Olanzapine 185388 225192861 2008-07-12T11:21:39Z 82.227.63.96 {{Drugbox| | IUPAC_name = ''2-methyl-4-(4-methyl-1-piperazinyl)-<BR>10''H''-thieno[2,3-''b''][1,5]benzodiazepine'' | image = Olanzapine 2.png | width = 172 | image2= Olanzapine-from-xtal-3D-vdW.png | CAS_number = 132539-06-1 | ATC_prefix = N05 | ATC_suffix = AH03 | PubChem = 4585 | DrugBank = APRD00138 | C=17|H=20|N=4|S=1 | molecular_weight = 312.439 | smiles = CN1CCN(CC1)C1=c2cc(C)sc2=Nc2ccccc2N1 | bioavailability = ? | metabolism = Hepatic | elimination_half-life = 21–54 hours | excretion = ? | pregnancy_category = C | legal_status = Prescription only | routes_of_administration = oral, intramuscular }} '''Olanzapine''' ('''Zyprexa''', '''Zyprexa Zydis''', '''Zalasta''', '''Zolafren''', '''Olzapin''', or in combination with [[fluoxetine]] '''Symbyax''') is an [[atypical antipsychotic]], approved by the [[Food and Drug Administration|FDA]] for the treatment of: [[schizophrenia]] on [[1996-09-30]];<ref> {{cite web | title = Electronic Orange Book | publisher = Food and Drug Administration | month = April | year = 2007 | url =http://www.accessdata.fda.gov/scripts/cder/ob/docs/obdetail.cfm?Appl_No=020592&TABLE1=OB_Rx | accessdate = 2007-05-24 }} </ref> depressive episodes associated with bipolar disorder, as part of the Symbyax formulation, on [[2003-12-24]];<ref> {{cite web | title = NDA 21-520 | publisher = Food and Drug Administration | date = 2003-12-24 | url = http://www.fda.gov/cder/foi/appletter/2003/21520ltr.pdf | accessdate = 2007-10-31 }} </ref> acute manic episodes and maintenance treatment in [[bipolar disorder]] on [[2004-01-14]].<ref> {{cite web | title = NDA 20-592 / S-019 | publisher = Food and Drug Administration | date = 2004-01-14 | url = http://www.fda.gov/cder/foi/appletter/2004/20592se1-019ltr.pdf | accessdate = 2007-10-31 }} </ref> [[Off-label use]]s are [[#Off-label uses|listed below]]. The olanzapine formulations are manufactured and marketed by the [[pharmaceutical company]] [[Eli Lilly and Company]], whose patent for olanzapine proper expires in 2011. ==Pharmacology== Olanzapine is structurally similar to [[clozapine]], and is classified as a [[thienobenzodiazepine]]. Olanzapine has a higher affinity for [[serotonin receptor|5-HT<sub>2</sub> serotonin receptors]] than [[dopamine receptor|D<sub>2</sub> dopamine]] receptors. Like most atypical antipsychotics, compared to the older typical ones, olanzapine has a lower affinity for [[histamine receptor|histamine]], [[Muscarinic acetylcholine receptor|cholinergic muscarinic]] and [[alpha-adrenergic receptor|alpha adrenergic]] receptors. The mode of action of olanzapine's antipsychotic activity is unknown. It may involve antagonism at [[serotonin]] receptors. Antagonism of dopamine receptors is associated with [[extrapyramidal effects]] such as [[tardive dyskinesia]], and with therapeutic effects. Antagonizing H<sub>1</sub> histamine receptors causes sedation and may cause weight gain, although antagonistic actions at 5-HT<sub>2C</sub> receptors have also been implicated in weight gain. ==Dosing and administration== Olanzapine is available as a tablet in strengths of 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg and 20 mg and orally disintegrating wafers (known as Zydis), which dissolve on the tongue, in strengths of 5 mg, 10 mg, 15 mg and 20 mg. It is also available as a rapid-acting [[intramuscular injection]] for short-term acute use. Dose may be adjusted depending on the person's response to the drug. The dose also will depend on certain medical problems the person may have. It is generally recommended to be taken once daily before bed as it is highly [[sedative|sedating]]. However, sedation tends to diminish as treatment is pursued. ==Pharmacokinetics== Olanzapine displays linear kinetics. Its elimination half-life ranges from 21 to 54 hours. Steady