. Advise the client to avoid the use of alcohol. Tell the client to rise slowly to avoid dizziness. Monitor the client for weight gains. Monitor client for anticholinergic side effects. Monitor the client for signs of tardive dyskinesia. Observe the client for evidence of neuroleptic malignant syndrome, which is rare but potentially fatal.
