Olanzapine orodispersible
| Olanzapine orodispersible | |
| What is it? | Anti-psychotic |
| Mechanism of action | Antagonist to: D1, D2, D3, D4, 5HT(2A, 2C, 3, 6, 7), α1 and α2; anti-cholinergic |
| Starting dose | 2.5 mg–10 mg prn ON initially, can be increased to BD |
| Time to onset of effect | Hours to days17 |
| Formulation | Orodispersible tabs (placed on the tongue and allowed to dissolve, or can be dissolved in small volume water/juice) |
| Indication | Nausea and vomiting (low dose) or delirium and terminal agitation (higher dose) |
| Common adverse effects | ‘Anticholinergic syndrome; appetite increased; arthralgia; asthenia; eosinophilia; fever; glycosuria; oedema; sexual dysfunction’16 |
| Contraindications | ‘Bone-marrow depression; hypereosinophilic disorders; low leucocyte count; low neutrophil count; myeloproliferative disease; paralytic ileus’16 Narrow angle glaucoma17 |
| Caution | Fatalities when injected due to over sedation or cardiorespiratory depression. Increased risk of this is coadministered with midazolam. |
| Licencing | ‘Off label’ use of licensed drug if used for nausea and vomiting |
| Benefits | Improves mood, appetite, sleep as well as nausea and vomiting, and delirium* |
| Risks | Hyper somnolence, if used long-term patients will require blood monitoring—lipids, FBC, BM |
| Cost | £6.86 for 28×5 mg orodispersible tablets sugar free—those containing sugar are much more expensive |
FBC - full blood count; BM blood glucose measurement
*Level of evidence supporting its use via the oral route as an anti-emetic in chemotherapy induced nausea and vomiting (CBEM): 1a (multiple meta-analyses) number needed to treat to benefit: 5; number needed to treat to harm: 1922