state plasma concentrations are achieved in about a week. Olanzapine undergoes extensive [[first pass metabolism]] and [[bioavailability]] is not affected by food. In cases of acute agitiation, olanzapine can also be administered by intramuscular injection in doses up to 10 milligrams. Olanzapine injection should not be given by the intravenous route, and should not be co-administered with [[benzodiazepine]]s. ==Metabolism== Olanzapine is metabolized by the [[cytochrome P450]] system isoenzymes 1A2 and 2D6 (minor pathway). Drug metabolism may be increased or decreased by agents that induce (e.g. cigarette smoke) or inhibit (e.g. [[fluvoxamine]] or [[ciprofloxacin]]) CYP1A2 activity respectively. ==Side effects== As with all neuroleptic drugs, olanzapine can cause [[tardive dyskinesia]] and rare, but life-threatening, [[neuroleptic malignant syndrome]]. Other recognised side effects may include: *[[akathisia]] inability to remain still *dry mouth *[[dizziness]] *[[sedation]] *[[insomnia]] *[[Urinary Retention]] inability to pass urine, can lead to cathterisation if treament isn't stoped *[[orthostatic hypotension]] *weight gain (90% of users experience weight gain) (see below) *increased appetite *runny nose *low blood pressure *impaired judgment, thinking, and motor skills *impaired spatial orientation *impaired responses to senses *[[seizure]] *trouble swallowing *dental problems and discoloration of teeth *missed periods *problems with keeping body temperature regulated *[[apathy]], lack of emotion ===Weight gain=== Of the atypical antipsychotics, olanzapine and [[clozapine]] are the most likely to induce weight gain.<ref>Wirshing DA, Wirshing WC, Kysar L, Berisford MA. (1999) Novel antipsychotics: comparison of weight gain liabilities. ''Journal of Clinical Psychology'' '''60''' 358-63</ref> The effect is more pronounced if high doses of olanzapine are used.<ref>Green B (1999) Focus on olanzapine ''Current Med Res Opin'' '''15''' 79-85</ref> The amount of weight gain experienced will be reduced by keeping an eye on ones diet and sugar consumption. Smaller amounts of weight gain are induced by [[risperidone]] and [[quetiapine]]. [[Ziprasidone]] and [[aripiprazole]] are considered to be weight neutral antipsychotics. Recently the [[Food and Drug Administration]] required the manufacturers of all atypical antipsychotics to include a warning about the risk of [[hyperglycemia]] and [[diabetes]] with these drugs. These effects may be related to the drugs' ability to induce weight gain, although there are some reports of metabolic changes in the absence of weight gain, and recent (2007) evidence suggests that olanzapine may directly affect [[adipocyte]] function, promoting fat deposition. There are some case reports of olanzapine-induced [[diabetic ketoacidosis]].<ref>{{cite journal | last = Fulbright | first = April R. | authorlink = April R. Fulbright | year = 2006 | title = Complete Resolution of Olanzapine-Induced Diabetic Ketoacidosis | journal = Journal of Pharmacy Practice | volume = 19 | issue = 4 | pages = 255–258 | publisher = [[SAGE Publications]] | location = [[Thousand Oaks, CA]] | doi = 10.1177/0897190006294180 | url = http://jpp.sagepub.com/cgi/content/abstract/19/4/255 | format = abstract | accessdate = 2007-12-02 | quote = Olanzapine has been associated with diabetic ketoacidosis and also with weight gain, lipid abnormalities, and the development of type 2 diabetes. }}</ref> There are data that suggest that olanzapine can decrease insulin sensitivity.