Discontinuation of Olanzapine

Introduction to Tapering

The American College of Oncology recommends reducing the dose in older patients and those with hepatic impairment when discontinuing olanzapine treatment 1
The American Medical Association suggests that if a patient is on benzodiazepines, these may need separate tapering protocols when discontinuing olanzapine treatment 2
Caution is advised when combining olanzapine with benzodiazepines due to the risk of oversedation and respiratory depression, as recommended by the American College of Oncology 1

A hyperbolic tapering schedule is recommended to minimize the risk of relapse and withdrawal symptoms, with a reduction of 25% of the most recent dose every 3-4 weeks for standard doses (5-20 mg/day) 1
For high doses (>20 mg/day), evidence shows that most patients can be successfully reduced to standard doses using 25% reductions every 3-4 weeks, then followed by the standard dose tapering protocol 1
The tapering schedule may need to be slowed if withdrawal symptoms emerge, with consideration of smaller reductions (10-15% of the most recent dose) for patients experiencing difficulty 1

Patients should be monitored weekly during the first month of tapering, every 2 weeks during subsequent months, and more frequently if symptoms emerge, as recommended by the American Medical Association 2
Patients with treatment-resistant schizophrenia may require slower tapering, and those with a history of relapse with previous discontinuation attempts need closer monitoring 1
Consider longer intervals between dose reductions (4-6 months) for patients with a history of multiple relapses, as suggested by the American College of Oncology 1

Rebound psychosis or anxiety, insomnia, nausea, vomiting, diarrhea, movement disorders (including emergence of tardive dyskinesia), and autonomic symptoms (sweating, tachycardia) are potential risks and complications of olanzapine discontinuation 1
Mistaking withdrawal symptoms for relapse could lead to unnecessary reinstatement of higher doses, and failing to monitor for emergence of tardive dyskinesia may become apparent during withdrawal 2