Dosing: Adult

Schizophrenia:

Oral: Initial: 5-10 mg once daily (increase to 10 mg once daily within 5-7 days); thereafter, adjust by 5 mg/day at 1-week intervals, up to a recommended maximum of 20 mg/day. Maintenance: 10-20 mg once daily. Doses of 30-50 mg/day have been used; however, doses >10 mg/day have not demonstrated better efficacy, and safety and efficacy of doses >20 mg/day have not been evaluated.

Extended-release I.M. injection: Note: Establish tolerance to oral olanzapine prior to changing to extended-release I.M. injection. Maximum dose: 300 mg/2 weeks or 405 mg/4 weeks

Patients established on oral olanzapine 10 mg/day: Initial dose: 210 mg every 2 weeks for 4 doses or 405 mg every 4 weeks for 2 doses; Maintenance dose: 150 mg every 2 weeks or 300 mg every 4 weeks

Patients established on oral olanzapine 15 mg/day: Initial dose: 300 mg every 2 weeks for 4 doses; Maintenance dose: 210 mg every 2 weeks or 405 mg every 4 weeks

Patients established on oral olanzapine 20 mg/day: Initial and maintenance dose: 300 mg every 2 weeks

Acute mania associated with bipolar disorder: Oral:

Monotherapy: Initial: 10-15 mg once daily; increase by 5 mg/day at intervals of not less than 24 hours. Maintenance: 5-20 mg/day; recommended maximum dose: 20 mg/day.

Combination therapy (with lithium or valproate): Initial: 10 mg once daily; dosing range: 5-20 mg/day

Agitation (acute, associated with bipolar disorder or schizophrenia): Short-acting I.M. injection: Initial dose: 10 mg (a lower dose of 5-7.5 mg may be considered when clinical factors warrant); additional doses (up to 10 mg) may be considered; however, 2-4 hours should be allowed between doses to evaluate response (maximum total daily dose: 30 mg, per manufacturer's recommendation)

Depression:

Depression associated with bipolar disorder (in combination with fluoxetine): Oral: Initial: 5 mg in the evening; adjust as tolerated to usual range of 5-12.5 mg/day. See "Note."

Treatment-resistant depression (in combination with fluoxetine): Oral: Initial: 5 mg in the evening; adjust as tolerated to range of 5-20 mg/day. See "Note."

Note: When using individual components of fluoxetine with olanzapine rather than fixed dose combination product (Symbyax®), approximate dosage correspondence is as follows:

Olanzapine 2.5 mg + fluoxetine 20 mg = Symbyax® 3/25

Olanzapine 5 mg + fluoxetine 20 mg = Symbyax® 6/25

Olanzapine 12.5 mg + fluoxetine 20 mg = Symbyax® 12/25

Olanzapine 5 mg + fluoxetine 50 mg = Symbyax® 6/50

Olanzapine 12.5 mg + fluoxetine 50 mg = Symbyax® 12/50

Delirium (unlabeled use): Oral: 5 mg once daily for up to 5 days (NICE, 2010)

Prevention of chemotherapy-associated delayed nausea or vomiting (unlabeled use; in combination with a corticosteroid and serotonin [5HT3] antagonist): Oral: 10 mg once daily for 3-5 days, beginning on day 1 of chemotherapy or 5 mg once daily for 2 days before chemotherapy, followed by 10 mg once daily (beginning on the day of chemotherapy) for 3-8 days

Dosing: Pediatric

(For additional information see "Olanzapine: Pediatric drug information" )

Schizophrenia/bipolar disorder: Adolescents ≥13 years: Oral: Initial: 2.5-5 mg once daily; adjust by 2.5-5 mg/day to target dose of 10 mg/day; dosing range: 2.5-20 mg/ day

Dosing: Geriatric

Refer to adult dosing.

Short-acting I.M., Oral: Consider lower starting dose of 2.5-5 mg/day for elderly or debilitated patients; may increase as clinically indicated and tolerated with close monitoring of orthostatic blood pressure

Extended release I.M.: Consider lower starting dose of 150 mg every 4 weeks for elderly or debilitated patients; increase dose with caution as clinically indicated.

Delirium (unlabeled use): Oral: Patients >60 years: Oral: 2.5 mg/day for up to 5 days (NICE, 2010)

Psychosis/agitation related to Alzheimer’s dementia (unlabeled use): Oral: Initial: 2.5-5 mg/day (Sultzer, 2008