1 INDICATIONS AND USAGE
ZYPREXA (olanzapine) is an atypical antipsychotic indicated:
As oral formulation for the:
Treatment of schizophrenia. (1.1)
Adults: Efficacy was established in three clinical trials in patients with schizophrenia: two 6-week trials and one maintenance trial.(14.1)
Adolescents (ages 13-17): Efficacy was established in one 6-week trial in patients with schizophrenia (14.1). The increased potential (in adolescents compared with adults) for weight gain and dyslipidemia may lead clinicians to consider prescribing other drugs first in adolescents. (1.1)
Acute treatment of manic or mixed episodes associated with bipolarI disorder and maintenance treatment of bipolarI disorder. (1.2)
Adults: Efficacy was established in three clinical trials in patients with manic or mixed episodes of bipolarI disorder: two 3- to 4-week trials and one maintenance trial. (14.2)
Adolescents (ages 13-17): Efficacy was established in one 3-week trial in patients with manic or mixed episodes associated with bipolar I disorder (14.2). The increased potential (in adolescents compared with adults) for weight gain and dyslipidemia may lead clinicians to consider prescribing other drugs first in adolescents. (1.2)
Medication therapy for pediatric patients with schizophrenia or bipolarI disorder should be undertaken only after a thorough diagnostic evaluation and with careful consideration of the potential risks. (1.3)
Adjunct to valproate or lithium in the treatment of manic or mixed episodes associated with bipolarI disorder. (1.2)
Efficacy was established in two 6-week clinical trials in adults (14.2). Maintenance efficacy has not been systematically evaluated.
As ZYPREXA IntraMuscular for the:
Treatment of acute agitation associated with schizophrenia and bipolarI mania. (1.4)
Efficacy was established in three 1-day trials in adults. (14.3)
As ZYPREXA and Fluoxetine in Combination for the:
Treatment of depressive episodes associated with bipolarI disorder. (1.5)
Efficacy was established with Symbyax (olanzapine and fluoxetine in combination); refer to the product label for Symbyax.
Treatment of treatment resistant depression. (1.6)
Efficacy was established with Symbyax (olanzapine and fluoxetine in combination) in adults; refer to the product label for Symbyax.
1.1 Schizophrenia
Oral ZYPREXA is indicated for the treatment of schizophrenia. Efficacy was established in three clinical trials in adult patients with schizophrenia: two 6-week trials and one maintenance trial. In adolescent patients with schizophrenia (ages 13-17), efficacy was established in one 6-week trial [see Clinical Studies (14.1)].
When deciding among the alternative treatments available for adolescents, clinicians should consider the increased potential (in adolescents as compared with adults) for weight gain and dyslipidemia. Clinicians should consider the potential long-term risks when prescribing to adolescents, and in many cases this may lead them to consider prescribing other drugs first in adolescents [see Warnings and Precautions (5.5)].
1.2 Bipolar I Disorder (Manic or Mixed Episodes)
Monotherapy
Oral ZYPREXA is indicated for the acute treatment of manic or mixed episodes associated with bipolarI disorder and maintenance treatment of bipolarI disorder. Efficacy was established in three clinical trials in adult patients with manic or mixed episodes of bipolar I disorder: two 3- to 4-week trials and one monotherapy maintenance trial. In adolescent patients with manic or mixed episodes associated with bipolarI disorder (ages 13-17), efficacy was established in one 3-week trial [see Clinical Studies (14.2)].
When deciding among the alternative treatments available for adolescents, clinicians should consider the increased potential (in adolescents as compared with adults) for weight gain and dyslipidemia. Clinicians should consider the potential long-term risks when prescribing to adolescents, and in many cases this may lead them to consider prescribing other drugs first in adolescents [see Warnings and Precautions (5.5)].
Adjunctive Therapy to Lithium or Valproate
Oral ZYPREXA is indicated for the treatment of manic or mixed episodes associated with bipolarI disorder as an adjunct to lithium or valproate. Efficacy was established in two 6-week clinical trials in adults. The effectiveness of adjunctive therapy for longer-term use has not been systematically evaluated in controlled trials [see Clinical Studies (14.2)].
1.3 Special Considerations in Treating Pediatric Schizophrenia and BipolarI Disorder
Pediatric schizophrenia and bipolarI disorder are serious mental disorders; however, diagnosis can be challenging. For pediatric schizophrenia, symptom profiles can be variable, and for bipolarI disorder, pediatric patients may have variable patterns of periodicity of manic or mixed symptoms. It is recommended that medication therapy for pediatric schizophrenia and bipolarI disorder be initiated only after a thorough diagnostic evaluation has been performed and careful consideration given to the risks associated with medication treatment. Medication treatment for both pediatric schizophrenia and bipolarI disorder should be part of a total treatment program that often includes psychological, educational and social interventions.
1.4 ZYPREXA IntraMuscular: Agitation Associated with Schizophrenia and BipolarI Mania
ZYPREXA IntraMuscular is indicated for the treatment of acute agitation associated with schizophrenia and bipolarI mania.
Efficacy was demonstrated in 3 short-term (24 hours of IM treatment) placebo-controlled trials in agitated adult inpatients with: schizophrenia or bipolarI disorder (manic or mixed episodes) [see Clinical Studies (14.3)].
Psychomotor agitation is defined in DSM-IV as excessive motor activity associated with a feeling of inner tension. Patients experiencing agitation often manifest behaviors that interfere with their diagnosis and care, e.g., threatening behaviors, escalating or urgently distressing behavior, or self-exhausting behavior, leading clinicians to the use of intramuscular antipsychotic medications to achieve immediate control of the agitation.
1.5 ZYPREXA and Fluoxetine in Combination: Depressive Episodes Associated with BipolarI Disorder
Oral ZYPREXA and fluoxetine in combination is indicated for the treatment of depressive episodes associated with bipolarI disorder, based on clinical studies. When using ZYPREXA and fluoxetine in combination, refer to the Clinical Studies section of the package insert for Symbyax.
ZYPREXA monotherapy is not indicated for the treatment of depressive episodes associated with bipolarI disorder.
1.6 ZYPREXA and Fluoxetine in Combination: Treatment Resistant Depression
Oral ZYPREXA and fluoxetine in combination is indicated for the treatment of treatment resistant depression (major depressive disorder in patients who do not respond to 2 separate trials of different antidepressants of adequate dose and duration in the current episode), based on clinical studies in adult patients. When using ZYPREXA and fluoxetine in combination, refer to the Clinical Studies section of the package insert for Symbyax.
ZYPREXA monotherapy is not indicated for the treatment of treatment resistant depression.