<ref>{{cite journal|author=Sacher J, et al|journal=Neuropshchopharmacology|date= 2007-08-22}}</ref> though there are other studies that seem to refute this<ref>{{cite journal | last = Sowell | first = Margaret | authorlink = Margaret Sowell | coauthors = et al. | date = [[August 8]], [[2003]] | title = Evaluation of Insulin Sensitivity in Healthy Volunteers Treated with Olanzapine, Risperidone, or Placebo: A Prospective, Randomised Study Using the Two-Step Hyperinsulinemic, Euglycemic Clamp | journal = Journal of Clinical Endocrinology & Metabolism | volume = 88 | issue = 12 | pages = 5875–5880 | publisher = The Endocrine Society | url = http://jcem.endojournals.org/cgi/content/full/88/12/5875 | accessdate = 2007-12-02 | quote = In summary, this study did not demonstrate significant changes in insulin sensitivity in healthy subjects after 3 wk of treatment with olanzapine or risperidone. | doi = 10.1210/jc.2002-021884 | pmid = 14671184 }}</ref> [[Triglyceride]] levels rose from 99 to 166 in one year with olanzapine, in the CAFE ("Comparison of Atypicals for First-Episode Psychosis") study.{{Fact|date=December 2007}} Of the three drugs administered in that study, "olanzapine was associated with the greatest increases in body weight and related measures."<ref>{{cite web | url = http://www.astrazenecaclinicaltrials.com/Article/526695.aspx | title = Efficacy and Tolerability of Olanzapine, Quetiapine and Risperidone in the Treatment of First Episode Psychosis: A Randomised Double Blind 52 Week Comparison | accessdate = 2007-12-03 | author = AstraZeneca Pharmaceuticals | date = [[4 April]] [[2006]] | work = AstraZeneca Clinical Trials | publisher = [[AstraZeneca]] PLC | quote = At week 12, the olanzapine-treated group had more weight gain, a higher increase in [ [[body mass index]] ], and a higher proportion of patients with a BMI increase of at least 1 unit compared with the [[quetiapine]] and [[risperidone]] groups (p<=0.01). }}</ref> In the same study, where the median patient age was 23, 46% of male patients on Zyprexa had a waist size of 40" or greater after one year,{{Fact|date=December 2007}} and "80% gained 7% or more over their baseline weight compared with 57.6% of those receiving risperidone and 50% of those receiving quetiapine."<ref>{{cite news | first = Paula | last = Moyer | authorlink = Paula Moyer | title = CAFE Study Shows Varying Benefits Among Atypical Antipsychotics | url = http://www.medscape.com/viewarticle/515435 | work = Medscape Medical News | publisher = [[WebMD]] | date = 2005-10-25 | accessdate = 2007-12-03 }}</ref> Impaired glucose metabolism, high triglycerides, and obesity have been shown to be constituents of the [[metabolic syndrome]] and may increase the risk of [[cardiovascular disease]]. The results of a large, random-design study funded by [[National Institutes of Health|NIH]]'s [[National Institute of Mental Health]] were published in September 2005. The 18-month study, which involved 1,400 participants at 57 sites around the country, found that "patients on olanzapine also experienced substantially more weight gain and metabolic changes associated with an increased risk of diabetes than those participants taking the other drugs."<ref>{{cite press release | title = NIMH study to guide treatment choices for schizophrenia | publisher = [[National Institute of Mental Health]] | date = [[19 September]] [[2005]] | url = http://www.eurekalert.org/pub_releases/2005-09/niom-nst091905.php | accessdate = 2006-12-18 }}</ref> However, the study also found that olanzapine helped more patients control symptoms for significantly longer than the other drugs. Specifically, after 18 months, the researchers found, "64 percent of the patients taking olanzapine had stopped, while at least 74 percent had quit each of the other medications."