THERAPEUTICS

Brands

• Zyprexa, Zyprexa Zydis, Zyprexa Relprevv, Zyprexa IntraMuscular, Symbyax (olanzapine/fluoxetine)

Generic?

• Ye

• Atypical antipsychotic

Commonly Prescribed for

(FDA approved in bold)

• Schizophrenia for adolescents or adults

• Monotherapy for bipolar I disorder, manic or mixed episode

• Adjunct therapy to valproate or lithium for bipolar I disorder, manic or mixed episode

• Bipolar I depression (Symbyax only)

• Treatment-resistant depression (Symbyax only)

• Acute agitation associated with schizophrenia and bipolar I mania (IntraMuscular only)

• Augmentation for refractory obsessivecompulsive disorder

• Migraine refractory to standard treatment

• Acute psychosis

• Delirium

• Antiemetic

How the Drug Works

• It is a thiobenzodiazepine derivative that binds strongly to 5-HT2A/2B/2C, 5-HT6, D1-5, H1,2, and α1,2 receptors, and moderately to 5-HT3 and M1-5 receptors. It exerts the action via D2 antagonism (for positive symptoms), 5-HT2A antagonism (negative symptoms), and 5-HT3 antagonism (antiemetic)

How Long Until It Works

• Migraine: hours. Often use to initiate sleep

• Schizophrenia/bipolar: may be effective in days, more commonly takes weeks or months to determine best dose and achieve best clinical effect. Usually 4–6 weeks

• Agitation/insomnia: may be effective Immediately

if It Works

• Continue to use at lowest required dose. Most patients with schizophrenia see a reduction in psychosis with neuroleptics

If It Doesn't Work

• Increase dose

• Psychosis related to Parkinson's disease (PD) or dementia with Lewy bodies (DLB): clozapine is more efficacious. For acute treatment only

• Insomnia: if no sedation occurs despite adequate dosing, change to another agent

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Patients with affective disorders, such as bipolar disorder, may respond to moodstabilizing AEDs, lithium, or benzodiazepines. For PD/DLB, treating dementia and psychosis with rivastigmine/donepezil and clozapine, respectively, may be efficacious

Tests

• Prior to starting treatment and periodically during treatment, monitor weight, blood pressure, lipids, and fasting glucose due to risk of metabolic syndrome