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What is maximum dose of olanzapine drug? My sister is at hospital and she was treated with 20mg of olanzapine and now it was raised to 25mg.

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The manufacturer’s prescribing information (a.k.a. package insert) provides recommended dosing based on safety and efficacy data obtained during the drug development and approval process. It indicates that 10 mg/day is a “normal” target dose for most indications. A higher dose of 15 mg/day is appropriate in acute manic episodes. In the portion of the PI discussing safety data, it refers to the “maximum” dose as 20 mg/day.

There have been reports of using up to 60 mg daily in cases of treatment-resistant schizophrenia, but this is rare and the data supporting it are weak.1

In the course of normal clinical practice, including care of many psychiatric patients on atypical antipsychotics, I have never seen doses above 20 mg daily used. It is rarely used in twice daily dosing due to the long half-life of ~30 hours (as described in the PI).

  1. Lehman AF, Lieberman JA, Dixon LB, et al, American Psychiatric Association, Steering Committee on Practice Guidelines. Practice guidelines for the treatment of patients with schizophrenia, second edition. Am J Psychiatry. 2004;161(2 Suppl):1-56.
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  • "For the rapid control of agitation and disturbed behaviour in patients with schizophrenia or mania olanzapine may be given intramuscularly in an initial dose of 5 to 10 mg, followed by 5 to 10 mg as required after 2 hours. Not more than three injections should be given in any 24-hour period and the maximum daily dose, including olanzapine given by mouth, should not exceed 20 mg. Parenteral administration may be used for up to a maximum of 3 days but transfer to oral therapy should be initiated as soon as possible." Martindale: The Complete Drug Reference 34th edition agrees with you :-) – Lucky Jul 7 '15 at 14:11
  • Does Lilly give a reason why? Can this maybe cause brain damage or insomnia or other issues? – William May 2 '18 at 16:31

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