<ref>{{cite news | first = Benedict | last = Carey | authorlink = Benedict Carey | title = Little Difference Found in Schizophrenia Drugs | url = http://www.nytimes.com/2005/09/20/health/psychology/20drug.html | work = [[New York Times]] | publisher = The New York Times Company | date = [[September 20]], [[2005]] | accessdate = 2007-12-03 }}</ref> Data from a small, open-label, non-randomized study seem to suggest that taking olanzapine by orally dissolving tablets may not be associated with the same degree of weight gain as conventional tablet formulations;<ref>{{cite journal |author=de Haan L, van Amelsvoort T, Rosien K, Linszen D |title=Weight loss after switching from conventional olanzapine tablets to orally disintegrating olanzapine tablets |journal=Psychopharmacology (Berl) |volume=175 |issue=3 |pages=389–90 |year=2004 |pmid=15322727 |doi=10.1007/s00213-004-1951-2}}</ref> however this has not been substantiated in a blinded experimental setting. ==Off-label uses== Case-reports, open-label, and small pilot studies suggest efficacy of olanzapine for the treatment of some anxiety spectrum disorders (e.g. [[generalized anxiety disorder]],<ref>{{cite journal |author=Pollack MH, Simon NM, Zalta AK, Worthington JJ, Hoge EA, Mick E, Kinrys G, Oppenheimer J. |title=Olanzapine augmentation of fluoxetine for refractory generalized anxiety disorder: a placebo controlled study. |journal=Biol Psychiatry. |volume=59 |issue=3 |pages=211–5 |year=2006 | pmid=16139813 |doi=10.1016/j.biopsych.2005.07.005}}</ref> [[panic disorder]],<ref>{{cite journal |author=Sepede G, De Berardis D, Gambi F, Campanella D, La Rovere R, D'Amico M, Cicconetti A, Penna L, Peca S, Carano A, Mancini E, Salerno RM, Ferro FM. |title=Olanzapine augmentation in treatment-resistant panic disorder: a 12-week, fixed-dose, open-label trial. |journal=J Clin Psychopharmacol. |volume=107 |issue=5 |pages=394–6 |year=2003 | pmid=16415705 }}</ref> [[post-traumatic stress disorder]]<ref>{{cite journal |author=Jakovljević M, Sagud M, Mihaljević-Peles A. |title=Olanzapine in the treatment-resistant, combat-related PTSD&mdash;a series of case reports. |journal=[[Acta Psychiatrica Scandinavica]] |volume=26 |issue=1 |pages=45–9 |year=2006 | pmid=12752037 |doi=10.1111/j.1600-0447.1951.tb10961.x }}</ref>); however, olanzapine has not been rigorously evaluated in randomized, placebo-controlled trials for this use and is not FDA approved for these indications. Other common off-label uses of olanzapine include the treatment of eating disorders (e.g. [[anorexia nervosa]]) and as an adjunctive treatment for major depressive disorder without psychotic features. It has also been used for [[Tourette's syndrome]] and [[stuttering]]. Olanzapine has been marketed for [[dementia]] by Eli Lilly though it has never been shown to help with the symptoms of dementia. According to internal documents obtained by the [[New York Times]], Lilly instructed its sales representatives to suggest that physicians prescribe Zyprexa to older patients with symptoms of dementia. One such document states "dementia should be first message" for primary care doctors, since they "do not treat bipolar" or schizophrenia, but "do treat dementia". Three months after its launch, Lilly's Zyprexa campaign, called "Viva Zyprexa", led to 49,000 new prescriptions. In 2002, the company changed the name of the primary care campaign to "Zyprexa Limitless" and began to focus on people with mild bipolar disorder who had previously been diagnosed as depressed, despite the fact that Zyprexa has been FDA approved only for the treatment of [[mania]] in bipolar disorder, not depression.<ref name="NYT1206">{{cite news | first = Alex | last = Berenson | authorlink = Alex Berenson | title = Drug Files Show Maker Promoted Unapproved Use | url = http://query.nytimes.com/gst/fullpage.html?res=9E05E2DA1331F93BA25751C1A9609C8B63&pagewanted=all | work = [[New York Times]] | publisher = The New York Times Company | date = [[December 18]], [[2006]] | accessdate = 2007-12-03 }}</ref> ===Use in elderly=== Citing an increased risk of [[stroke]], in 2004 the [[Committee on the Safety of Medicines]] (CSM) in the UK issued a warning that olanzapine and [[risperidone]], both atypical antipsychotic medications, should not be given to elderly patients with [[dementia]]. In the U.S., olanzapine comes with a [[black box warning]] for increased risk of death in elderly patients. It is not approved for use in patients with dementia-related psychosis.