Last update June 14, 2022

Olanzapine

Compatible

Safe substance and/or breastfeeding is the best option.

Olanzapine is an second-generation atypical antipsychotic, antimanic, and mood stabilizer used for the treatment of schizophrenia and moderate to severe mania associated with bipolar disorder, and in combination with fluoxetine for the treatment of the depressive phase of bipolar disorder and treatment-resistant unipolar depression. Oral administration once daily. Long-acting intramuscular administration every 2 to 4 weeks.

It is excreted in breast milk in clinically non-significant amount (Manouilenko 2018, Aydin 2015, Stiegler 2014, Whitworth 2010, Lutz 2008, Ambresin 2004, Gardiner 2003, Croke 2002), without problems observed in infants whose mothers were receiving this treatment, whether on psychomotor development, speech improvement and weight gaining. (Uguz 2015, Grover 2015, Stiegler 2014, Gilad2011, Whitworth 2010, Lutz 2008, Gardiner 2003, Friedman 2003, Croke 2002, Kirchheiner 2000)

Drug plasma levels in these infants were undetectable or very low. (Manouilenko 2018, Stiegler 2014, Whitworth 2010, Lutz 2008, Gardiner 2003, Kirchheiner 2000)

Isolated cases of sedation (in association with other medication) and constipation have been published. (Sinha 2021)

May induce increased plasma levels of Prolactin but less frequently and lower than other antipsychotic drugs. (David 2000, Crawford 1997)

Some expert authors consider the use of olanzapine safe during breastfeeding (Uguz 2021 y 2016, Teodorescu 2020, Rybakowski 2019, Larsen 2015, Parikh 2014, Rowe 2013, Klinger 2013), being the antipsychotic drug of first choice in breastfeeding. (Pacchiarotti 2016)


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Alternatives

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

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Other names

Olanzapine is also known as


Olanzapine in other languages or writings:

Groups

Olanzapine belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Olanzapine in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 60 %
Molecular weight 312 daltons
Protein Binding 93 %
VD 14.28 l/Kg
pKa 15.67 -
Tmax 6 - 8 hours
T½ 30 (21 - 54) hours
M/P ratio 0.2 - 0.8 -
Theoretical Dose 0.01 - 0.3 mg/Kg/d
Relative Dose 0.3 - 4 %

