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Zyprexa Relprevv

olanzapine
Used for Schizophrenia
Used for Schizophrenia

Zyprexa Relprevv (olanzapine) is an atypical antipsychotic. It's a long-acting injection used to treat schizophrenia in adults. This medication is injected into the muscle, typically every 2 to 4 weeks, by a healthcare provider in a clinic setting. Some of the more common side effects of this medication include weight gain, nausea, and making you more sleepy.

Last reviewed on January 2, 2024
basics-icon

What is Zyprexa Relprevv (olanzapine)?

What is Zyprexa Relprevv (olanzapine) used for?

How Zyprexa Relprevv (olanzapine) works

Zyprexa Relprevv (olanzapine) is an atypical antipsychotic. It's thought to work by balancing out the levels of chemicals (dopamine and serotonin) in the brain to help control thoughts and behaviors.

Are you looking for information on olanzapine tablets (Zyprexa) instead?

Drug Facts

Common BrandsZyprexa Relprevv
Drug ClassAtypical antipsychotic
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only

More on Zyprexa Relprevv (olanzapine) essentials

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What are the side effects of Zyprexa Relprevv (olanzapine)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Headache (up to 18%)
  • Sleepiness (up to 13%)
  • Cough (up to 9%)
  • Nasal congestion (up to 7%)
  • Weight gain (up to 7%)
  • Diarrhea (up to 7%)
  • Dry mouth (up to 6%)
  • Runny nose and sore throat (up to 6%)
  • More appetite (up to 6%)
  • Vomiting (up to 6%)
  • Back pain (up to 5%)
  • Nausea (up to 5%)

Other Side Effects

  • Stomach pain
  • Pain at injection site
  • Upper respiratory tract infection
  • Joint pain
  • Muscle stiffness
  • Muscle spasms
  • Dizziness
  • Restlessness
  • Ear pain
  • Toothache
  • Tiredness
  • Vaginal discharge

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Post-injection delirium sedation syndrome (PDSS): sleepiness, confusion, disorientation, agitation, uncontrollable movements, trouble talking or walking, aggression, dizziness, weakness, high blood pressure, and seizures
  • Seizures
  • Suicidal ideation or thoughts of self-harm
  • 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, fruity breath, 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

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 or nurse 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

drooling

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

shakiness in the legs, arms, hands, or feet

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, or feet

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

chest pain

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, redness, and swelling at the injection site

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

trouble with breathing, speaking, or swallowing

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

fever

heartburn

increased appetite

increased cough

indigestion

lack of appetite

lack or loss of strength

loss of interest or pleasure

runny nose

sneezing

stomach discomfort, upset, or pain

stuffy nose

thirst

trouble sleeping

trouble with concentrating

watering of the mouth

weight gain

Less common

Body aches or pain

chills

cold sweats

congestion

cough

dry skin

dryness or soreness of the throat

false or unusual sense of well-being

heavy menstrual bleeding

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

Pros and cons of Zyprexa Relprevv (olanzapine)

thumbs-up

Pros

Given once every 2 to 4 weeks, depending on the dose

Good choice for people who don't want to take medications by mouth

thumbs-down

Cons

Must be given as an injection into the buttocks muscle by a healthcare provider

Need to be monitored for at least 3 hours after each injection for severe sleepiness

pharmacist-tips

Pharmacist tips for Zyprexa Relprevv (olanzapine)

pharmacist
  • Make sure to mark your appointments in your calendar to see your provider and receive your Zyprexa Relprevv (olanzapine) doses so you don't miss any of your doses.

    • You'll need to stay at the clinic where you receive Zyprexa Relprevv (olanzapine) for about 3 hours after each injection. This is so you can be monitored for extreme sleepiness or confusion (delirium) after the injection and get medical attention if needed.

      • Make arrangements to have someone drive you home after the Zyprexa Relprevv (olanzapine) injection. You shouldn't drive or do anything that requires focus or concentration on the days you receive the medication because of the risk of sleepiness and dizziness.