<ref>{{cite web | url = http://zyprexa.com/common_pages/safety.jsp | title = Important Safety Information for Olanzapine | accessdate = 2007-12-03 | year = 2007 | work = Zyprexa package insert | publisher = Eli Lilly & Company | quote = Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. [...] ZYPREXA® (olanzapine) is not approved for the treatment of elderly patients with dementia-related psychosis. }}</ref> However, a BBC investigation in June 2008 found that this warning was being widely ignored by doctors.<ref>{{cite news | last = | first = | coauthors = | title = Doctors 'ignoring drugs warning' | work = | pages = | language = | publisher = BBC News | date = Tuesday, [[17 June]] [[2008]] | url = http://news.bbc.co.uk/1/hi/programmes/file_on_4/7457132.stm | accessdate = 2008-06-22}}</ref> == Overdose == Symptoms of an overdose include [[tachycardia]], [[agitation]], [[dysarthria]], decreased consciousness and coma. Death has been reported after an acute overdose of 450 mg, but also survival after an acute overdose of 1500 mg.<ref name="RxList">{{cite web | url = http://www.rxlist.com/cgi/generic/symbyax_od.htm | title = Symbyax (Olanzapine and fluoxetine) drug overdose and contraindication information | accessdate = 2007-12-03 | year = 2007 | work = RxList: The Internet Drug Index | publisher = [[WebMD]] }}</ref> There is no specific, known antidote for olanzapine overdose, and even physicians are recommended to call a certified [[poison control center]] for information on the treatment of such a case.<ref name="RxList"/> ==PRIME== The Prevention through Risk Identification, Management, and Education (PRIME) study, funded by the [[National Institute of Mental Health]] and Eli Lilly, tested the hypothesis that olanzapine might prevent the onset of psychosis in people at very high risk for [[schizophrenia]]. The study examined 60 patients with [[Prodrome|prodromal]] schizophrenia, who were at an estimated risk of 36&ndash;54% of developing schizophrenia within a year, and treated half with olanzapine and half with [[placebo]].<ref>{{cite journal | last = McGlashan | first = T.H. | authorlink = Thomas McGlashan | coauthors = et al. | date = [[1 May]] [[2003]] | title = The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. I. Study rationale and design | journal = Schizophrenia Research | volume = 61 | issue = 1 | pages = 7–18 | publisher = [[Elsevier]] | location = [[Amsterdam]] | pmid = 12648731 | doi = 10.1016/S0920-9964(02)00439-5 }}</ref> In this study, patients receiving olanzapine had a lower risk of progressing to psychosis, although the difference did not reach [[statistical significance]]. Olanzapine was effective for treating the prodromal symptoms, but was associated with significant weight gain.<ref>{{cite journal | last = McGlashan | first = Thomas H. | authorlink = Thomas McGlashan | coauthors = et al. | year = 2006 | month = May | title = Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis | journal = [[American Journal of Psychiatry]] | volume = 163 | issue = 5 | pages = 790–99 | publisher = [[American Psychiatric Association]] | location = [[Arlington, VA]] | pmid = 16648318 | doi = 10.1176/appi.ajp.163.5.790 | url = http://ajp.psychiatryonline.org/cgi/content/full/163/5/790 | accessdate = 2007-12-03 }}</ref> == Legal == According to a ''[[New York Times]]'' article published on [[December 17]], [[2006]],<ref>[http://www.nytimes.com/2006/12/17/business/17drug.html The New York Times [[December 17]], [[2006]]</ref> "Eli Lilly has engaged in a decade-long effort to play down the health risks of Zyprexa, its best-selling medication for schizophrenia, according to hundreds of internal Lilly documents and e-mail messages among top company managers", most of which had been disclosed as the result of lawsuits by the mentally ill against the company though some had been stolen.