Q: Olanzapine (trade = Zyprexa) is a commonly used drug in ICU for various reasons including delirium and psychosis. In which subset of patients, it may not work or require higher dose?
Answer: Olanzapine after oral dose is removed by the hepatic first-pass effect. Patients who are smoker have increase activity of CYP1A2, and may significantly increase the hepatic first-pass clearance of Olanzapine.
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