        • Zyprexa Relprevv (olanzapine) interacts with a lot of commonly prescribed medications. For example, Zyprexa Relprevv (olanzapine) can affect blood pressure, so your provider might need to adjust the dose of blood pressure medications if you're taking any.

          • Avoid alcohol while taking Zyprexa Relprevv (olanzapine) because it can worsen side effects (e.g., drowsiness, dizziness, low blood pressure) as well as worsen your schizophrenic symptoms.

            • Zyprexa Relprevv (olanzapine) can raise your blood sugar levels. If you have diabetes, ask your provider if you need to check your blood sugar more often while taking Zyprexa Relprevv (olanzapine).

              • Zyprexa Relprevv (olanzapine) can raise cholesterol (fat) levels in your blood and can cause weight gain. It's important that you eat a healthy and balanced diet low in fat and sugar and maintain a regular exercise routine while taking Zyprexa Relprevv (olanzapine).

                • Zyprexa Relprevv (olanzapine) 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, seek medical help right away.

                  • Although rare, Zyprexa Relprevv (olanzapine) 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.

                    • Drink water to stay hydrated, especially if you're out in the sun or exercising. Be careful if you're traveling to a place that is very hot. This is because Zyprexa Relprevv (olanzapine) might make it hard for your body to maintain a normal body temperature.

                      faqs

                      Frequently asked questions about Zyprexa Relprevv (olanzapine)

                      How long does it take Zyprexa Relprevv (olanzapine) to kick in?
                      Even though studies have shown Zyprexa Relprevv (olanzapine) gets into your bloodstream within a few hours, it can take about 1 week for Zyprexa Relprevv (olanzapine) to fully kick in. The effects of the medication typically last for about 1 month.
                      Is Zyprexa Relprevv (olanzapine) a controlled substance?
                      No, Zyprexa Relprevv (olanzapine) isn't a controlled substance because it doesn't have a risk of misuse or dependence.
                      Is Zyprexa Relprevv (olanzapine) a benzodiazepine?
                      No, Zyprexa Relprevv (olanzapine) isn't a benzodiazepine; it's an atypical antipsychotic.
                      Does Zyprexa Relprevv (olanzapine) cause weight gain
                      Yes, it's possible to gain weight from taking Zyprexa Relprevv (olanzapine). You might start to notice weight gain within the first few weeks of starting the medication. It might take 4 to 9 months for changes in weight to stabilize. The amount of weight you can gain is hard to predict because it'll depend on your dose and how long you're taking Zyprexa Relprevv (olanzapine) for. In studies, adults taking oral olanzapine (Zyprexa) for 6 weeks gained an average of 6 lbs. To lower your risk for weight gain while taking Zyprexa Relprevv (olanzapine), make sure to have a healthy diet and regular exercise routine. Let your provider know if you have more questions about Zyprexa Relprevv (olanzapine) and weight gain.
                      Does Zyprexa Relprevv (olanzapine) make you sleepy?
                      Yes, sleepiness is one of the more common side effects of Zyprexa Relprevv (olanzapine). Make sure to tell your provider if you're taking other medications that cause sleepiness. Also, it's best to avoid alcohol because it can make you more sleepy and dizzy. Contact your provider if you feel too sleepy during the day to the point where it's interfering with your daily activities. They might recommend tips to try and cope, or they might lower your Zyprexa Relprevv (olanzapine) dose.
                      Does Zyprexa Relprevv (olanzapine) help with anxiety?
                      Zyprexa Relprevv (olanzapine) isn't FDA-approved for the treatment of anxiety. But some studies that suggest olanzapine might help with anxiety. Talk to your provider about available treatment options for anxiety.
                      What is the Zyprexa Relprevv Patient Care Program?
                      The Zyprexa Relprevv Patient Care Program is a special program you need to enroll in before you can receive Zyprexa Relprevv (olanzapine) injections. This is because this medication can cause extreme sleepiness and delirium after each injection, which can be life-threatening. Your healthcare provider, the clinic where you'll get your injections, and the pharmacy that delivers Zyprexa Relprevv (olanzapine) to the clinic all must register with this program so that they're aware of these risks. Please be aware that you'll need to stay at the clinic for at least 3 hours after each injection so that the clinic staff can monitor you for extreme sleepiness and delirium and give you medical help if needed.
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                      warings-icon

                      What are the risks and warnings for Zyprexa Relprevv (olanzapine)?

