Medication Safety Issues
OLANZapine may be confused with olsalazine, QUEtiapine
ZyPREXA may be confused with CeleXA, Reprexain, Zestril, ZyrTEC
ZyPREXA Zydis may be confused with Zelapar, zolpidem, zapelon
ZyPREXA Relprevv may be confused with ZyPREXA IntraMuscular
Beers Criteria: Antipsychotics are identified in the Beers Criteria as potentially inappropriate medications to be avoided in patients 65 years and older due to an increased risk of stroke and a greater rate of cognitive decline and mortality in patients with dementia. Evidence also suggests there may be an increased risk of mortality with use independent of dementia. Avoid antipsychotics for behavioral problems associated with dementia or delirium unless alternative nonpharmacologic therapies have failed and patient may harm self or others. In addition, antipsychotics should be used with caution in older adults due to their potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium closely with initiation or dosage adjustments in older adults. Use of antipsychotics may be appropriate for labeled indications including schizophrenia, bipolar disorder, Parkinson disease psychosis, adjunctive therapy in major depressive disorder, or for short-term use as an antiemetic (Beers Criteria [AGS 2023]).
Antipsychotics are identified in the Screening Tool of Older Person's Prescriptions (STOPP) criteria as a potentially inappropriate medication in older adults (≥65 years of age) with a history of recurrent falls due to an increased risk of falls. Initiation is not recommended for treatment of sleep disorder. Some disease states of concern include dementia, parkinsonism, dysphagia, benign prostatic hyperplasia, urinary retention, and coronary, cerebral, or peripheral vascular disease (O’Mahony 2023).
KIDs List: Olanzapine, when used long term (>24 weeks) in pediatric patients <18 years of age, is identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list and should be used with caution due to risk of metabolic syndrome (weight gain, hyperlipidemia, hyperglycemia) (strong recommendation; high quality of evidence) (PPA [Meyers 2020]).