Olanzapine (Zyprexa) is an atypical antipsychotic that can help improve mood, thoughts, and behaviors for people with schizophrenia and bipolar disorder. Olanzapine (Zyprexa) can also be used to treat depression, in combination with fluoxetine (Prozac), when other treatments haven't worked well. It's taken by mouth or dissolved under the tongue once daily. Olanzapine (Zyprexa) is more likely to cause weight gain and high blood sugar levels than some similar medications.
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 haven't responded well to other treatments
Olanzapine (Zyprexa) is an atypical antipsychotic. It's not completely known how olanzapine (Zyprexa) works, but it's thought to work by balancing out the levels of chemicals (dopamine and serotonin) in your brain to help control your thoughts, mood, and behaviors.
Source:Â DailyMed
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.
Good option for treating bipolar disorder and schizophrenia
Might notice an improvement in your symptoms in as early as a week of starting olanzapine (Zyprexa)
Available as a dissolvable tablet for people who have a hard time swallowing pills
Available as a lower-cost generic
Taken by mouth once per day
Must be avoided in older adults who have dementia-related psychosis
Can make you feel sleepy throughout the day
More likely to cause weight gain, high cholesterol, and high blood sugar than other atypical antipsychotics
Not a good choice for people with prostate problems or constipation, can make it more difficult for you to urinate or have a bowel movement
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, it's recommended to take in the evening or at night time.
Don't crush or chew the immediate-release tablets. If you're having trouble swallowing the tablets, contact your provider to be switched to the dissolvable tablets.
For the dissolvable tablet (ODT), make sure your hands are dry before handling the medication. Peel off the foil backing and remove the tablet from the blister card. Don't try to push the tablet through the foil; this can damage the medication. Place the tablet on the tongue to let it dissolve, and swallow with saliva.
Limit or avoid consuming 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 alcohol while taking olanzapine (Zyprexa) because it can worsen side effects (e.g., drowsiness, dizziness) as well as worsen your schizophrenic or bipolar disorder symptoms.
Olanzapine (Zyprexa) interacts with a lot of commonly used medications. For example, olanzapine (Zyprexa) can change your blood pressure, so you might need to adjust the dose of blood pressure medications if you're taking any. In addition, taking olanzapine (Zyprexa) with anticholinergic medications can lead to stomach-related side effects, such as constipation. Make sure to tell your provider and pharmacist about all of the medications you're taking before starting olanzapine (Zyprexa).
Don't change your dose or suddenly stop taking olanzapine (Zyprexa) without talking to your provider first. Doing so can cause withdrawal symptoms, such as nausea, vomiting, and dizziness. If you're interested in stopping the medication, contact your provider. They'll give you specific instructions on how to lower your dose slowly over a period of time before completely stopping the medication.
Olanzapine (Zyprexa) 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 olanzapine (Zyprexa).
Olanzapine (Zyprexa) 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 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, seek 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 healthcare provider 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.
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.
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 provider know if you or your loved one has dementia before starting olanzapine (Zyprexa).
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 that you have suicidal thoughts or, get medical help right away.
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.
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 provider will likely have you stop taking olanzapine (Zyprexa) and switch you to something else.
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 provider 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).
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 provider right away.
*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 provider.
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 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 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 provider right away.
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 provider know if you have a history of seizures or have a medical condition that puts you at risk for getting seizures.
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 provider will likely measure your prolactin levels during treatment to make sure they aren't too high.
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 provider right away if you feel too sleepy from taking olanzapine (Zyprexa).
The olanzapine (Zyprexa) orally disintegrating tablets (ODTs) contain phenylalanine, a component of the artificial sweetener aspartame. If you have a genetic condition called phenylketonuria (PKU), taking the ODTs can be dangerous for you. Let your provider know if you have PKU so they can prescribe a different formulation of olanzapine (Zyprexa) that might be safer for you.
Tablets and orally disintegrating tablets: The tablets are taken by mouth and swallowed, while the orally disintegrating tablets (ODTs) are placed on the tongue where they dissolve without you needing to swallow. Your provider will adjust your dose based on how well it's working to treat your condition and if you're having side effects.
Schizophrenia:
Adults: The typical starting dose is 5 mg to 10 mg by mouth once daily. The typical maintenance dose is 10 mg to 15 mg once daily.
Children (13 to 17 years old): The typical starting dose is 2.5 mg to 5 mg by mouth once daily. The typical maintenance dose is 10 mg once daily.
Bipolar I disorder (mixed or manic episodes):
Adults: The typical starting dose is 10 mg or 15 mg once daily. The typical maintenance dose ranges from 5 mg to 20 mg once daily. Your dose might be different if your provider is also prescribing lithium (Lithobid) or valproic acid.
Children (13 to 17 years old): The typical starting dose is 2.5 mg to 5 mg by mouth once daily. The typical maintenance dose ranges from 10 mg to 20 mg once daily.
Depressive episodes of bipolar I disorder (with fluoxetine (Prozac)):
Adults: 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.
Children (10 to 17 years old): The typical starting dose is 2.5 mg by mouth once daily.
Depression:
Adults: The typical starting dose is 5 mg by mouth once daily. The typical maintenance 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 provider, typically in a hospital or clinic setting.
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.
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 haven'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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American Regent, Inc. (2022). OLANZAPINE injection, powder, lyophilized, for solution [package insert]. DailyMed.
Apotex Corp. (2022). OLANZAPINE tablet, orally disintegrating [package insert]. DailyMed.
Aurobindo Pharma Limited. (2022). OLANZAPINE tablet [package insert]. DailyMed.
Correll, C. U., et al. (2018). What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatry: Official Journal of the World Psychiatric Association (WPA).
Drugs and Lactation Database (LactMed). (2022). Olanzapine. National Institute of Child Health and Human Development.
Eli Lilly and Company. (2022). ZYPREXA- olanzapine tablet ZYPREXA ZYDIS- olanzapine tablet, orally disintegrating ZYPREXA INTRAMUSCULAR- olanzapine injection, powder, for solution [package insert]. DailyMed.
Mauri, M. C., et al. (2014). Clinical pharmacology of atypical antipsychotics: An update. EXCLI Journal.
National Human Genome Institute. (2014). About phenylketonuria.
Simon, L. V., et al. (2023). Neuroleptic Malignant Syndrome. StatPearls.
U.S. Food and Drug Administration. (2017). FDA Drug Safety Communication: Antipsychotic drug labels updated on use during pregnancy and risk of abnormal muscle movements and withdrawal symptoms in newborns.
Uçok, A., et al. (2008). Side effects of atypical antipsychotics: A brief overview. World Psychiatry: Official Journal of the World Psychiatric Association (WPA).
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