                      Zyprexa Relprevv (olanzapine) 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.

                      risk-warning

                      Extreme sleepiness and delirium after injection

                      Though rare, there has been reports of people experiencing extreme sleepiness (sedation), coma, and confusion (delirium) after getting Zyprexa Relprevv (olanzapine). This is called post-injection delirium/sedation syndrome and it can be life-threatening. Because of this risk, you, your provider, the clinic where you get treatment, and the pharmacy that delivers Zyprexa Relprevv (olanzapine) to your clinic, must all be enrolled in a special program called the Zyprexa Relprevv Patient Care Program. After your injection, you'll be monitored for at least 3 hours at the clinic for symptoms. If needed, you'll be able to get medical attention right away.

                      When your provider thinks its safe for you to leave the clinic, a caregiver must go with you. You can't go home by yourself because there's still a possible risk of being extremely sleepy. Don't drive or do anything that requires a lot of focus or attention for the rest of the day. Get medical help right away if you experience symptoms, such as sleepiness, confusion, anxiety, uncontrollable movements, slurred speech, dizziness, weakness, high blood pressure, and seizures.

                      risk-warning

                      Higher risk of death in older people with dementia-related psychosis

                      • Risk factors: Age 65 years and older with dementia and psychosis

                        Older adults who also have dementia sometimes have some of the symptoms of schizophrenia, like hallucinations and delusions. This is called dementia-related psychosis, and it shouldn't be treated with Zyprexa Relprevv (olanzapine). Older people with dementia-related psychosis have a high risk of death if they take medications like Zyprexa Relprevv (olanzapine). Because of this risk, Zyprexa Relprevv (olanzapine) shouldn't be used in people 65 years and older with dementia-related psychosis. Let your provider know if you or your loved one has dementia before starting Zyprexa Relprevv (olanzapine).

                        risk-warning

                        Worsening depression, suicidal thoughts and behavior

                        Having schizophrenia can put people at risk for self-harm or suicidal thoughts. If you or anyone around you notice that you have suicidal thoughts or behavior, get medical help right away.

                        risk-warning

                        Severe allergic skin reactions

                        Although rare, Zyprexa Relprevv (olanzapine) 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, get medical attention right away.

                        risk-warning

                        Neuroleptic malignant syndrome

                        Taking antipsychotic medications like Zyprexa Relprevv (olanzapine) can cause a rare, but life-threatening condition called neuroleptic malignant syndrome (NMS). 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 Zyprexa Relprevv (olanzapine), get medical attention as soon as possible. Your provider will likely have you stop taking Zyprexa Relprevv (olanzapine) and switch you to something else.

                        risk-warning

                        High blood sugar, high cholesterol, and weight gain

                        • Risk factors: History of diabetes | History of high cholesterol

                          Zyprexa Relprevv (olanzapine) can raise your blood sugar levels. Rarely, it can reach dangerous levels resulting in coma or death. Let your provider know if you have symptoms of high blood sugar, such as feeling very hungry or thirsty, urinating more often, stomach pain, weakness, or fruity-smelling breath.

                          Zyprexa Relprevv (olanzapine) can also cause high cholesterol levels and weight gain. Your provider might check your weight and order blood tests regularly to make sure your blood sugar, cholesterol, and weight aren't too high.

                          risk-warning

                          Difficulty controlling body movements

                          Zyprexa Relprevv (olanzapine) can cause uncontrolled and possibly permanent muscle movements in the tongue, face, mouth, lips, neck, hands, arms, legs, and feet (tardive dyskinesia). To lower your risk of tardive dyskinesia, your provider will have you take the lowest dose that treats your symptoms. Get medical help right away if you notice any unusual movements you can't control. This side effect can sometimes occur even after you stop the medication.