<ref name=finaljudgement/> These had been sent to a number of journalists by a lawyer advocate for mentally ill opponents of psychiatric treatment. Eli Lilly filed a protection order to stop the dissemination of certain Eli Lilly documents about Zyprexa which they, and the judge, believed to be confidential and "not generally appropriate for public consumption".<ref name=finaljudgement>http://www.eff.org/files/filenode/zyprexa/zyprexa_judgement.pdf</ref> Temporary injunctions required those who had been received the documents to return them and that the documents be removed from websites which had posted them.<ref>http://www.eff.org/files/filenode/zyprexa/eli-lilly-order.pdf</ref> In his final judgement, Judge Weinstein issued a permanent judgement against further dissemination of the documents and requiring their return by a number of parties named by Lilly.<ref name=finaljudgement/> These health risks include an increased risk for diabetes through Zyprexa's links to obesity and its tendency to raise [[blood sugar]]. Zyprexa is Lilly’s top-selling drug, with sales of $4.2 billion last year. The documents, given to ''The New York Times'' by [[James Gottstein|Jim Gottstein]], a lawyer representing mentally ill patients, show that Lilly executives kept important information from doctors about Zyprexa’s links to obesity and its tendency to raise blood sugar — both known risk factors for diabetes. ''The Times'' of London also obtained copies of the documents and reported that as early as October 1998, Lilly considered the risk of drug-induced obesity to be a "top threat" to Zyprexa sales.<ref name=timeso>[http://www.business.timesonline.co.uk/article/0,,13129-2560841,00.html Eli Lilly was Concerned by Zyprexa Side-Effects from 1998], The Times (London), [[January 23]], [[2007]]</ref> In another document, dated [[October 9]], [[2000]], senior Lilly research physician Robert Baker noted that an academic advisory board he belonged to was "quite impressed by the magnitude of weight gain on olanzapine and implications for glucose."<ref name=timeso/> Lilly’s own published data, which it told its sales representatives to play down in conversations with doctors, has shown that 30 percent of patients taking Zyprexa gain 22 pounds or more after a year on the drug, another study showed 16% of Zyprexa patients gained at least 30kg (66 pounds) in one year, and some patients have reported gaining 100 pounds or more. But Lilly was concerned that Zyprexa’s sales would be hurt if the company was more forthright about the fact that the drug might cause unmanageable weight gain or [[diabetes]], according to the documents, which cover the period 1995 to 2004. In 2006, Lilly paid $700 million to settle 8,000 lawsuits from people who said they had developed diabetes or other diseases after taking Zyprexa. Thousands more suits are still pending.<ref>[http://www.nytimes.com/2007/01/04/business/04drug.html?ref=health] Mother Wonders if Psychosis Drug Helped Kill Son, New York Times, [[January 4]], [[2007]]</ref> In 2002, British and Japanese regulatory agencies warned that Zyprexa may be linked to diabetes, but even after the FDA issued a similar warning in 2003, Lilly did not publicly disclose their own findings. Eli Lilly agreed on [[January 4]], [[2007]] to pay up to $500 million to settle 18,000 lawsuits from people who claimed they developed diabetes or other diseases after taking Zyprexa. Including; on [[January 8]], [[2007]], Judge [[Jack B. Weinstein]] refused the [[Electronic Frontier Foundation]]'s motion to stay his order<ref>[http://www.eff.org/news/archives/2007_01.php#005058 Press Releases: January, 2007 | Electronic Frontier Foundation<!