Home Drug Guide Olanzapine Pamoate

Drug Guide

Generic Name

Olanzapine Pamoate

Brand Names Zyprexa Relprevv

Classification

Therapeutic: Antipsychotic, mood stabilizer

Pharmacological: Atypical antipsychotic

FDA Approved Indications

  • Schizophrenia

Mechanism of Action

Olanzapine Pamoate blocks multiple neurotransmitter receptors in the brain, including dopamine D2 and serotonin 5-HT2A receptors, which helps correct the imbalance of neurotransmitters associated with schizophrenia.

Dosage and Administration

Adult: Typically administered via intramuscular injection every 2-4 weeks, based on individual response and tolerability. Dose titration is necessary to minimize adverse effects.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution in elderly patients, especially considering risk of mortality in elderly patients with dementia-related psychosis.

Renal Impairment: Adjust dose based on clinical response and tolerability.

Hepatic Impairment: Use with caution; no specific adjustments established.

Pharmacokinetics

Absorption: Absorbed slowly from the injection site, with peak levels occurring approximately 4 days after administration.

Distribution: Widely distributed in body tissues; crosses the blood-brain barrier.

Metabolism: Metabolized in the liver primarily via CYP1A2 and CYP2D6 pathways.

Excretion: Excreted mainly via hepatic metabolism; minimal renal excretion.

Half Life: Approximately 30 days (release phase characteristic, due to the depot formulation).

Contraindications

  • Hypersensitivity to olanzapine or excipients.
  • Current or prior presence of neuroleptic malignant syndrome.

Precautions

  • Use cautiously in elderly patients, especially those with cardiovascular disease, risk of stroke, or metabolic syndrome.
  • Monitor for sedation, metabolic changes, and movement disorders.
  • Patients should be monitored for signs of post-injection delirium/sedation syndrome.

Adverse Reactions - Common

  • Weight gain (Very common)
  • Sedation (Common)
  • Elevated blood glucose (Common)
  • Elevated cholesterol (Common)

Adverse Reactions - Serious

  • Neuroleptic malignant syndrome (Rare)
  • Post-injection delirium/sedation syndrome (PDSS) (Rare, but potentially serious)
  • Tardive dyskinesia (Low but significant over long-term use)
  • D muffed mortality in elderly with dementia-related psychosis (Fatal)

Drug-Drug Interactions

  • CNS depressants (enhanced sedation)
  • Antihypertensives (additive hypotensive effect)

Drug-Food Interactions

  • None specific

Drug-Herb Interactions

  • None established

Nursing Implications

Assessment: Monitor mental health symptoms, metabolic parameters, movement disorders, and signs of sedation.

Diagnoses:

  • Risk of falls secondary to sedation
  • Risk for impaired glucose or lipid metabolism

Implementation: Administer intramuscular injections as prescribed. Observe patient post-injection for delirium or sedation.

Evaluation: Assess for symptom control and adverse effects, including neuroleptic malignant syndrome and metabolic changes.

Patient/Family Teaching

  • Report any signs of sedation, movement disorders, or signs of infection immediately.
  • Discuss the importance of adherence to injection schedules.
  • Educate about signs of hyperglycemia and hyperlipidemia.

Special Considerations

Black Box Warnings:

  • Increased mortality in elderly patients with dementia-related psychosis.
  • Post-injection delirium/sedation syndrome (PDSS).

Genetic Factors: None specifically established.

Lab Test Interference: May affect blood glucose, lipid, and prolactin levels.

Overdose Management

Signs/Symptoms: Excess sedation, agitation, confusion, hypotension, extrapyramidal symptoms, possibly coma.

Treatment: Supportive care, monitoring vital signs, symptomatic treatment, and possibly hospitalization. No specific antidote.

Storage and Handling

Storage: Store at controlled room temperature between 20°C to 25°C (68°F to 77°F).

Stability: Stable until expiration date when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.