Olanzapine
A second-generation antipsychotic used for schizophrenia and bipolar disorder, known for weight gain and raised glucose and lipids.
Drug card
- How it works
- Blocking dopamine D2 and serotonin 5-HT2A receptors
- Used for
- Schizophrenia
- Bipolar I disorder: acute mania and maintenance
- Treatment-resistant depression, with fluoxetine
- Known for
- Weight gain and increased appetite
- High blood sugar and diabetes, rarely ketoacidosis
- Its name
- -apine means an atypical antipsychotic (clozapine type)
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does olanzapine work?
Olanzapine, a thienobenzodiazepine, binds 5-HT2A/2C, D1 to D4, H1 and α1 receptors with high affinity and muscarinic and 5-HT3 receptors moderately. Its antipsychotic effect probably comes from combined dopamine and 5-HT2 blockade; the 5-HT2 and 5-HT3 block also gives it antiemetic activity.
Like other second-generation antipsychotics: Most second-generation antipsychotics block dopamine D2 receptors together with serotonin 5-HT2A receptors, though exactly how they work is unclear; aripiprazole instead is a partial agonist at D2 receptors. As a group they cause fewer extrapyramidal effects than first-generation drugs, but many also block H1, α1 or muscarinic receptors, and weight gain with raised glucose and lipids is common.
Uses
What is olanzapine used for?
- Schizophrenia
- Bipolar I disorder: acute mania and maintenance
- Treatment-resistant depression, with fluoxetine
Side effects
Side effects of olanzapine
- Weight gain and increased appetiteKnown for
- High blood sugar and diabetes, rarely ketoacidosisKnown forSerious
- Raised cholesterol and triglycerides
- Drowsiness
- Dizziness on standing (orthostatic hypotension)
- Constipation
- Dry mouth
- Akathisia (restlessness)
- Tardive dyskinesiaSerious
- Neuroleptic malignant syndromeSerious
- DRESS: rash with fever and organ inflammationSerious
- Stroke in older people with dementiaSerious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Check fasting glucose, lipids and weight before starting and regularly during treatment.
- Use with care in heart or cerebrovascular disease and when dehydration is likely, as orthostatic hypotension can occur.
- Older people with dementia-related psychosis have a higher death rate and more strokes on it.
Good to know: Weight gain and raised glucose and lipids are prominent, and adolescents are more prone to them than adults, so other drugs may be tried first in teenagers.
Remember it
A way to remember it
Atypicals: fewer shakes, more cakes.
As a group they cause fewer extrapyramidal movement effects than first-generation antipsychotics, but more weight gain and raised glucose and lipids, so weight and blood tests are checked.
Written for biofideX
Its name
-apine means atypical antipsychotic (clozapine type)
Clozapine, olanzapine and quetiapine share it. Mirtazapine, an antidepressant, also ends in -apine, and carbamazepine in -zepine: both come from WHO's broader stem -pine.
- Every drug name stem
Its class
Second-generation antipsychotics
Other second-generation antipsychotics with a card:
Easily mixed up with first-generation antipsychotics and lithium.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Psychosis, mood and ADHD
Olanzapine is one of 9 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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