Appropriate educational placement is essential and psychosocial intervention is often helpful. The need for continued treatment should be reassessed periodically. Patients treated with any antipsychotic medicines, including olanzapine, should be monitored regularly for lipids in accordance with utilised antipsychotic guidelines, e.g. Dosage adjustments, if indicated, can be made according to efficacy and tolerability within dose ranges of oral olanzapine 5 to 12.5 mg and fluoxetine 20 to 50 mg. Antidepressant efficacy was demonstrated with olanzapine and fluoxetine in combination in adult patients with a dose range of olanzapine 6 to 12 mg and fluoxetine 25 to 50 mg. Safety of co-administration of doses above 18 mg olanzapine with 75 mg fluoxetine has not been evaluated in clinical studies.Oral olanzapine should be administered in combination with fluoxetine once daily in the evening, without regard to meals, generally beginning with 2.5 mg of oral olanzapine and 20 mg of fluoxetine. Olanzapine was used as a flexible dose starting with 2.5 and ranging up to 20 mg/day. [Specific package insert requirement for olanzapine] WARNINGS: Hyperglycemia and Diabetes Mellitus Hyperglycemia in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics. These trials included patients with or without psychotic features and with or without a rapid-cycling course. ALT values returned to normal, or were decreasing, at last follow-up in the majority of patients who either continued treatment with olanzapine or discontinued olanzapine. Aspiration pneumonia is a common cause of morbidity and mortality in patients with advanced Alzheimer’s disease. It begins disintegrating in the mouth within seconds, allowing its contents to be subsequently swallowed with or without liquid. Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever, and primary central nervous system pathology.The 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. When using olanzapine and fluoxetine in combination, also refer to the Use in Specific Populations section of the package insert for Symbyax. immobilisation of patients, should be identified and preventive measures undertaken.Given the primary CNS effects of olanzapine, caution should be used when it is taken in combination with other centrally acting medicines and alcohol. The percentages of patients who gained at least 7%, 15%, or 25% of their baseline body weight with long-term exposure were 64%, 32%, and 12%, respectively. Induction of emesis is not recommended. This increase in heart rate may be related to olanzapine’s potential for inducing orthostatic changes The following adverse reactions have been identified during post-approval use of olanzapine. The magnitude of weight gain and the proportion of adolescent patients who had clinically significant weight gain were greater with long-term exposure (at least 24 weeks) than with short-term exposure.Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness. Potential consequences of weight gain should be considered prior to starting olanzapine. There is no general agreement about specific pharmacological treatment regimens for NMS. In analyses of patients who completed 9-12 months of olanzapine therapy, mean change in fasting and nonfasting glucose levels continued to increase over time.Undesirable alterations in lipids have been observed with olanzapine use. Olanzapine is not approved for the treatment of patients with dementia-related psychosis The possibility of a suicide attempt is inherent in schizophrenia and in bipolar I disorder, and close supervision of high-risk patients should accompany drug therapy.

Bipolar I Disorder (Manic or Mixed Episodes) Monotherapy: Overall, there was no difference in the incidence of discontinuation due to adverse reactions (2% for oral olanzapine vs 2% for placebo). Symptomatic treatment and monitoring of vital organ function should be instituted according to clinical presentation, including treatment of hypotension and circulatory collapse and support of respiratory function. In placebo-controlled trials, there was a significantly higher incidence of cerebrovascular adverse events in patients treated with olanzapine compared to patients treated with placebo.