olanzapine
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.
What is Olanzapine (Zyprexa)?
What is Olanzapine (Zyprexa) used for?
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
How Olanzapine (Zyprexa) works
Olanzapine (Zyprexa) is an atypical antipsychotic. The way it works isn't well-understood, but it's thought to balance the levels of certain chemicals (dopamine and serotonin) in the brain. This can help control thoughts, mood, and behaviors.
Drug Facts
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What are the side effects of Olanzapine (Zyprexa)?
Common Side Effects
- Sleepiness (29%)
- Trouble sleeping (12%)
- Accidental injury (12%)
- Dizziness (11%)
- Weakness (10%)
- Dry mouth (9%)
- Constipation (9%)
- Upset stomach (7%)
- Runny nose (7%)
Other Side Effects
- Cough
- Fever
- Back pain
- Joint pain
- Tremors
- Weight gain
- Vomiting
Serious Side Effects
- Seizures
- Suicidal thoughts or actions
- Neuroleptic malignant syndrome: fever, sweating, stiff muscles, confusion, not aware of your surroundings, fast or irregular heartbeat
- Difficulty swallowing
- Dangerously high blood sugar: frequently thirsty, needing to urinate often, tiredness, nausea, vomiting, difficulty breathing, having fruity breath, having dry mouth
- Serious infections: fever, headache, chills, body aches, cough, weakness
- Serious allergic and skin reactions: hives, blisters, skin reddening or peeling, swelling of the lips or tongue, difficulty breathing
Source: DailyMed
More on Olanzapine (Zyprexa) side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Bloating or swelling of the face, arms, hands, lower legs, or feet
blurred vision
change in vision
change in walking and balance
clumsiness or unsteadiness
difficulty with speaking
difficulty with swallowing
impaired vision
inability to sit still
loss of balance control
mask-like face
muscle trembling, jerking, or stiffness
need to keep moving
rapid weight gain
restlessness
shuffling walk
slowed movements
slurred speech
stiffness of the arms and legs
tic-like (jerky) movements of the head, face, mouth, and neck
tingling of the hands or feet
trembling or shaking of the fingers, hands, feet, legs, or arms
twisting movements of the body
uncontrolled movements, especially of the face, neck, and back
unusual weight gain or loss
Less common
Bladder pain
bloody or cloudy urine
bruising
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
difficult or labored breathing
difficult, burning, or painful urination
dizziness
excessive muscle tone
frequent urge to urinate
headache
inability to move the eyes
increased blinking or spasms of the eyelid
itching of the vagina or genital area
lack of coordination
large, flat, blue, or purplish patches in the skin
loss of bladder control
loss of memory
lower back or side pain
muscle tension or tightness
nervousness
pain during sexual intercourse
pounding in the ears
problems with memory
rhythmic movement of the muscles
slow, fast, pounding, or irregular heartbeat or pulse
speaking is less clear than usual
sticking out the tongue
thick, white vaginal discharge with no odor or with a mild odor
tightness in the chest
twitching
uncontrolled twisting movements of the neck, trunk, arms, or legs
unusual or incomplete body or facial movements
weakness of the arms and legs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Acid or sour stomach
back pain
belching
change in personality
difficulty having a bowel movement (stool)
discouragement
feeling sad or empty
increased appetite
increased cough
indigestion
lack of appetite
lack or loss of strength
loss of interest or pleasure
stomach discomfort, upset, or pain
thirst
trouble sleeping
trouble with concentrating
watering of the mouth
Less common
Blemishes on the skin
body aches or pain
chills
cold sweats
congestion
dryness or soreness of the throat
false or unusual sense of well-being
heavy menstrual bleeding (periods)
hoarseness
joint pain
lack of feeling or emotion
leg cramps
pain in the arms or legs
sweating
tender, swollen glands in the neck
uncaring feelings
voice change
vomiting
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Olanzapine (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
Pharmacist tips for Olanzapine (Zyprexa)
You can take olanzapine (Zyprexa) with or without food, but if it's hurting your stomach, try taking your dose with food to help.
You can take olanzapine (Zyprexa) any time of the day. But since olanzapine (Zyprexa) typically causes sleepiness, ask your psychiatrist if you can take it in the evening or at night time.
Limit or avoid drinking caffeine or taking medications containing caffeine (e.g., Excedrin (acetaminophen / aspirin / caffeine)) while taking olanzapine (Zyprexa). This is because caffeine affects how well olanzapine (Zyprexa) is broken down in your body, which raises your risk for side effects.
Avoid drinking alcohol while taking olanzapine (Zyprexa) because it can worsen side effects, such as drowsiness and dizziness.
Don't change your dose or suddenly stop taking olanzapine (Zyprexa) without talking to your prescriber first. Doing so can cause withdrawal symptoms, such as nausea, vomiting, and dizziness. If you're interested in stopping the medication, contact your healthcare professional (HCP). They can help you do so safely by lowering your dose slowly over time.
Olanzapine (Zyprexa) can raise your blood sugar levels. If you have diabetes, ask your HCP if you need to check your blood sugar more often while taking olanzapine (Zyprexa).
Olanzapine (Zyprexa) can cause a drop in blood pressure when moving positions, such as from sitting to standing. This is more common when starting treatment and when your dose changes. Make sure to get up slowly and try to hold onto something for stability. If you end up falling or hitting your head, get medical help right away.
Although rare, olanzapine (Zyprexa) can cause difficulty swallowing, which can raise the risk for choking. Make sure to take small bites of food and eat slowly to lower your risk for choking.
Olanzapine (Zyprexa) can make it harder for your body to cool down if your body temperature gets too high. This makes it more likely for you to become dehydrated and your body to overheat. Let your HCP know if you feel very hot or thirsty, notice a change in the amount of sweat or urine you make, or if you notice very dark-colored urine.
Talk with your psychiatrist about the risks and benefits of taking olanzapine (Zyprexa) while pregnant. Studies suggest olanzapine (Zyprexa) doesn't raise the risk for miscarriage or birth defects. But it might cause pregnancy complications like gestational diabetes.
Ask your psychiatrist if it's okay to breastfeed while taking olanzapine (Zyprexa). Research shows olanzapine (Zyprexa) is found in small amounts in breastmilk. But more research is needed to understand how it might affect breastfed babies.
Frequently asked questions about Olanzapine (Zyprexa)
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What are the risks and warnings for Olanzapine (Zyprexa)?
Olanzapine (Zyprexa) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Higher risk of death in older people with dementia-related psychosis
Risk factors: Age 65 years and older with dementia and psychosis
People 65 years and older with dementia sometimes have symptoms of schizophrenia, like delusions and hallucinations (believing, seeing, or hearing things that aren't real). This is called dementia-related psychosis. Older people with dementia-related psychosis have a high risk of death if they take medications like olanzapine (Zyprexa). Because of this risk, olanzapine (Zyprexa) shouldn't be used in people 65 years and older with dementia-related psychosis. Let your prescriber know if you or your loved one has dementia before starting olanzapine (Zyprexa).
Worsening depression, suicidal thoughts and behavior
Risk factors: Age younger than 24 years old | History of depression or other mental health conditions
Having schizophrenia or bipolar I disorder can put people at risk for self-harm or suicidal thoughts. If you or anyone around you notice(s) that you have suicidal thoughts or behavior(s), get medical help right away.
Severe allergic skin reactions
Although rare, olanzapine (Zyprexa) can cause serious skin reactions, such as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). If you notice changes in your skin (e.g., rash, blisters, swollen lymph nodes, skin reddening, skin peeling) or experience swelling in your face or trouble breathing, stop using olanzapine (Zyprexa) and get medical attention right away.
Neuroleptic malignant syndrome
Taking antipsychotic medications like olanzapine (Zyprexa) can cause a rare, but life-threatening condition called neuroleptic malignant syndrome. Symptoms include fever, sweating, stiff muscles, confusion, not aware of your surroundings, and fast or irregular heartbeat. If you experience any of these symptoms while taking olanzapine (Zyprexa), get medication attention as soon as possible. Your prescriber will likely have you stop taking olanzapine (Zyprexa) and switch you to something else.
Weight gain, higher blood sugar, and higher cholesterol levels
Risk factors: Diabetes | High cholesterol | Obesity
Olanzapine (Zyprexa) can raise your blood sugar and cholesterol levels as well as raise your appetite, all of which can lead to weight gain. Your prescriber will likely order blood tests regularly throughout treatment with olanzapine (Zyprexa) to make sure your blood sugar and cholesterol aren't too high. Make sure to have a healthy and balanced diet low in fat and sugar and maintain a regular exercise routine while taking olanzapine (Zyprexa).
Difficulty controlling body movements
Taking antipsychotic medications like olanzapine (Zyprexa) can cause uncontrolled body movements, such as eye-twitching or lip-smacking. This is more likely to happen the longer you take medications like olanzapine (Zyprexa). This can become permanent if it's not caught in time. If you experience any uncontrolled movements and aren't able to stop them, talk to your healthcare professional right away.
Changes in blood pressure and higher risk of falls
Risk factors: Low blood pressure | Taking medications that lowers blood pressure | History of medical conditions that can lower blood pressure | High olanzapine (Zyprexa) doses
Olanzapine (Zyprexa) can make you tired, lower your blood pressure, or lose your balance, which can lead to falls. When standing from a sitting or lying position, make sure to get up slowly and hold onto something. If you experience a fall while taking olanzapine (Zyprexa), contact your healthcare professional.
