Indications for ZYPREXA RELPREVV:
Schizophrenia. Do not dispense directly to patient; must enroll in Zyprexa Relprevv Patient Care Program (877) 772-9390.
Give by deep IM gluteal inj. Olanzapine-naïve: establish oral olanzapine tolerance prior to initiation. Target oral dose 10mg/day: inject 210mg every 2 weeks or 405mg every 4 weeks for first 8 weeks, then 150mg every 2 weeks or 300mg every 4 weeks as maintenance. Target oral dose 15mg/day: inject 300mg every 2 weeks for first 8 weeks, then 210mg every 2 weeks or 405mg every 4 weeks as maintenance dose. Target oral dose 20mg/day: inject 300mg every 2 weeks for first 8 weeks, then as maintenance dose. Debilitated, risk of hypotension, slow metabolizers, or sensitive to olanzapine: initially 150mg every 4 weeks; titrate with caution. Monitor patient post injection for at least 3 hours for overdose symptoms (post-injection delirium/sedation syndrome): see full labeling. Do not confuse with short-acting Zyprexa IM.
<18yrs: not established.
Increased mortality in elderly patients with dementia-related psychosis.
Relprevv: post-injection delirum/sedation syndrome: monitor after each injection. Elderly with dementia-related psychosis (not approved use); increased risk of death or cerebrovascular events (eg, stroke, TIA). Cardio- or cerebrovascular disease. Discontinue if neuroleptic malignant syndrome occurs or if DRESS is suspected; consider discontinuation if tardive dyskinesia occurs. Diabetes. Monitor for hyperglycemia, hyperlipidemia; do fasting blood glucose and lipids testing at beginning, and during therapy. Monitor for weight gain. Hypovolemia. Dehydration. History of seizures. Conditions that affect metabolism or hemodynamic responses. Hepatic impairment (monitor ALT/AST). Prostatic hypertrophy. Narrow angle glaucoma. History of paralytic ileus or breast cancer. Pre-existing low WBCs or history of leukopenia/neutropenia; monitor CBCs during 1st few months of treatment; discontinue if WBCs decline. Perform fall risk assessments when initiating and recurrently on long-term therapy. Exposure to extreme heat. Dysphagia. Suicidal ideation (monitor). Reevaluate periodically. Write ℞ for smallest practical amount. Debilitated. Neonates: risk of extrapyramidal and/or withdrawal symptoms post delivery (due to exposure during 3rd-trimester pregnancy). Pregnancy. Nursing mothers: monitor infants.
Orthostatic hypotension with antihypertensives, alcohol (caution), diazepam. Caution with other CNS drugs, anticholinergics, hepatotoxic agents. Concomitant IV benzodiazepine: not recommended with IM olanzapine. May antagonize levodopa, dopamine agonists. May be antagonized by rifampin, omeprazole, carbamazepine, others that induce CYP1A2 or glucuronyl transferase. May be potentiated by fluvoxamine, others that inhibit CYP1A2. Smokers may have increased clearance.
Somnolence, sedation, dizziness, constipation, weight gain, increased appetite, personality disorder, akathisia, asthenia, postural hypotension, headache, abdominal pain, dry mouth, fatigue, tremor, extremity/back pain, nausea, diarrhea, vomiting, cough, nasopharyngitis; neutropenia, hyperprolactinemia, elevated liver enzymes, EPS.
Tabs—30; Zydis—30; Vial—1; Relprevv (kit)—1 (w. diluent + supplies)