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What is Zyprexa (olanzapine)?

Zyprexa (olanzapine) is a medication prescribed to treat schizophrenia and bipolar 1 disorder. It is a second-generation atypical antipsychotic and antimanic drug. This drug works to rebalance dopamine and serotonin within the brain to help stabilize mood, reduce psychotic symptoms, and improve behavior.

It is used in the treatment of several different adult psychiatric disorders, including schizophrenia and bipolar 1 disorder, mania.

Zyprexa can be used in conjunction with fluoxetine (Prozac) to treat episodes of depression in adults and children who are at least 10 years old with bipolar 1 disorder, and mania.

How is it used?

Storage

Zyprexa should be stored between 68°F to 77°F (20°C to 25°C)

How to Take

Zyprexa comes in the form of a tablet and an oral-disintegrating tablet. It can be taken with or without food. Zyprexa oral-disintegrating tablets should be kept in the original packaging until it is time to take your medication.

Dosage

Zyprexa is available in tablet form in the following dosages

  • 2.5mg, 5mg, 7.5mg, 10mg, 15mg and 20mg

Zyprexa is also available in orally disintegrating tablets in the following dosages

  • 5mg, 10mg, 15mg and 20mg

Dosing for Adults

Schizophrenia

The recommended starting dose of Zyprexa in patients with schizophrenia is 5-10mg daily. The dosage may be increased in increments of 5mg at intervals of at least one week.

Bipolar 1 disorder, mania

The recommended starting dose of Zyprexa in patients with bipolar 1 disorder is 10-15mg daily. The dosage can be increased by 5mg at one-week intervals.

Zyprexa can be used in conjunction with lithium or valproate at 10mg daily.

The maximum daily dose of Zyprexa is 20mg per day.

Dosing for Children

Schizophrenia and Bipolar 1 disorder, mania

In children 13-17 years of age, the recommended starting dose of Zyprexa is 2.5-5mg per day. The average daily dose of Zyprexa to treat bipolar 1 disorder is 10mg per day. Dosage adjustments can be made in increments of 2.5-5mg per week.

The maximum daily dosage of Zyprexa in children is 20mg per day.

Bipolar Depression

In children who are 10-17 years of age, Zyprexa can be used in conjunction with fluoxetine for episodes of depression associated with bipolar 1 disorder. The recommended starting dose of Zyprexa in these situations is 2.5mg daily at bedtime.

The maximum daily dosage of Zyprexa in conjunction with fluoxetine is 12mg per day.

Missed Dose

If you miss a dose of Zyprexa, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not take two doses at the same time.

Overdose

If you overdose on Zyprexa, serious side effects can develop. Symptoms of an overdose include drowsiness, agitation, aggression, slurred speech, confusion, increased heart rate, jerky or uncontrolled muscle movements, trouble breathing, or fainting. If you suspect an overdose, seek emergency medical care or call the poison control helpline at 1-800-222-1222.

Side Effects

The most common side effects of Zyprexa include:

  • Inability to sit still
  • Constipation
  • Headache
  • Dizziness
  • Lightheadedness
  • Drowsiness
  • Tiredness
  • Restlessness
  • Weight gain or increased appetite
  • Memory problems
  • Stomach pain or upset
  • Loss of bladder control
  • Back pain
  • Arm and leg pain
  • A feeling of numbness or tingling
  • Breast swelling or discharge in both men and women
  • Dry mouth
  • Menstrual Disturbances

Some patients who take Zyprexa can experience a drug reaction. Please call your doctor immediately or seek medical attention if you experience any of the following symptoms.

  • Skin rash
  • Fever
  • Swollen glands
  • Muscle aches
  • Severe weakness
  • Unusual bruising
  • Yellowing of the skin or eyes

Long-term use or high doses of Zyprexa can cause serious movement disorders that may not be reversible. Call your doctor if you notice:

  • Uncontrolled muscle movements in your face including chewing, lip-smacking, frowning, tongue movements, blinking, or irregular eye movements.
  • Ulcers, blisters, swelling, or peeling of the mouth
  • Breast pain, swelling, or nipple discharge
  • Fever, chills, mouth sores, skin sores, sore throat, cough, or trouble breathing.
  • Rigid muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, or feeling like you might pass out.
  • Upset stomach, itching, loss of appetite, dark urine, clay-colored stools, or yellowing of the skin or eyes.
  • Increased thirst, urination, hunger, dry mouth, blurred vision, or weight loss.

Warnings & Precautions

Zyprexa is contraindicated in those who have a known allergy or sensitivity to Zyprexa or any of its ingredients.

Children

Zyprexa is not approved for children younger than the age of 10.

