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Olanzapine Disease Interactions

There are 20 disease interactions with olanzapine:

Major

Atypical Antipsychotic Agents (Includes Olanzapine) ↔ Dementia

Severe Potential Hazard, High plausibility

Applies to: Dementia

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death, mostly from cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) causes. A causal relationship with antipsychotic use has not been established. In controlled trials, treatment with some atypical antipsychotic drugs had was also associated with an increased risk of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, in elderly patients with dementia-related psychosis. These agents are not approved for the treatment of patients with dementia-related psychosis.

Major

Neuroleptics (Includes Olanzapine) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Alcoholism

The use of neuroleptic agents is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of neuroleptic agents may be additive with those of alcohol. Severe respiratory depression and respiratory arrest may occur. Therapy with neuroleptic agents should be administered cautiously in patients who might be prone to acute alcohol intake.

References

  1. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  2. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  3. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
View all 10 references
Major

Neuroleptics (Includes Olanzapine) ↔ Cns Depression

Severe Potential Hazard, High plausibility

Applies to: Altered Consciousness, Respiratory Arrest

The use of neuroleptic agents is contraindicated in comatose patients and patients with severe central nervous system depression. Neuroleptic agents may potentiate the CNS and respiratory depression in these patients.

References

  1. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  2. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  3. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
View all 7 references
Major

Neuroleptics (Includes Olanzapine) ↔ Nms

Severe Potential Hazard, High plausibility

Applies to: Neuroleptic Malignant Syndrome

The central dopaminergic blocking effects of neuroleptic agents may precipitate or aggravate a potentially fatal symptom complex known as neuroleptic malignant syndrome (NMS). NMS is observed most frequently when high-potency agents like haloperidol are administered intramuscularly, but may occur with any neuroleptic agent given for any length of time. Clinical manifestations of NMS include hyperpyrexia, muscle rigidity, altered mental status and autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac arrhythmias). Additional signs may include elevated creatine phosphokinase, myoglobinuria, and acute renal failure. Neuroleptic agents should not be given to patients with active NMS and should be immediately discontinued if currently being administered in such patients. In patients with a history of NMS, introduction or reintroduction of neuroleptic agents should be carefully considered, since NMS may recur.

References

  1. Anderson ES, Powers PS "Neuroleptic malignant syndrome associated with clozapine use." J Clin Psychiatry 52 (1991): 102-4
  2. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  3. Sharma R, Trappler B, Ng YK, Leeman CP "Risperidone-induced neutroleptic malignant syndrome." Ann Pharmacother 30 (1996): 775-8
View all 40 references
Major

Neuroleptics (Includes Olanzapine) ↔ Tardive Dyskinesia

Severe Potential Hazard, High plausibility

Applies to: Tardive Dyskinesia

Neuroleptic agents may precipitate symptoms of tardive dyskinesia (TD), a syndrome consisting of rhythmic involuntary movements variously involving the tongue, face, mouth, lips, jaw, and/or trunk and extremities, following chronic use of at least several months but often years. Elderly patients, particularly women, are most susceptible. Both the risk of developing the syndrome and the likelihood that it will become irreversible increase with the duration and total cumulative dose of neuroleptic therapy administered. However, patients may infrequently develop symptoms after relatively brief treatment periods at low dosages. If TD occurs during neuroleptic therapy, prompt withdrawal of the offending agent or at least a lowering of the dosage should be considered. TD symptoms may become more severe after drug discontinuation or a dosage reduction, but may gradually improve over months to years. In patients with preexisting drug-induced TD, initiating or increasing the dosage of neuroleptic therapy may temporarily mask the symptoms of TD but could eventually worsen the condition. The newer, atypical neuroleptic agents (e.g., risperidone, quetiapine, olanzapine) tend to be associated with a substantially reduced risk of inducing TD and are considered the drugs of choice in patients being treated for psychosis.

References

  1. Pinder RM, Brogden RN, Swayer R, Speight TM, Spencer R, Avery GS "Pimozide: a review of its pharmacological properties and therapeutic uses in psychiatry." Drugs 12 (1976): 1-40
  2. Ghelber D, Belmaker RH "Tardive dyskinesia with quetiapine." Am J Psychiat 156 (1999): 796-7
  3. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
View all 42 references
Moderate

Antidepressant/Antipsychotic Agents (Includes Olanzapine) ↔ Depression

Moderate Potential Hazard, Moderate plausibility

Applies to: Depression, Bipolar Disorder

Adult and pediatric patients with depression and other psychiatric disorders may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset.

Moderate

Antipsychotic Agents (Includes Olanzapine) ↔ Aspiration

Moderate Potential Hazard, Moderate plausibility

Applies to: Dysphagia

Esophageal dysmotility and aspiration have been associated with the use of antipsychotic drugs. These drugs should be administered cautiously in patients at risk for aspiration pneumonia.

