【藥品性質提示】 根據 2019 AGS Beers Criteria，本藥品為【潛在不適當用藥 (PIM)】，不建議用於老年人 (除非用於思覺失調、雙極症、或化療止吐)。 #特殊劑型：不建議磨粉、管灌藥品

雙極症、重鬱症(輔助治療)、思覺失調症
Bipolar disorder: Treatment of acute mania, acute episodes with mixed features of bipolar I disorder (as monotherapy or in combination with lithium or valproate), and maintenance treatment; treatment of bipolar depression in combination with fluoxetine.
Major depressive disorder, treatment resistant: Treatment of treatment-resistant depression in combination with fluoxetine.
Schizophrenia: Treatment of the manifestations of schizophrenia.

Second Generation (Atypical) Antipsychotic
The exact mechanism by which olanzapine exerts its antipsychotic effect is unknown. However, this effect may be mediated through a combination of dopamine and serotonin 5-HT2 antagonism. Olanzapine is a selective monoaminergic antagonist with a strong affinity for serotonin 5-HT2A and 5-HT2C receptors, and dopamine D1, D2, D3, and D4 receptors.

Onset of action:
1. Bipolar disorder: Initial effects may be observed within days of treatment with continued improvements over 1-2 weeks
2. Schizophrenia: Initial effects may be observed within 1-2 weeks of treatment with continued improvements through 4-6 weeks
Absorption:
Well absorbed; not affected by food
Distribution:
1. Vd: Extensive, 1000 L
2. Protein binding, plasma: 93% bound to albumin and alpha1-glycoprotein
Metabolism:
Highly metabolized via direct glucuronidation and cytochrome P450 mediated oxidation (CYP1A2, CYP2D6); 40% removed via first pass metabolism
Half-life elimination:
1. Children (10 to 18 years): 37.2 ± 5.1 hours
2. Adults: 30 hours; approximately 1.5 times greater in elderly
Excretion:
1. Urine (57%, 7% as unchanged drug); feces (30%)
2. Clearance:
(1) Children (10-18 years): 9.6 ± 2.4 L/hour
(2) Adults: 25 L/hour; 40% increase in smokers; 30% decrease in females

1. Hypersensitivity to the active substance or to any of the excipients.
2. Patients with known risk of narrow-angle glaucoma.

C; Olanzapine crosses the placenta and can be detected in cord blood at birth.
1. Safety data related to atypical antipsychotics during pregnancy are limited, as such, routine use is not recommended.
2. However, if a woman is inadvertently exposed to an atypical antipsychotic while pregnant, continuing therapy may be preferable to switching to an agent that the fetus has not yet been exposed to; consider risk and benefit.

Olanzapine is present in breast milk. Patients should be advised not to breast-feed an infant if they are taking olanzapine.

Hypercholesterolemia, Hyperglycemia, Increased appetite, Increased prolactin level, Serum triglycerides raised, Weight gain; Constipation, Xerostomia; Akathisia, Asthenia, Dizziness, Somnolence, Tremor; Orthostatic hypotension, Peripheral edema

Bipolar disorder (Acute mania, acute episodes with mixed features):
1. Initial 10 to 15 mg once daily; may increase dose based on response and tolerability in 5 mg increments at intervals of ≥1 day up to 20 mg/day (maximum)
2. Experts suggest some patients may require doses up to 50 mg/day for optimal response

Major depressive disorder (adjunctive therapy with an antidepressant):
5 mg once daily; may increase dose based on response and tolerability in increments of 5 mg at intervals of 3 to 7 days up to 20 mg/day. After 4 to 6 months of sustained recovery, some experts suggest discontinuing the antipsychotic and continuing antidepressant monotherapy.

Schizophrenia:
1. Initial 5 mg once daily increasing to 10 mg once daily within several days or 10 mg once daily.
2. May increase dose based on response and tolerability in increments of 5 mg/day at intervals ≥1 week up to 20 mg/day; maximum dose: 20 mg/day
3. Further increases up to 30 mg/day may be necessary in some patients for optimal response; Doses up to 50 mg/day have been evaluated in clinical studies and are associated with increased adverse effects and generally not recommended

Note: Olanzapine is not considered first-line therapy due to increased incidence of adverse effects (weight gain, metabolic abnormalities, neurological), consider risks versus benefits

Bipolar disorder (Acute mania, acute episodes with mixed features): Limited data available
1. Children 4 to <6 years: Initial 1.25 mg once daily; increase at weekly intervals to target dose 10 mg/day.
2. Children 6 to 12 years: Initial 2.5 mg once daily; increase dose in 2.5 or 5 mg increments at weekly intervals to target dose of 10 mg once daily; maximum dose: 20 mg/day.
3. Adolescents: Initial 2.5 to 5 mg once daily; increase dose in 2.5 or 5 mg increments at weekly intervals to target dose of 10 mg once daily; maximum dose: 20 mg/day

Schizophrenia: Limited data available in ages <13 years
Children ≥8 years and Adolescents:
1. Initial 2.5 to 5 mg once daily; increase dose in 2.5 or 5 mg increments at weekly intervals to target dose of 10 mg once daily; maximum dose: 20 mg/day.
2. Doses up to 30 mg/day were used in one study, however, safety and efficacy of doses >20 mg/day have not been fully evaluated.