Pregnancy

Zyprexa may be used in pregnancy if the benefit outweighs the risk. There is a risk to the mother if psychiatric disorders are left untreated. The overall limited available data regarding Zyprexa in pregnancy does not show an increase in major birth defects, miscarriage, or adverse maternal outcomes. Zyprexa may be used in pregnancy if the benefit outweighs the risk. Neonates exposed to antipsychotics during the third trimester have exhibited agitation, muscle rigidity, tremors, respiratory distress, and feeding difficulties.

Lactation

It is not recommended to breastfeed while taking Zyprexa

Dementia-Related Psychosis

Zyprexa is not recommended in elderly patients with dementia-related psychosis. These patients exhibited a higher incidence of death and an increased incidence of cerebrovascular events such as stroke and TIA.

Suicidal Ideation

Patients should be monitored for suicidal thoughts while receiving treatment with Zyprexa. Patients with a history of suicidal thoughts should be closely monitored while taking Zyprexa.

Neuroleptic Malignant Syndrome

Some patients who have taken Zyprexa have developed Neuroleptic Malignant Syndrome (NMS). NMS is associated with hyperreflexia, muscle rigidity, altered mental status, autonomic instability (irregular or fast heart rate and blood pressure, sweating, and cardiac arrhythmias), elevated creatine phosphokinase, rhabdomyolysis, and acute renal failure. If you experience any of these symptoms, the use of Zyprexa should be discontinued.

Metabolic Changes

Atypical antipsychotic medications such as Zyprexa have been associated with metabolic changes such as hyperglycemia, dyslipidemia, and weight gain.

Hyperglycemia and Diabetes Mellitus

Patients taking Zyprexa should be monitored for hyperglycemia and should have a fasting blood glucose test before starting Zyprexa and periodically throughout treatment.

Dyslipidemia

Some patients taking Zyprexa have had an increase in lipid levels while receiving the medication. Lipids should be monitored before and periodically while receiving treatment with Zyprexa.

Weight Gain

There is a potential for weight gain while taking Zyprexa. Patients should have their weight monitored while receiving treatment.

Tardive Dyskinesia

Some patients who have taken Zyprexa have developed potentially irreversible, involuntary, and uncontrollable movements. The likelihood of developing tardive dyskinesia in patients who take Zyprexa is unknown. Patients taking Zyprexa should be monitored for facial grimacing, fish-like mouth movements, and involuntary tongue movements.

Orthostatic Hypotension/Syncope

Zyprexa can cause orthostatic hypotension and syncope in some patients. Patients should be instructed about non-pharmacologic interventions to reduce the occurrence of syncopal episodes, such as sitting on the edge of the bed for several minutes before attempting to stand. Caution should be used in patients with known cardiovascular disease and cerebrovascular disease.

Leukopenia, Neutropenia, and Agranulocytosis

Blood dyscrasias have been reported in some patients taking Zyprexa. Patients with preexisting low white blood cell counts, low neutrophil counts, or a history of drug-induced leukopenia/neutropenia should be monitored routinely while taking Zyprexa. Zyprexa should be discontinued if severe neutropenia occurs.

Seizures

Caution should be used in patients with a history of seizures. Zyprexa can lower the seizure threshold. Seizures may be more prevalent in patients who are 65 years of age and older.

Cognitive or Motor Impairment

Zyprexa has the potential to impair thinking, judgment, and motor skills. Caution should be used while operating machinery.

Hyperprolactinemia

Zyprexa can cause elevated prolactin levels. Hyperprolactinemia can result in impaired reproductive function in both males and females.

Drug Interactions

This is not a complete list of potential drug interactions. Before taking Zyprexa, tell your doctor if you take any medications, herbal supplements, or vitamins.

Diazepam

When used together, diazepam and Zyprexa may increase the occurrence of orthostatic hypotension.

Alcohol

Using alcohol and Zyprexa together may increase the occurrence of orthostatic hypotension.

Carbamazepine

Carbamazepine may decrease plasma concentrations of olanzapine, potentially reducing its efficacy.

Fluvoxamine

Fluvoxamine inhibits an enzyme that results in increased olanzapine levels, increasing the risk of adverse effects.

Antihypertensive Medications

Zyprexa can enhance the effects of antihypertensive medications; caution should be used in patients who take blood pressure medications.

CNS Acting Drugs

Caution should be used when taking Zyprexa in combination with other medications that can cause CNS depression. Medications such as opioids, alcohol, marijuana, sleep or anxiety medications, muscle relaxants, and antihistamines should be discussed with your doctor before taking Zyprexa.

Alternative Medications

There are other drugs available to treat schizophrenia and bipolar 1 disorder. Speak to your doctor to discuss other medications.

First-Generation Typical Antipsychotic Medications

Typical Antipsychotics are an older class of drugs used in the treatment of schizophrenia. They work by blocking dopamine receptors in the brain and improving motor control, focus, mood, and emotions.

  • Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Haloperidol (Haldol), Perphenazine (Trilafon), Thioridazine (Mellaril), Thiothixene (Navane), Trifluoperazine (Stelazine)

Second Generation Atypical Antipsychotic Medications

Atypical antipsychotics are a newer class of antipsychotic medications used in the treatment of schizophrenia and bipolar disorder. They work by blocking the excitatory activity of dopamine and serotonin. Dopamine and serotonin regulate pleasure sensation, mood, behavior, and memory.

  • Aripiprazole (Abilify), Aripiprazole lauroxil (Aristada), Brexpiprazole (Rexulti), Cariprazine (Vraylar), Clozapine (Clozaril), Iloperidone (Fanapt), Lumateperone (Caplyta), Lurasidone (Latuda), Olanzapine (Zyprexa) , Olanzapine/samidorphan (Lybalvi), Paliperidone (Invega Sustenna), Paliperidone palmitate (Invega Trinza), Quetiapine (Seroquel), Risperidone (Risperdal), Ziprasidone (Geodon).

Frequently Asked Questions

The recommended starting dose of Zyprexa is usually 5 to 10 milligrams per day for adults.

It may take several weeks for Zyprexa to reach its full effectiveness. It is important to be patient and consistent with the medication.

Zyprexa may interact with certain medications, so it is crucial to inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements, to avoid potential interactions.

Yes, drowsiness is a common side effect of Zyprexa. It is important to be cautious while driving or operating machinery until you know how the medication affects you.

Zyprexa is not approved for use in children under the age of 13. However, it may be prescribed off-label for certain conditions in adolescents.

Yes, weight gain is a potential side effect of Zyprexa. Monitoring weight and making lifestyle changes, such as a healthy diet and exercise, can help manage this side effect.

Grapefruit juice may interact with Zyprexa and increase its levels in the body. It is advisable to avoid consuming grapefruit or grapefruit juice while taking Zyprexa.

Zyprexa may pose risks to a developing fetus. It is important to discuss the potential benefits and risks with your healthcare provider before taking Zyprexa during pregnancy.

Zyprexa can be taken at any time of the day, but taking it at the same time each day can help with consistency and adherence to the medication.

Routine blood tests are generally not required for individuals taking Zyprexa unless otherwise advised by their healthcare provider.

Zyprexa is not approved for the treatment of anxiety disorders. It is primarily indicated for schizophrenia and bipolar disorder.

It is generally recommended to gradually taper off Zyprexa under the guidance of a healthcare professional to minimize the risk of withdrawal symptoms.

Yes, it may cause sexual side effects such as decreased libido or difficulty achieving orgasm. Discuss any concerns with your healthcare provider.

Zyprexa can be taken with or without food. However, taking it with food may help reduce the likelihood of stomach upset.

If you miss a dose, take it as soon as you remember, unless it is close to the time for your next dose. Do not double the dose to make up for a missed one.

Elderly individuals may be more sensitive to its side effects. Dosing adjustments and close monitoring may be necessary.

Zyprexa can pass into breast milk, so it is important to discuss the risks and benefits with your healthcare provider before breastfeeding while taking it.

Zyprexa is not approved as a standalone treatment for depression. However, it may be used in combination with other medications in certain cases.

Abruptly stopping Zyprexa can lead to withdrawal symptoms. It is important to work with a healthcare professional to gradually reduce the dosage when discontinuing the medication.

Zyprexa has been associated with an increased risk of developing diabetes or worsening existing diabetes. Regular monitoring of blood sugar levels is recommended during treatment.

Zyprexa Zydis is a formulation of the medication Zyprexa (olanzapine) that comes in a dissolvable tablet form. Unlike the standard tablet form of Zyprexa, which is swallowed with water, Zyprexa Zydis tablets can be placed on the tongue and allowed to dissolve without the need for water. This can be particularly beneficial for individuals who have difficulty swallowing or prefer a more convenient method of administration.

Disclaimer

Pharma Giant provides medical information to help you better understand medications and medical conditions.This content is for informational use only and does not replace advice from a licensed medical practitioner. Consult your doctor or pharmacist before starting or changing any medication. All our partners follow strict safety standards set by their country’s health authorities to make sure you receive safe and high-quality medications.

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Kenneth Fill, PharmD, MBA Fill

Kenneth Fill, PharmD, MBA, is a clinical pharmacist specialist and medical writer with a strong background in ambulatory care, pharmacogenomics, and medical content development. Based in the state of Michigan, he provides expert guidance on chronic disease state management. Kenneth completed his PharmD and MBA at the University of Toledo and pursued post-graduate residency training in ambulatory care and community-based pharmacy. His diverse background also includes academic detailing, clinical education, and interdisciplinary collaboration to enhance patient outcomes.