Moderate

Antipsychotic Agents (Includes Olanzapine) ↔ Seizure

Moderate Potential Hazard, Moderate plausibility

Applies to: Alcoholism, Seizures, Head Injury

Antipsychotic drugs can lower the seizure threshold and trigger seizures in a dose-dependent manner. This risk is greatest in patients with a history of seizures or with conditions that lower the seizure threshold. Therapy with Antipsychotic drugs should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism.

Moderate

Atypical Antipsychotic Agents (Includes Olanzapine) ↔ Hematologic Abnormalities

Moderate Potential Hazard, High plausibility

Applies to: Neutropenia

Cases of leukopenia, neutropenia, and agranulocytosis have been reported with the use of atypical antipsychotic agents. Patients with preexisting low white blood cell count may be at increased risk. Therapy with these agents should be administered cautiously in patients with a history of, or predisposition to, decreased white blood cell or neutrophil counts. Clinical monitoring of hematopoietic function is recommended. At the first sign of a clinically significant decline in white blood cells, discontinuation of atypical antipsychotic therapy should be considered in the absence of other causative factors, and the patient closely monitored for fever or other signs and symptoms of infection.

Moderate

Atypical Antipsychotic Agents (Includes Olanzapine) ↔ Hyperglycemia/Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus, Obesity

Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported with the use of atypical antipsychotic agents. Patients with diabetes should be monitored for worsening control of blood glucose when treated with these agents. It is recommended that patients with risk factors for diabetes mellitus starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment, and periodically thereafter. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when treatment with these agents was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the atypical antipsychotic drug.

Moderate

Atypical Antipsychotic Agents (Includes Olanzapine) ↔ Hypotension

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypotension, Dehydration, Diarrhea, Vomiting, Syncope, Ischemic Heart Disease, Congestive Heart Failure, History - Myocardial Infarction, Arrhythmias, Cerebrovascular Insufficiency

The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.

Moderate

Atypical Antipsychotic Agents (Includes Olanzapine) ↔ Lipid Alterations

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperlipidemia

Atypical antipsychotic drugs have been associated with undesirable alterations in lipid levels. While all agents in the class have been shown to produce some changes, each drug has its own specific risk profile. Before or soon after initiation of antipsychotic medication, obtain a fasting lipid profile at baseline and monitor periodically during treatment.

Moderate

Atypical Antipsychotic Agents (Includes Olanzapine) ↔ Weight Gain

Moderate Potential Hazard, Moderate plausibility

Applies to: Obesity

Weight gain has been observed with atypical antipsychotic use. While all agents in the class have been shown to produce some changes, each drug has its own specific risk profile. When treating pediatric patients with atypical antipsychotic agents, weight gain should be monitored and assessed against that expected for normal growth. Monitor weight at baseline and frequently thereafter.

Moderate

Neuroleptics (Includes Olanzapine) ↔ Anticholinergic Effects

Moderate Potential Hazard, High plausibility

Applies to: Gastrointestinal Obstruction, Glaucoma/Intraocular Hypertension, Urinary Retention

Most neuroleptic agents have anticholinergic activity, to which elderly patients are particularly sensitive. Clozapine and low-potency agents such as chlorpromazine and thioridazine tend to exhibit the greatest degree of anticholinergic effects in the class, while haloperidol as well as the newer, atypical agents like quetiapine, risperidone and ziprasidone have generally been associated with very low frequencies of anticholinergic adverse effects. Therapy with neuroleptic agents should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders.

References

  1. Frankenburg FR, Kando JC, Centorrino F, Gilbert JM "Bladder dysfunction associated with clozapine therapy." J Clin Psychiatry 57 (1996): 39-40
  2. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  3. Grohmann R, Ruther E, Sassim N, Schmidt LG "Adverse effects of clozapine." Psychopharmacology (Berl) 99 (1989): s101-4
View all 14 references
Moderate

Neuroleptics (Includes Olanzapine) ↔ Breast Cancer

Moderate Potential Hazard, Moderate plausibility

Applies to: Breast Cancer

The chronic use of neuroleptic agents can cause persistent elevations in prolactin levels. Based on in vitro data, approximately one-third of human breast cancers are thought to be prolactin-dependent. The clinical significance of this observation with respect to long-term neuroleptic therapy is unknown. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in rodent studies but not in human clinical or epidemiologic studies. Until further data are available, therapy with neuroleptic agents should be administered cautiously in patients with a previously detected breast cancer.

