Perinatal EvidenceCompass
Prepopulated workbenchMED-136

Emergency agitation — short-acting formulations

Olanzapine short-acting intramuscular

Short-acting formulation used in emergency agitation or acute symptom management

Brand / product examples: Zyprexa IntraMuscular

Not a categorical safety rating

This record organizes questions; it does not close them.

The clinical fields and position statements are prepopulated from the public-source corpus. They have not completed individual dual extraction, formal appraisal, exact-label reconciliation, or multidisciplinary sign-off. Do not use this page to justify abrupt discontinuation or reflexive switching.

Inventory identity

What this record represents

Canonical generic name
Olanzapine short-acting intramuscular
Entity type
single-ingredient drug
Active component(s)
Olanzapine
Formulation / route / interval
Short-acting intramuscular injection
Attachment entry
Olanzapine — IM emergency use
Separate monograph status
Yes — route-specific acute formulation
Identity and cross-reference
Cross-reference oral olanzapine and olanzapine pamoate LAI; not interchangeable
Inventory verification confidence
Moderate — molecule-level source; exact product/jurisdiction pending

Decision taxonomy

Five positions kept separate

These are workbench statements for reviewer execution. They are not independently commissioned, patient-specific recommendations.

  1. 01

    Stable continuation

    Workbench statement

    Do not withhold or discontinue solely because of pregnancy or lactation. For this record, assess indication, prior response, relapse severity, dose/formulation, alternatives, exposure timing, and mapped evidence; individual commissioned adjudication remains pending.

  2. 02

    New initiation in pregnancy

    Workbench statement

    For a new start, prefer an effective option with the strongest diagnosis-specific efficacy and reproductive evidence when clinically suitable. This record has not received an individual, independently verified initiation ranking.

  3. 03

    Switch before conception

    Workbench statement

    Before conception, consider a switch only when expected benefit exceeds relapse, withdrawal, failed-switch, and dual-exposure risks. Build and monitor the plan before pregnancy when feasible; no universal switch direction is assigned here.

  4. 04

    Unplanned exposure

    Workbench statement

    After unplanned exposure, confirm product, route, dose, timing, indication, co-exposures, and symptoms; do not advise abrupt cessation. Use the mapped evidence and current label to decide whether any targeted fetal assessment is indicated.

  5. 05

    Delivery, postpartum & lactation

    Workbench statement

    Create separate delivery, postpartum-dose, neonatal-observation, and lactation plans. Do not infer breastfeeding suitability from pregnancy evidence or routinely taper before delivery without drug-specific support.

Linked evidence

9 mapped claim summaries

Mapping can include class-wide, framework, formulation, regulatory, or evidence-gap claims. A linked claim is not necessarily a drug-specific causal estimate.

B-033Provisional public source

Large adjusted cohorts do not show a meaningful overall increase in major congenital malformations for antipsychotics as a class.

Public-source certainty descriptor
moderate—large adjusted cohorts
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
first trimester
Comparator
no antipsychotic exposure
Effect or numbers carried forward

Huybrechts: atypical adjusted RR 1.05 (95% CI 0.96–1.16); typical adjusted RR 0.90 (0.62–1.31)

Limitations

Contextual class evidence only; do not treat the class point estimates as drug-, route-, fixed-combination-, emergency-formulation-, or LAI-specific estimates. Class averages can hide rare drug-specific effects; confounding, live-birth selection, and exposure misclassification remain.

Sources, citation controls, and verification state
PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
B-035Provisional public source

An olanzapine–oral-cleft association in a Nordic/US study was unstable and hypothesis generating.

Public-source certainty descriptor
low—rare outcome and inconsistent sensitivity analyses
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
first trimester
Comparator
no antipsychotic exposure
Effect or numbers carried forward

Adjusted RR approximately 2.1 (95% CI 1.1–4.3), attenuated/unstable in sensitivity analyses

Limitations

Rare event, multiple comparisons, residual confounding, and no formulation-specific estimate.

Sources, citation controls, and verification state
PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
B-037Provisional public source

ACOG recommends gestational-diabetes screening for pregnant patients using antipsychotics consistent with standard prenatal care.

Public-source certainty descriptor
guideline recommendation
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
pregnancy
Comparator
standard prenatal care
Effect or numbers carried forward

No special early-screening effect estimate established

Limitations

Evidence linking exposure to GDM is heterogeneous and confounded.

Sources, citation controls, and verification state
PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
B-038Provisional public source

Neonatal EPS or withdrawal/adaptation signs have been reported after third-trimester antipsychotic exposure.

Public-source certainty descriptor
regulatory class warning; absolute risk unknown
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
third trimester/near delivery
Comparator
no late antipsychotic exposure
Effect or numbers carried forward

Reported signs include agitation, hypertonia or hypotonia, tremor, somnolence, respiratory distress, and feeding disorder; severity and duration vary, and no reliable incidence is available.

Limitations

Spontaneous reports, co-medications, illness severity, and no reliable denominator; Cobenfy is mechanistically distinct and excluded from this class claim.

Sources, citation controls, and verification state

Linked sources

PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
B-046Provisional public source

Olanzapine has comparatively substantial lactation experience with generally low infant serum exposure.

Public-source certainty descriptor
low-to-moderate—case series and PK reports
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
lactation
Comparator
other antipsychotics with less milk data
Effect or numbers carried forward

Infant serum often undetectable; occasional sedation or abnormal movements reported

Limitations

Healthy-term selection and limited high-dose/LAI infant data.

Sources, citation controls, and verification state
PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
B-059Provisional public source

ACOG identifies haloperidol or olanzapine with lorazepam as acute pharmacotherapy options for postpartum psychosis while awaiting lithium response.

Public-source certainty descriptor
guideline recommendation
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
acute postpartum psychosis
Comparator
no acute treatment/other emergency regimen
Effect or numbers carried forward

No comparative pregnancy effect estimate

Limitations

Postpartum emergency guidance is not a fetal-malformation study; regimen must fit medical status, sedation, QT, and feeding plans.

Sources, citation controls, and verification state
PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
B-062Provisional public source

A short-acting emergency route changes onset and maternal monitoring but does not create separate reassuring reproductive evidence.

Public-source certainty descriptor
very low for fetal comparison; high for route distinction
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
acute pregnancy or postpartum emergency exposure
Comparator
oral maintenance exposure
Effect or numbers carried forward

No comparative fetal-safety estimate by IM/IV route

Limitations

Emergency cohorts are confounded by severe agitation, restraint, co-sedatives, and medical instability.

Sources, citation controls, and verification state
PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
B-063Provisional public source

A stable patient should not be switched reflexively after conception solely to use a medicine with more pregnancy data.

Public-source certainty descriptor
guideline recommendation
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
after conception
Comparator
continuing an effective regimen
Effect or numbers carried forward

No single effect estimate; relapse and fetal polypharmacy tradeoff

Limitations

Important exceptions include valproate and compelling toxicity/ineffectiveness; individual history controls the decision.

Sources, citation controls, and verification state
PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
B-064Provisional public source

If an antipsychotic was effective throughout pregnancy, routine postpartum switching solely for lactation is usually discouraged.

Public-source certainty descriptor
guideline recommendation
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
postpartum/lactation
Comparator
switching to a different agent
Effect or numbers carried forward

No single effect estimate

Limitations

Clozapine, milk-supply goals with aripiprazole, infant prematurity/illness, and long-lived/LAI exposure may change the decision.

Sources, citation controls, and verification state
PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending