Time to re-think the olanzapine dose

Nausea and vomiting associated with chemotherapy remains an area of unmet need for patients, despite substantial advancements in antiemetic research in the past 10 years. One such advancement is the use of olanzapine as an antiemetic drug. Olanzapine has been shown to significantly improve chemotherapy-induced nausea and vomiting when added to a standard triple combination of antiemetics, supported by evidence from Navari and colleagues' trials, but is currently a contentious issue, as the initial trials investigating 10 mg olanzapine showed it was associated with side-effects. Olanzapine added to triple combination therapy is already recommended by the American Society of Clinical Oncology and National Comprehensive Cancer Network antiemetic guidelines, whereas the Multinational Association of Supportive Care in Cancer and the European Society of Medical Oncology guidelines have made more cautious recommendations, all based on a 10 mg dose.