Risk of infection (from low white blood cell count)
Risk factors: History of low blood cell counts
Though rare, olanzapine (Zyprexa) can lower your white blood cell counts (WBCs) and put you at risk for developing infections. You'll need to get blood tests done regularly during the first few months of taking olanzapine (Zyprexa) so your healthcare professional can make sure your WBCs are in a safe range. If your WBC count drops too low, you'll likely need to stop taking olanzapine (Zyprexa). If you develop any signs of infection, such as fever, tiredness, chills, cough, or trouble breathing, and they don't go away, contact your healthcare professional right away.
Seizures
Risk factors: History of seizures | Health conditions that make it easier to get seizures
Olanzapine (Zyprexa) can potentially cause seizures. Before starting this medication, let your healthcare professional know if you have a history of seizures or have a medical condition that puts you at risk for getting seizures.
High prolactin levels
Antipsychotics like olanzapine (Zyprexa) can raise the levels of prolactin in your body. High prolactin can lead to fertility problems, enlarged male breasts, sexual dysfunction, absence or irregular menstrual periods, and weak bones. Your healthcare professional will likely measure your prolactin levels during treatment to make sure they aren't too high.
Difficulty concentrating and extreme sleepiness
Risk factors: Taking high doses of olanzapine (Zyprexa) | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness
Olanzapine (Zyprexa) can cause extreme sleepiness and lower your ability to think, react, and focus. Your risk is higher if you're also taking other medications that can cause drowsiness, such as benzodiazepines, anxiety medications, muscle relaxants, and sleep medications. Make sure you know how this medication affects you before driving a car or doing activities that require your concentration. Talk to your healthcare professional right away if you feel too sleepy from taking olanzapine (Zyprexa).
Anticholinergic side effects
Olanzapine (Zyprexa) might cause anticholinergic side effects, including trouble urinating, constipation, and bowel movement problems. The risk of these side effects are higher if you're taking other anticholinergic medications, such as certain ones for treating overactive bladder or motion sickness. Before starting olanzapine (Zyprexa), ask your healthcare team to help you check for medication interactions.
Olanzapine (Zyprexa) dosage forms
Typical dosing for Olanzapine (Zyprexa)
Your psychiatrist will determine your dose of olanzapine (Zyprexa) based on your condition, how well the medication is helping your symptoms, and if you're having side effects.
Schizophrenia:
Age 18 years and older: The typical starting dose is 5 mg to 10 mg by mouth once daily. The typical maintenance dose is 10 mg to 20 mg once daily.
Age 13 years to under 18 years: The typical starting dose is 2.5 mg to 5 mg by mouth once daily. Your child's pediatrician will adjust their dose as needed.
Bipolar I disorder (mixed or manic episodes):
Age 18 years and older: The typical starting dose is 10 mg or 15 mg by mouth once daily. The typical maintenance dose ranges from 5 mg to 20 mg once daily. Your dose might differ if your psychiatrist is also prescribing lithium (Lithobid) or valproic acid.
Age 13 years to under 18 years: The typical starting dose is 2.5 mg to 5 mg by mouth once daily. Your child's pediatrician will adjust their dose as needed.
Depressive episodes of bipolar I disorder (with fluoxetine (Prozac)):
Age 18 years and older: The typical starting dose is 5 mg by mouth once daily in the evening. The typical recommended dose ranges from 5 mg to 12.5 mg once daily.
Age 10 years to under 18 years: The typical starting dose is 2.5 mg by mouth once daily. Your child's pediatrician will adjust their dose as needed.
Treatment-resistant depression (with fluoxetine (Prozac)):
Age 18 years and older: The typical starting dose is 5 mg by mouth once daily in the evening. The typical recommended dose ranges from 5 mg to 20 mg once daily.
Olanzapine (Zyprexa) is also available as an immediate-release injection that treats agitation from schizophrenia or bipolar disorder. It's only given by a healthcare professional (HCP), typically in a hospital or clinic setting.
More on Olanzapine (Zyprexa) dosage forms
Interactions between Olanzapine (Zyprexa) and other drugs
More on Olanzapine (Zyprexa) interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bepridil
- Bromopride
- Cisapride
- Dronedarone
- Levomethadyl
- Mesoridazine
- Metoclopramide
- Pimozide
- Piperaquine
- Saquinavir
- Sparfloxacin
- Terfenadine
- Thioridazine
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Alfentanil
- Alprazolam
- Amiodarone
- Amisulpride
- Anagrelide
- Apomorphine
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Benzhydrocodone
- Bromazepam
- Buprenorphine
- Buserelin
- Butorphanol
- Calcium Oxybate
- Cannabidiol
- Capmatinib
- Carbamazepine
- Ceritinib
- Cetirizine
- Chloroquine
- Clarithromycin
- Clobazam
- Clofazimine
- Clomipramine
- Clozapine
- Codeine
- Crizotinib
- Dabrafenib
- Dasatinib
- Degarelix
- Delamanid
- Deslorelin
- Deutetrabenazine
- Dihydrocodeine
- Donepezil
- Doxylamine
- Efavirenz
- Encorafenib
- Entrectinib
- Escitalopram
- Esketamine
- Fentanyl
- Fingolimod
- Flibanserin
- Fluconazole
- Fluoxetine
- Formoterol
- Foscarnet
- Fostemsavir
- Gabapentin
- Gabapentin Enacarbil
- Glasdegib
- Glucagon
- Glycopyrrolate
- Glycopyrronium Tosylate
- Gonadorelin
- Goserelin
- Histrelin
- Hydrocodone
- Hydromorphone
- Hydroxychloroquine
- Hydroxyzine
- Inotuzumab Ozogamicin
- Ivabradine
- Ivosidenib
- Ketamine
- Ketoconazole
- Lefamulin
- Lemborexant
- Lenvatinib
- Levocetirizine
- Levofloxacin
- Levorphanol
- Lithium
- Lofexidine
- Loxapine
- Macimorelin
- Magnesium Oxybate
- Meperidine
- Methacholine
- Methadone
- Metronidazole
- Milnacipran
- Mirtazapine
- Morphine
- Morphine Sulfate Liposome
- Moxifloxacin
- Nafarelin
- Nalbuphine
- Nilotinib
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxycodone
- Oxymorphone
- Ozanimod
- Panobinostat
- Pasireotide
- Pazopanib
- Pentazocine
- Periciazine
- Pimavanserin
- Pitolisant
- Pixantrone
- Ponesimod
- Posaconazole
- Potassium Oxybate
- Pregabalin
- Quetiapine
- Remifentanil
- Remimazolam
- Revefenacin
- Ribociclib
- Scopolamine
- Secretin Human
- Selpercatinib
- Sertraline
- Sevoflurane
- Siponimod
- Sodium Oxybate
- Solifenacin
- Sotalol
- Sufentanil
- Sulpiride
- Sunitinib
- Tacrolimus
- Tapentadol
- Tetrabenazine
- Tiotropium
- Tramadol
- Trazodone
- Triclabendazole
- Triptorelin
- Vandetanib
- Vemurafenib
- Vinflunine
- Voclosporin
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amprenavir
- Betel Nut
- Ciprofloxacin
- Fluvoxamine
- Fosamprenavir
- Haloperidol
- Ritonavir
- Valproic Acid
How much does Olanzapine (Zyprexa) cost?
What are alternatives to Olanzapine (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
Tourette syndrome in children
Depression (add-on treatment)
Irritability associated with autistic disorder in children
Schizophrenia in adults and children age 13 years and older
Bipolar disorder in adults and children age 10 years and older
Add-on to antidepressants for depression (extended-release only)
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References
Best studies we foundAmerican Regent, Inc. (2020). OLANZAPINE injection, powder, lyophilized, for solution [package insert]. DailyMed.
Drugs and Lactation Database (LactMed). (2022). Olanzapine. National Institute of Child Health and Human Development.
Eli Lilly and Company. (2023). ZYPREXA- olanzapine tablet ZYPREXA ZYDIS- olanzapine tablet, orally disintegrating ZYPREXA INTRAMUSCULAR- olanzapine injection, powder, for solution [package insert]. DailyMed.
Koran, L.M., et al. (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. American Psychiatric Association.
Lieberman, J. A., et al. (2005). Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia. The New England Journal of Medicine.
National Cancer Institute. (2020). Olanzapine Reduces Nausea and Vomiting Caused by Advanced Cancer.
Simon, L. V., et al. (2023). Neuroleptic Malignant Syndrome. StatPearls.
Stein, M.B., et al. (2009). PRACTICE GUIDELINE FOR THE Treatment of Patients With Panic Disorder. American Psychiatric Association.
Strawn, J.R., et al. (2018). Pharmacotherapy for Generalized Anxiety Disorder in Adults and Pediatric Patients: An Evidence-Based Treatment Review. Expert Opinion on Pharmacotherapy.
Stroup, T. S., et al. (2018). Management of common adverse effects of antipsychotic medications. World Psychiatry.
Zhang, X., et al. (2022). Olanzapine for the Prevention and Treatment of Chemotherapy-Induced Nausea and Vomiting: A Review to Identify the Best Way to Administer the Drug. Current Oncology.
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