What is Zyprexa (olanzapine)?
Zyprexa (olanzapine) is a medication prescribed to treat schizophrenia and bipolar 1 disorder. Zyprexa is a second-generation atypical antipsychotic and antimanic drug. This drug works to rebalance dopamine and serotonin within the brain to improve thinking, mood, and behavior.
What Is Zyprexa Used For?
Zyprexa 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?
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.
Zyprexa is available in tablet form in the following dosages
- 5mg, 5mg, 7.5mg, 10mg, 15mg and 20mg
Zyprexa is also available in orally disintegrating tablets in the following dosages
Dosing for Adults
The recommended starting dose of Zyprexa in patients with schizophrenia is 5-10mg daily. The dosage can be increased by 5mg per day at intervals greater than 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 per day at intervals greater than 24 hours.
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 2.5mg-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 2.5mg-5mg per day.
The maximum daily dosage of Zyprexa in children is 20mg per day.
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.
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.
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.
The most common side effects of Zyprexa include:
- Inability to sit still
- 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 immediate medical attention if you experience any of the following symptoms.
- Skin rash
- 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.
Zyprexa is not approved for children younger than the age of 10.
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.
It is not recommended to breastfeed while taking Zyprexa
Zyprexa is not recommended in elderly patients with dementia-related psychosis. These patients exhibited a higher incidence of death and increased incidence of cerebrovascular events such as stroke and TIA.
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.
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.
Some patients taking Zyprexa have had an increase in lipid levels while receiving patients. Lipids should be monitored before and periodically while receiving treatment with Zyprexa.
There is a potential for weight gain while taking Zyprexa. Patients should have their weight monitored while receiving treatment.
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.
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.
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.
Zyprexa can cause elevated prolactin levels. Hyperprolactinemia can result in impaired reproductive function in both males and females.
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.
When used together, diazepam and Zyprexa may increase the occurrence of orthostatic hypotension.
Using alcohol and Zyprexa together may increase the occurrence of orthostatic hypotension.
Carbamazepine can increase the potency of olanzapine and can worsen side effects.
Carbamazepine can increase the potency of olanzapine and can worsen side effects.
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.
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), Lumateperonee (Caplyta), Lurasidone (Latuda), Olanzapine (Zyprexa) , Olanzapine/samidorphan (Lybalvi), Paliperidone (Invega Sustenna), Paliperidone palmitate (Invega Trinza), Quetiapine (Seroquel), Risperidone (Risperdal), Ziprasidone (Geodon).