Olanzapine structure

Drug of the Month:
Olanzapine (Zyprexa)

Some benefit, many harms



Biological mechanism

Olanzapine is a dopamine blocker with potent D2 receptor blockade, along with strong anticholinergic effects.  The D2 blockade is dose dependent, such that at 10-20 mg/d, over 90% of D2 receptors are blocked.  This level of D2 blockade produces extrapyramidal symptoms (EPS) such as parkinsonian tremor and ridigity, and akathisia.  The parkinsonian effects are somewhat mitigated by this agent’s anticholinergic properties, but the latter cause...  

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