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Diabetes Effect On Erectile Dysfunction Used as monotherapy or in combination with lithium or valproate Monotherapy: 10-15 mg/day PO initially Adjunct to lithium or valproate: 10 mg/day PO initially Maintenance: 5-20 mg/day PO; not to exceed 20 mg/day 10 mg IM (short-acting); consider 5-7.5 mg for geriatric patients or if circumstances warrant; subsequent IM doses up to 10 mg may be administered 2 hours after 1st dose and 4 hours after 2nd dose; not to exceed 30 mg/day 2.5-5 mg/day PO initially IM (extended-release): 150 mg every 4 weeks in patients who are debilitated or predisposed to hypotensive episodes; not studied in patients with renal or hepatic impairment; requires deep IM administration (muscle mass in elderly may be sufficient) Orthostatic hypotension (≥20%) Weht gain, dose dependent (5-40%) Hypertrlyceridemia (≤39%) Hypercholesterolemia (≤39%) Somnolence, dose dependent (6-39%) Extrapyramidal symptoms (EPS), dose dependent (15-32%) Xerostomia (9-22%) Weakness (2-20%) Dizziness (4-18%) Accidental injury (12%) Insomnia (12%) Elevated alanine aminotransferase (ALT) level (5-12%) Constipation (9-11%) Dyspepsia (7-11%) Hyperprolactinemia (30%) Hyperglycemia (12.8%) Syncope Sudden cardiac death Hyperglycemia Diabetic coma with ketoacidosis Diabetic ketoacidosis Acute hemorrhagic pancreatitis Venous thromboembolism Immune hypersensitivity reaction Cerebrovascular disease Seizure, status epilepticus Suicidal intent Pulmonary embolism Death Neuroleptic malnant syndrome (NMS) Tardive dyskinesia Not approved for dementia-related psychosis; elderly patients with dementia-related psychosis who are treated with antipsychotic drugs are at increased risk of death, as shown in short-term controlled trials; in these trials, deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature Patients are at risk for severe sedation (including coma) or delirium after each injection and must be observed for at least 3 hours in registered facility with ready access to emergency response services Because of this risk, olanzapine is available only through restricted distribution program Increased risk of hyperglycemia and diabetes; in some cases, hyperglycemia concomitant with use of atypical antipsychotics has been associated with ketoacidosis, hyperosmolar coma, or death Monitor blood glucose of hh-risk patients Irreversible, involuntary, dyskinetic movements may develop with antipsychotic drugs; prevalence appears to be hhest among elderly individuals, especially elderly women; discontinue if cliniy appropriate May cause anticholinergic effects including paralytic ileus, urinary retention, xerostomia, BPH, and visual problems Neutropenia, leukopenia, and agranulocytosis reported; discontinue therapy at firs sn of blood dyscrasias or if absolute neutrophil count 1 injection is associated with substantial orthostatic hypotension (33%); maintain patient in recumbent position and monitor blood pressure before repeating IM doses Use caution in patients with history of seizures or with conditions that potentially lower seizure threshold Changes from normal to hh prolactin levels observed in controlled studies (incidence, 30%) Use caution in patients at risk of pneumonia; may cause esophageal dysmotility and aspiration Use caution with strenuous exercise, dehydration, heat exposure, and medications with anticholinergic effects; impaired core body temperature regulation may occur Increased potential (in adolescents as compared with adults) for weht gain and hyperlipidemia; clinicians prescribing to adolescents should consider potential long-term risks, which in many cases may lead them to prescription of other drugs first in this population Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) reported with olanzapine exposure; DRESS may present with a cutaneous reaction (such as rash or exfoliative dermatitis), eosinophilia, fever, and/or lymphadenopathy with systemic complications such as hepatitis, nephritis, pneumonitis, myocarditis, and/or pericarditis; DRESS is sometimes fatal; discontinue olanzapine if DRESS suspected Possibility of suicide attempt is inherent in schizophrenia and in bipolar I disorder, and close supervision of hh-risk patients should accompany drug therapy; when using in combination with fluoxetine, also refer to Boxed Warning and Precautions sections of package insert for Symbyax A potentially fatal symptom complex sometimes referred to as Neuroleptic Malnant Syndrome (NMS) reported; management of NMS should include: 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy; 2) intensive symptomatic treatment and medical monitoring; and 3) treatment of any concomitant serious medical problems for which specific treatments are available; there is no general agreement about specific pharmacological treatment regimens for NMS; if patient requires antipsychotic drug treatment after recovery from NMS, potential reintroduction of drug therapy should be carefully considered; patient should be carefully monitored, since recurrences of NMS reported Has potential to impair judgment, thinking, and motor ss; use caution when operating machinery Olanzapine indicated as integral part of comprehensive treatment program for pediatric patients with schizophrenia and bipolar disorder, which may include other measures (eg, psychological, educational, social) as well Pregnancy category: C Neonates exposed to antipsychotic drugs during 3rd trimester of pregnancy are at risk for EPS or withdrawal symptoms after delivery; these complications vary in severity, with some being self-limited and others requiring ICU support and prolonged hospitalization Lactation: Drug enters breast milk; not recommended The above information is provided for general informational and educational purposes only. 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