olanzapine pamoate

Quick answers

• What is olanzapine pamoate?

  Olanzapine pamoate (Zyprexa Relprevv) is a long-acting injectable formulation of olanzapine used for schizophrenia maintenance. It is clinically “olanzapine-like” in efficacy and metabolic burden, but with a unique safety workflow due to PDSS.

• What is ZYPREXA RELPREVV?

  ZYPREXA RELPREVV is a brand name for olanzapine pamoate.

• What is ZYPREXA RELPREVV (olanzapine pamoate) used for?

  Label indications include: Schizophrenia.

• What drug class is ZYPREXA RELPREVV (olanzapine pamoate)?

  Long-acting injectable antipsychotic.

• What is the mechanism of action of ZYPREXA RELPREVV (olanzapine pamoate)?

  Long-acting injectable olanzapine formulation (D2/5-HT2A antagonist with strong H1 and muscarinic activity) used for schizophrenia maintenance; requires post-injection observation due to PDSS risk.

• What strengths does ZYPREXA RELPREVV (olanzapine pamoate) come in?

  Deep intramuscular injection every 2–4 weeks (dose/interval per label).

• Is ZYPREXA RELPREVV (olanzapine pamoate) a controlled substance?

  No — it is not scheduled as a controlled substance under U.S. federal law.

Snapshot

• Class: Long-acting injectable antipsychotic
• Common US brands: ZYPREXA RELPREVV
• Long-acting injectable formulation available.
• Therapeutic drug monitoring not routinely recommended.
• Last reviewed: 2025-12-30

Clinical Highlights

Olanzapine pamoate (Zyprexa Relprevv) is a long-acting injectable formulation of olanzapine used for schizophrenia maintenance. It is clinically “olanzapine-like” in efficacy and metabolic burden, but with a unique safety workflow due to PDSS. PDSS (post-injection delirium/sedation syndrome) is a rare reaction after olanzapine LAI injections that requires a structured observation period after every injection per label. This logistical requirement often drives product selection more than pharmacology.

Dosing & Formulations

Administration is deep intramuscular injection (commonly gluteal). Dose and interval (q2–4 weeks) are individualized to symptom control and tolerability within labeled schedules. Post-injection monitoring is not optional: a structured observation period after each injection is required per labeling due to PDSS risk. Clinic workflows often include staffing, space, and vital sign checks to support safe administration.

Monitoring & Risks

Boxed warning: increased mortality in elderly patients with dementia-related psychosis (antipsychotic class warning). Boxed warning: PDSS risk requires post-injection observation after every dose per label; patients must be monitored for sedation, delirium symptoms, and impaired coordination.

Drug Interactions

Olanzapine is primarily metabolized via CYP1A2. Smoking induces 1A2 and can lower exposure; smoking cessation can increase exposure and sedation risk. Strong CYP1A2 inhibitors (e.g., fluvoxamine, ciprofloxacin) can increase exposure; dose reduction and close monitoring for sedation and orthostasis are common.

Practice Notes

The “right patient” is often defined by logistics: stable housing and transport, a clinic able to perform required observation, and a clear shared plan for what to do if an injection is late. Because olanzapine carries high metabolic risk, teams often document baseline metabolic status and the monitoring schedule at initiation, and revisit lifestyle counseling at each injection visit.

Long-acting injectable (LAI) options

• Olanzapine pamoate

  Interval

  q2–4wk

  Oral overlap

  Per label

  Injection site

  Gluteal

  Notes

  • Post‑injection observation required per labeling (PDSS)

References

1. ZYPREXA RELPREVV prescribing information (DailyMed, 2025). — DailyMed (2025)
2. Post Injection Delirium/sedation Syndrome IN Patients Treated With Olanzapine Pamoate: Mechanism, Incidence, AND Management — CNS Drugs (2015)
3. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia — American Psychiatric Association (2020)
4. ZYPREXA (olanzapine) label — DailyMed (2025)