-- Bot generated title -->]</ref>. The documents can now only be downloaded from public Internet sites outside the US.<ref>[http://zyprexakills.ath.cx/ ZyprexaKills: Download the documents and memos as multi-page tiff files]</ref><ref>[http://robwipond.com/archives/47 Canadian journalist Rob Wipond: Download the documents and memos as multi-page tiff files]</ref><ref>[http://boocompany.com/zyprexakills/ Swiss/German web site Boocompany.com: Download or browse the documents and memos as pdf files and OCR-generated searchable ASCII text files]</ref> earlier settlements over Zyprexa, Lilly has now agreed to pay at least $1.2 billion to 28,500 people who claim they were injured by the drug. At least 1,200 suits are still pending, the company said. About 20 million people worldwide have taken Zyprexa since its introduction in 1996.<ref>[http://www.nytimes.com/2007/01/04/business/04cnd-drug.html?hp&ex=1167973200&en=32c3e3c2d5309a8b&ei=5094&partner=homepage] Lilly to Pay Up to $500 Million to Settle Claims. The New York Times, [[January 4]], [[2007]]</ref> ==See also== *[[Antipsychotics]] *[[Eli Lilly and Company]] *[[Eli Lilly Controversy]] ==Note and References== {{Reflist|2}} == External links == ===Manufacturer site=== * [http://www.zyprexa.com/ Zyprexa.com] - 'Zyprexa (Olanzapine): Opening the Door to Possibility' ([[Eli Lilly]]'s official Zyprexa brand website) * {{cite web| url = http://pi.lilly.com/us/zyprexa-pi.pdf| title = Zyprexa package insert | accessdate = 2006-12-18| date = [[13 November]] [[2006]] | format = PDF| publisher = [[Eli Lilly and Company]] }} ===Consumer information=== * [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15846619&dopt=Abstract NIH.gov] - 'Olanzapine for schizophrenia', Duggan Lorna, Fenton M, Rathbone J, Dardennes R, El-Dosoky A, Indran S., ''[[The Cochrane Library|Cochrane Review]] (2005) * [http://medlibrary.org/drugs/anti-psychotic/zyprexa.html MedLibrary.org] - 'Information on Zyprexa and How to Use It, Precautions and Other Medications to Avoid While Taking, [[MedLibrary]] * [http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203492.html NIH.gov] - 'Olanzapine (Systemic)' Drug Information, [[MedlinePlus]] * [http://www.psycheducation.org/depression/meds/olanzapine.htm PsychEducation.org] - 'Zyprexa (olanzapine)' (updated April, 2004) ===Controversy=== * [http://www.dailykos.com/story/2007/10/15/165958/44 Sickening Meds Part I: Zyprexa - by A.Etzioni] - Call for transparency in the pharmaceutical industry, on [[Daily Kos]]. * [http://www.mindfreedom.org/search?SearchableText=Olanzapine MindFreedom.org] - 'Info on "Zyprexa Kills" Campaign', [[MindFreedom International]] * [http://query.nytimes.com/gst/fullpage.html?sec=health&res=9F00E5DB1430F936A35752C0A9619C8B63 nytyimes.com] - Lilly Settles With 18,000 Over Zyprexa, Alex Berenson, ''[[New York Times]]'' ([[December 17]], [[2006]]) * [http://zyprexa.pbwiki.com Zyprexa.pbwiki.com] - 'Zyprexa Kills' campaign (with links to the Eli Lilly Memos) * [http://zyprexakills.ath.cx/ ZyprexaKills.ath.cx] - Leaked Memos on [[BitTorrent (protocol)|BitTorrent]] * [http://www.youtube.com/watch?v=nj0LZZzrcrs Youtube] Eli Lilly Rep Talks about Zyprexa * [http://www.signs-of-the-times.org/articles/show/126548-Zyprexa+Injury+Clock+Keeps+Ticking+Away Zyprexa Injury Clock Ticking Away] - Signs of the Times (2007) {{Antipsychotics}} <!--Categories--> [[Category:Atypical antipsychotics]] [[Category:Eli Lilly and Company]] [[Category:Thiophenes]] [[Category:Piperazines]] <!--Other languages--> [[da:Zyprexa]] [[de:Olanzapin]] [[es:olanzapina]] [[fr:Olanzapine]] [[it:Olanzapina]] [[hu:Olanzapin]] [[nl:Olanzapine]] [[ja:オランザピン]] [[pl:Olanzapina]] [[ru:Оланзапин]] [[fi:Olantsapiini]] [[sv:Olanzapin]] [[zh:奥氮平]]