Table 23

Olanzapine orodispersible

Olanzapine orodispersible
What is it?Anti-psychotic
Mechanism of actionAntagonist to: D1, D2, D3, D4, 5HT(2A, 2C, 3, 6, 7), α1 and α2; anti-cholinergic
Starting dose2.5 mg–10 mg prn ON initially, can be increased to BD
Time to onset of effectHours to days17
FormulationOrodispersible tabs (placed on the tongue and allowed to dissolve, or can be dissolved in small volume water/juice)
IndicationNausea 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
CautionFatalities 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
BenefitsImproves mood, appetite, sleep as well as nausea and vomiting, and delirium*
RisksHyper 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