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ZypAdhera ® (olanzapine pamoate monohydrate)
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What are the precautions during administration that help prevent a post injection syndrome with ZypAdhera® (olanzapine pamoate)?
Olanzapine pamoate is for deep intramuscular gluteal injection only. Do not administer intravenously or subcutaneously.
Precautions during administration
Olanzapine pamoate should only be administered by deep intramuscular gluteal injection by a healthcare professional trained in the appropriate injection technique and in locations where post-injection observation and access to appropriate medical care in the case of overdose can be assured.1
After insertion of the needle, aspirate for several seconds to ensure no blood appears. If any blood is drawn into the syringe, discard the syringe and the dose and begin reconstitution and administration procedure again.
The injection should be performed with steady, continuous pressure. Do not massage the injection site.1
If blood was visible, the new reconstituted dose should be injected into the alternate buttock, deep into the gluteal muscle.2
The ventrogluteal site is preferred for intramuscular (IM) injections to decrease risk of accessing the sciatic nerve or major blood vessel. Administration at this site also maximizes the likelihood of achieving an IM injection, as opposed to an accidental subcutaneous injection.3,4
It is important to note that proper injection technique does not guarantee that a blood vessel injury has not occurred during the injection.2
Precautions after administration
After each injection, patients should be observed in a health care facility by appropriately qualified personnel for at least 3 hours for signs and symptoms consistent with olanzapine overdose.1
Immediately prior to leaving the health care facility, it should be confirmed that the patient is alert, oriented, and absent of any signs and symptoms of overdose.1
If an overdose is suspected, close medical supervision and monitoring should continue until examination indicates that signs and symptoms have resolved.1
The 3-hour observation period should be extended as clinically appropriate for patients who exhibit any signs or symptoms consistent with olanzapine overdose.1
1ZypAdhera [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.
2Detke HC, McDonnell DP, Brunner E, et al. Post-injection delirium/sedation syndrome in patients with schizophrenia treated with olanzapine long-acting injection, I: analysis of cases. BMC Psychiatry. 2010;10(1):43. http://dx.doi.org/10.1186/1471-244X-10-43
3Beyea SC, Nicoll LH. Administration of medications via the intramuscular route: an integrative review of the literature and research-based protocol for the procedure. Appl Nurs Res. 1995;8(1):23-33. http://dx.doi.org/10.1016/S0897-1897(95)80279-7
4Workman B. Safe injection techniques. Nurs Stand. 1999;13(39):47-53. http://dx.doi.org/10.7748/ns1999.06.13.39.47.c2623
Date of Last Review: 12 December 2022