References

  1. Dickson RA, Dalby JT, Williams R, Edwards AL "Risperidone-induced prolactin elevations in premenopausal women with schizophrenia." Am J Psychiatry 152 (1995): 1102-3
  2. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  3. Meco G, Falaschi P, Casacchia M, et al "Neuroendocrine effects of haloperidol decanoate in patients with chronic schizophrenia." Adv Biochem Psychopharmacol 40 (1985): 89-93
View all 16 references
Moderate

Neuroleptics (Includes Olanzapine) ↔ Liver Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Most neuroleptic agents are extensively metabolized by the liver. The plasma concentrations of these agents may be increased and the half-lives prolonged in patients with impaired hepatic function. Therapy with neuroleptic agents should be administered cautiously in patients with significant liver disease. Lower initial dosages and slower titration may be appropriate.

References

  1. Hobbs DC "Metabolism of thiothixene." J Pharm Sci 57 (1968): 105-11
  2. Jann MW, Grimsley SR, Gray EC, Chang WH "Pharmacokinetics and pharmacodynamics of clozapine." Clin Pharmacokinet 24 (1993): 161-76
  3. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
View all 11 references
Moderate

Neuroleptics (Includes Olanzapine) ↔ Parkinsonism

Moderate Potential Hazard, Moderate plausibility

Applies to: Parkinsonism

The use of neuroleptic agents is associated with pseudo-parkinsonian symptoms such as akinesia, bradykinesia, tremors, pill-rolling motion, cogwheel rigidity, and postural abnormalities including stooped posture and shuffling gait. The onset is usually 1 to 2 weeks following initiation of therapy or an increase in dosage. Older neuroleptic agents such as haloperidol are more likely to induce these effects, and their use may be contraindicated in patients with Parkinson's disease or parkinsonian symptoms.

References

  1. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  2. Pinder RM, Brogden RN, Swayer R, Speight TM, Spencer R, Avery GS "Pimozide: a review of its pharmacological properties and therapeutic uses in psychiatry." Drugs 12 (1976): 1-40
  3. Moleman P, Janzen G, von Bargen BA, et al "Relationship between age and incidence of parkinsonism in psychiatric patients treated with haloperidol." Am J Psychiatry 143 (1986): 232-4
View all 14 references
Moderate

Neuroleptics (Includes Olanzapine) ↔ Seizure Disorders

Moderate Potential Hazard, Moderate plausibility

Applies to: CNS Disorder, Alcoholism

Neuroleptic agents can lower the seizure threshold and induce seizures, particularly when dosages are high or increased rapidly and during the initiation of therapy. Clozapine appears to have the greatest epileptogenic potential, while most of the other newer, atypical neuroleptic agents (e.g., risperidone, quetiapine, olanzapine), as well as haloperidol and molindone, have the least. Therapy with neuroleptic agents should be administered cautiously in patients with a history of seizures or other factors predisposing to seizures such as abnormal EEG, preexisting CNS pathology, or head trauma. Adequate anticonvulsant therapy should be maintained during administration of neuroleptic agents. Clozapine should not be used in patients with uncontrolled epilepsy.

References

  1. Mahr GC, Berchou R, Balon R "A grand mal seizure associated with desipramine and haloperidol." Can J Psychiatry 32 (1987): 463-4
  2. Welch J, Manschreck T, Redmond D "Clozapine-induced seizures and EEG changes." J Neuropsychiatry Clin Neurosci 6 (1994): 250-6
  3. Pinder RM, Brogden RN, Swayer R, Speight TM, Spencer R, Avery GS "Pimozide: a review of its pharmacological properties and therapeutic uses in psychiatry." Drugs 12 (1976): 1-40
View all 29 references
Moderate

Olanzapine (Includes Olanzapine) ↔ Alt Elevations

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

The use of olanzapine may be associated with elevations in serum transaminase. During clinical trials, 2% of patients exposed to olanzapine experienced clinically significant ALT (SGPT) elevations (>= 3 times the upper limit of normal), compared to none in the placebo group. Jaundice did not occur in any of the affected patients, however, and liver enzymes tended to return toward baseline during treatment or following its discontinuation. The manufacturer recommends that therapy with olanzapine be administered cautiously in patients with signs and symptoms of hepatic impairment and in patients with preexisting conditions associated with limited hepatic functional reserve. Periodic assessment of serum transaminases should be performed in patients with significant hepatic disease.

References

  1. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
Moderate

Olanzapine (Includes Olanzapine) ↔ Pku

Moderate Potential Hazard, High plausibility

Applies to: Phenylketonuria

Zyprexa Zydis (brand of olanzapine orally distintegrating tablets) contains 0.34 mg and 0.45 mg of phenylalanine per each 5 mg and 10 mg tablet, respectively. The phenylalanine content should be considered when this and similar products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

References

  1. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.

You should also know about...

olanzapine drug Interactions

There are 894 drug interactions with olanzapine

olanzapine alcohol/food Interactions

There are 4 alcohol/food interactions with olanzapine

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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