Olanzapine embonate

How it works

Olanzapine antagonises multiple receptors, principally dopamine D2 and serotonin 5-HT2A, and the embonate salt provides slow release of olanzapine from an intramuscular depot.

Prescribing in practice

• This depot is associated with post-injection delirium/sedation syndrome, so each injection must be given in a setting with resuscitation facilities and the patient observed by a healthcare professional for a prolonged period afterwards.
• Olanzapine carries a significant risk of weight gain and metabolic disturbance, including hyperglycaemia and dyslipidaemia.
• It is associated with increased stroke and mortality risk in elderly patients with dementia-related psychosis and is not indicated for that use.

Monitoring

Patients must be observed for several hours after each injection for signs of post-injection syndrome, and metabolic parameters such as weight, glucose and lipids should be monitored throughout treatment.

Counselling the patient

• You will need to stay and be observed for a period after each injection and must not drive yourself home that day.
• If you feel very drowsy, confused or unwell after an injection, tell staff straight away.
• Regular checks of your weight, blood sugar and cholesterol are an important part of this treatment.

Evidence & guidelines

The post-injection syndrome and the requirement for post-dose observation with long-acting olanzapine are described in its product information and have been highlighted by regulators.