References

  1. Uguz F. A New Safety Scoring System for the Use of Psychotropic Drugs During Lactation. Am J Ther. 2021 Jan-Feb 01;28(1):e118-e126. Abstract
  2. Glocker C, Grohmann R, Engel R, Seifert J, Bleich S, Stübner S, Toto S, Schüle C. Galactorrhea during antipsychotic treatment: results from AMSP, a drug surveillance program, between 1993 and 2015. Eur Arch Psychiatry Clin Neurosci. 2021 Dec;271(8):1425-1435. Abstract
  3. Sinha SK, Kishore MT, Thippeswamy H, Kommu JVS, Chandra PS. Adverse effects and short-term developmental outcomes of infants exposed to atypical antipsychotics during breastfeeding. Indian J Psychiatry. 2021 Jan-Feb;63(1):52-57. Abstract
  4. Teodorescu A, Dima L, Popa MA, Moga MA, Bîgiu NF, Ifteni P. Antipsychotics in Postpartum Psychosis. Am J Ther. 2020 Jun 22;28(3):e341-e348. Abstract
  5. Uygur OF, Uygur H. Neurodevelopmental and growth follow-up of the baby exposed to antipsychotics during pregnancy and lactation: A case report. Psychiat Clin Psychopharmacol. 2019;29:744–7. DOI: 10.1080/24750573.2019.1627695 Full text (link to original source)
  6. Rybakowski J, Cubała WJ, Gałecki P, Rymaszewska J, Samochowiec J, Szulc A, Dudek D. Recommendations of the Polish Psychiatric Association regarding the treatment of affective disorders in women of childbearing age. Part II: Bipolar disorder. Psychiatr Pol. 2019 Apr 30;53(2):263-276. Abstract Full text (link to original source)
  7. Manouilenko I, Öhman I, Georgieva J. Long-acting olanzapine injection during pregnancy and breastfeeding: a case report. Arch Womens Ment Health. 2018 Oct;21(5):587-589. Abstract
  8. Pacchiarotti I, León-Caballero J, Murru A, Verdolini N, Furio MA, Pancheri C, Valentí M, Samalin L, Roigé ES, González-Pinto A, Montes JM, Benabarre A, Crespo JM, de Dios Perrino C, Goikolea JM, Gutiérrez-Rojas L, Carvalho AF, Vieta E. Mood stabilizers and antipsychotics during breastfeeding: Focus on bipolar disorder. Eur Neuropsychopharmacol. 2016 Oct;26(10):1562-78. Abstract
  9. Uguz F. Breastfed Infants Exposed to Combined Antipsychotics: Two Case Reports. Am J Ther. 2016;23(6):e1962-e1964. Abstract
  10. Uguz F. Second-Generation Antipsychotics During the Lactation Period: A Comparative Systematic Review on Infant Safety. Am J Ther. 2016;36(3):244-52. Abstract
  11. Larsen ER, Damkier P, Pedersen LH, Fenger-Gron J, Mikkelsen RL, Nielsen RE, Linde VJ, Knudsen HE, Skaarup L, Videbech P. Use of psychotropic drugs during pregnancy and breast-feeding. Acta Psychiatr Scand Suppl. 2015 Abstract
  12. Grover S, Avasthi A. Mood stabilizers in pregnancy and lactation. Indian J Psychiatry. 2015 Abstract Full text (link to original source) Full text (in our servers)
  13. Aydin B, Nayir T, Sahin S, Yildiz A. Olanzapine and quetiapine use during breastfeeding: excretion into breast milk and safe breastfeeding strategy. J Clin Psychopharmacol. 2015 Apr;35(2):206-8. Abstract
  14. Parikh T, Goyal D, Scarff JR, Lippmann S. Antipsychotic drugs and safety concerns for breast-feeding infants. South Med J. 2014 Abstract
  15. Stiegler A, Schaletzky R, Walter G, Wüst R, Abele H, Goelz R, Farger G, Wiatr G, Fallgatter AJ, Batra A. Olanzapine treatment during pregnancy and breastfeeding: a chance for women with psychotic illness? Psychopharmacology (Berl). 2014 Abstract
  16. Klinger G, Stahl B, Fusar-Poli P, Merlob P. Antipsychotic drugs and breastfeeding. Pediatr Endocrinol Rev. 2013 Mar-Apr;10(3):308-17. Review. Abstract
  17. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  18. Gilad O, Merlob P, Stahl B, Klinger G. Outcome of infants exposed to olanzapine during breastfeeding. Breastfeed Med. 2011 Abstract
  19. Whitworth A, Stuppaeck C, Yazdi K, Kralovec K, Geretsegger C, Zernig G, Aichhorn W. Olanzapine and breast-feeding: changes of plasma concentrations of olanzapine in a breast-fed infant over a period of 5 months. J Psychopharmacol. 2010 Abstract
  20. Lutz UC, Wiatr G, Orlikowsky T, Gaertner HJ, Bartels M. Olanzapine treatment during breast feeding: a case report. Ther Drug Monit. 2008 Abstract
  21. Ambresin G, Berney P, Schulz P, Bryois C. Olanzapine excretion into breast milk: a case report. J Clin Psychopharmacol. 2004 Abstract
  22. Gardiner SJ, Kristensen JH, Begg EJ, Hackett LP, Wilson DA, Ilett KF, Kohan R, Rampono J. Transfer of olanzapine into breast milk, calculation of infant drug dose, and effect on breast-fed infants. Am J Psychiatry. 2003 Abstract
  23. Friedman SH, Rosenthal MB. Treatment of perinatal delusional disorder: a case report. Int J Psychiatry Med. 2003 Abstract
  24. Croke S, Buist A, Hackett LP, Ilett KF, Norman TR, Burrows GD. Olanzapine excretion in human breast milk: estimation of infant exposure. Int J Neuropsychopharmacol. 2002 Abstract
  25. David SR, Taylor CC, Kinon BJ, Breier A. The effects of olanzapine, risperidone, and haloperidol on plasma prolactin levels in patients with schizophrenia. Clin Ther. 2000 Abstract
  26. Kirchheiner J, Berghöfer A, Bolk-Weischedel D. Healthy outcome under olanzapine treatment in a pregnant woman. Pharmacopsychiatry. 2000 Abstract
  27. Crawford AM, Beasley CM Jr, Tollefson GD. The acute and long-term effect of olanzapine compared with placebo and haloperidol on serum prolactin concentrations. Schizophr Res. 1997 Jul 25;26(1):41-54. Abstract

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