                          risk-warning

                          Changes in blood pressure and higher risk of falls

                          • Risk factors: Low blood pressure | Taking medications that lower blood pressure | History of medical conditions that can lower blood pressure | High Zyprexa Relprevv (olanzapine) doses

                            Zyprexa Relprevv (olanzapine) can make you tired, lower your blood pressure, or cause you to 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 Zyprexa Relprevv (olanzapine), contact your provider.

                            risk-warning

                            Risk of infection (from low white blood cell count)

                            • Risk factors: History of low blood cell counts

                              Though rare, Zyprexa Relprevv (olanzapine) 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 Zyprexa Relprevv (olanzapine) so your provider can make sure your WBCs are in a safe range. If your WBC count drops too low, you'll likely need to stop taking Zyprexa Relprevv (olanzapine). If you develop any signs of infection, such as fever, tiredness, chills, cough, or trouble breathing, and they don't go away, contact your provider right away.

                              risk-warning

                              Seizures

                              • Risk factors: History of seizures | Health conditions that make it easier to get seizures

                                Zyprexa Relprevv (olanzapine) can potentially cause seizures. Before starting this medication, let your provider know if you have a history of seizures or have a medical condition that puts you at risk for getting seizures.

                                risk-warning

                                High prolactin levels

                                Antipsychotics like Zyprexa Relprevv (olanzapine) 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 provider will likely measure your prolactin levels during treatment to make sure they aren't too high.

                                risk-warning

                                Difficulty concentrating and extreme sleepiness

                                • Risk factors: Taking high doses of Zyprexa Relprevv (olanzapine) | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness

                                  Zyprexa Relprevv (olanzapine) 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 provider right away if you feel too sleepy from taking Zyprexa Relprevv (olanzapine).

                                  risk-warning

                                  Worsening of bladder problems, constipation, and bowel problems

                                  Zyprexa Relprevv (olanzapine) can cause anticholinergic problems, such as constipation, dry mouth, and fast heart rate. The risk for these side effects is higher if you're also taking other anticholinergic medications.

                                  You don't necessarily need to stop Zyprexa Relprevv (olanzapine) if you have these symptoms. But if you've certain medical conditions, such as difficulty urinating, enlarged prostate, constipation, or a history of bowel blockage, this medication can make those conditions worse. Let your provider know if these side effects make it difficult for you to go about your daily life, you might need to switch to a different medication.

                                  dosage

                                  Zyprexa Relprevv (olanzapine) dosage forms

                                  Typical dosing for Zyprexa Relprevv (olanzapine)

                                  Zyprexa Relprevv (olanzapine) is given as an injection into the buttock muscle by a healthcare provider.

                                  Your provider will calculate your dose of Zyprexa Relprevv (olanzapine) based on what dose of oral olanzapine (Zyprexa) you were previously taking.

                                  • Treatment during the first 2 months: The typical dose is 210 mg or 300 mg injected every 2 weeks, or 405 mg every month.

                                  • Treatment after month 2: The typical dose is 150 mg, 210 mg, or 300 mg injected every 2 weeks. Or, 300 mg or 405 mg every month.

                                  interactions

                                  Interactions between Zyprexa Relprevv (olanzapine) and other drugs

                                  Zyprexa Relprevv (olanzapine) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Zyprexa Relprevv (olanzapine). Please note that only the generic name of each medication is listed below.

                                  Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

                                  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.

                                  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.

                                  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.

                                  alternatives

                                  What are alternatives to Zyprexa Relprevv (olanzapine)?

                                  There are a number of medications that your doctor can prescribe in place of Zyprexa Relprevv (olanzapine). Compare a few possible alternatives below.
                                  Zyprexa Relprevv (olanzapine)
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                                  References

                                  Best studies we found
                                  View All References (4)

                                  Eli Lilly and Company. (2023). Zyprexa Relprevv- olanzapine pamoate kit [package insert]. DailyMed.

                                  Heres, S., et al. (2014). Pharmacokinetics of olanzapine long-acting injection: The clinical perspective. International Clinical Psychopharmacology.

                                  MedlinePlus. (2023). Delirium.

                                  You and Your Hormones. (2023). Prolactin. Society for Endocrinology.

                                  GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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