Zyprexa vs. Reglan for Bipolar Disorder and Heartburn: Important Differences and Potential Risks.

Key takeaways

Olanzapine (Zyprexa) and metoclopramide (Reglan) are both medications that can be used to treat nausea, although this is an off-label use for olanzapine. Olanzapine is an atypical antipsychotic primarily used for schizophrenia and bipolar disorder, while metoclopramide is a dopamine antagonist used for gastroesophageal reflux disease (GERD) and diabetic gastroparesis. Olanzapine is available in oral and injectable forms, whereas metoclopramide is available in various forms, including tablets, liquid, nasal spray, and injection. Olanzapine is typically taken once daily, while metoclopramide is taken multiple times a day, usually before meals and at bedtime. Common side effects of olanzapine include sleepiness and weight gain, while metoclopramide can cause drowsiness and restlessness. Both medications can cause serious side effects like neuroleptic malignant syndrome and difficulty controlling body movements. Both medications are available as a lower-cost generic.

Olanzapine

(Zyprexa)

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Metoclopramide

(Reglan)

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Summary for Zyprexa

Prescription only

Olanzapine (Zyprexa) is an atypical antipsychotic used treat schizophrenia or bipolar disorder. It can also treat depression, in combination with fluoxetine (Prozac), when other treatments haven't worked well. This medication is thought to work by balancing the levels of certain chemicals in the brain. Olanzapine (Zyprexa) is taken by mouth, typically once daily, by adults and children. Olanzapine (Zyprexa) is also available as an injection that's usually given in a hospital or clinic setting. Some of the more common side effects of olanzapine (Zyprexa) include sleep problems, dizziness, and weight gain.

Indications for Zyprexa

Schizophrenia in adults and children age 13 years and older
Bipolar I disorder in adults and children age 13 years and older

When taken with fluoxetine (Prozac):

Bipolar depression in adults and children age 10 years and older
Depression that hasn't responded well to other treatments

Pros and Cons for Zyprexa

Pros

Taken by mouth
Taken once daily
Might notice an improvement in your symptoms in as early as a week of starting olanzapine (Zyprexa)
Available as a lower-cost generic

Cons

Can cause anticholinergic side effects, such as constipation and dry mouth
Can affect your sleep
More likely to cause weight gain, high blood cholesterol, and high blood sugar levels compared to some other atypical antipsychotics

Common Side Effects for Zyprexa

Sleepiness (29%)
Trouble sleeping (12%)
Accidental injury (12%)
Dizziness (11%)
Weakness (10%)
Dry mouth (9%)
Constipation (9%)
Upset stomach (7%)
Runny nose (7%)

Warnings for Zyprexa

Higher risk of death in older people with dementia-related psychosis
Worsening depression, suicidal thoughts and behavior
Severe allergic skin reactions
Neuroleptic malignant syndrome
Weight gain, higher blood sugar, and higher cholesterol levels
Difficulty controlling body movements
Changes in blood pressure and higher risk of falls
Risk of infection (from low white blood cell count)
Seizures
High prolactin levels
Difficulty concentrating and extreme sleepiness
Anticholinergic side effects

Summary for Reglan

Prescription only

Metoclopramide (Reglan) is FDA-approved to treat gastroesophageal reflux disease (GERD), as well as gastroparesis in people with diabetes. Providers might also prescribe it off-label for morning sickness during pregnancy and nausea and vomiting caused by chemotherapy. But metoclopramide (Reglan) isn’t a first-choice medication for these conditions because it has a black box warning for a serious side effect called tardive dyskinesia. Metoclopramide (Reglan) can interact with some commonly prescribed medications, such as risperidone (Risperdal) and quetiapine (Seroquel).

Indications for Reglan

Delayed stomach-emptying caused by diabetes (diabetic gastroparesis)
Severe acid reflux (gastroesophageal reflux disease or GERD) when other medications haven’t worked

Pros and Cons for Reglan

Pros

Available as a lower-cost generic medication
Available in many forms including tablet, fast-melting tablet, liquid, nasal spray, and injection
Typically starts to work in 30 minutes to 1 hour
A possible option during pregnancy

Cons

Shouldn’t be used in children or for more than 12 weeks because of a higher risk of serious side effects
Needs to be taken multiple times a day
Interacts with a lot of medications such as antipsychotics, antidepressants, and opioids
Can't be used if you have Parkinson's disease, seizures, or stomach blockages or bleeds

Common Side Effects for Reglan

Restlessness (10%)
Drowsiness (10%)
Lack of energy (10%)
Tiredness (10%)

Warnings for Reglan

Difficulty controlling muscle movements (tardive dyskinesia)
Other conditions with uncontrolled muscle movements (dystonia, Parkinsonian symptoms, and restlessness)
Neuroleptic malignant syndrome (NMS)
Depression and suicidal thoughts and behavior
High blood pressure
Swelling in arms, legs, or around the belly
High prolactin levels