Olanzapine (Zyprexa) | NAMI: National Alliance on Mental Illness (2023)

Brand names:

  • Zyprexa®
    • Comprimido oral: 2,5 mg, 5 mg, 7,5 mg, 10 mg, 15 mg, 20 mg
    • Intramuscular injection (short acting): 10 mg
  • Zyprexa Zydis®
    • Oral dissolving tablet: 5mg, 10mg, 15mg, 20mg
  • Zyprexa Relprevv®
    • Intramuscular injection (long-acting): 210mg, 300mg, 405mg

Generic name:olanzapine (oh LANZ and peen)

  • olanzapine
    • Comprimido oral: 2,5 mg, 5 mg, 7,5 mg, 10 mg, 15 mg, 20 mg
    • Orally disintegrating tablet: 5mg, 10mg, 15mg, 20mg
    • Intramuscular injection (short acting): 10 mg

All FDA black box warnings are listed at the end of this datasheet. Please check before taking this medicine.

What is olanzapine and what is it used for?

Olanzapine is a drug that works in the brain to treat schizophrenia. It is also known as a second-generation antipsychotic (SGA) or atypical antipsychotic. Olanzapine rebalances dopamine and serotonin to improve thinking, mood and behavior.
Symptoms of schizophrenia include:

  • Hallucinations: imaginary voices or images that seem real
  • Delusions: beliefs that are not true (for example, other people are reading your thoughts)
  • Disorganized thinking or difficulty organizing your thoughts and making sense of them
  • Little desire to be around other people.
  • trouble speaking clearly
  • lack of motivation

Olanzapine may alleviate some or all of these symptoms.

Olanzapine can be used alone or with other medications to treat mental health conditions.

It is also FDA approved for the following indications:

  • Acute treatment of manic or mixed episodes of bipolar disorder
  • Maintenance (long-term) treatment of bipolar disorder
  • Acute treatment of agitation in schizophrenia and bipolar disorder
  • Episodes of depression that occur with bipolar I disorder, when used with fluoxetine
  • Episodes of depression that don't improve after trying 2 other medications, also called treatment-resistant depression, when used with fluoxetine

This medicine sheet will mainly focus on schizophrenia. You can find more information about bipolar disorder and depressionhere.

This medication may be prescribed for other uses; ask your doctor for more information.

What is the most important information I should know about olanzapine?

Schizophrenia requires long-term treatment. Do not stop taking olanzapine even when you feel better.

With your opinion, your doctor will assess how long you will need to take the medicine.

Skipping doses of olanzapine may increase the risk of symptom relapse.

Do not stop taking olanzapine or change your dose without first talking to your doctor.

For olanzapine to work properly, it must be taken every day as directed by your doctor.

Are there any specific concerns about olanzapine and pregnancy?

If you plan to become pregnant, notify your doctor to better manage your medications. People living with schizophrenia or another mental illness who want to become pregnant face important decisions. This is a complex decision, as untreated schizophrenia or another mental illness carries risks for the fetus as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers.

The use of antipsychotics during the third trimester of pregnancy carries a risk of abnormal muscle movements (extrapyramidal symptoms [EPS]) and/or withdrawal symptoms in neonates after delivery. Symptoms in the newborn may include restlessness, eating disorders, hypertonia, hypotonia, difficulty breathing, drowsiness, and tremors; these effects may be self-limiting or require hospitalization.

Caution is advised during breast-feeding as olanzapine passes into breast milk. It is recommended that women receiving olanzapine do not breast-feed.

What should I discuss with my doctor before taking olanzapine?

  • The symptoms of your condition that bother you the most
  • If you have thoughts of suicide or harming yourself
  • Medicines you have taken in the past for your condition that have been effective or have caused adverse effects
  • If you have ever had muscle stiffness, tremors, tardive dyskinesia, neuroleptic malignant syndrome or weight gain caused by medications
  • If you experience side effects from your medications, discuss them with your doctor. Some side effects may go away with time, but others may require changes in medication.
  • Any psychiatric or medical conditions you have, such as heart rhythm problems, long QT syndrome, heart attack, diabetes, high cholesterol, liver problems, or seizures.
  • If you have a family history of diabetes or heart disease.
  • All other medications you are currently taking (including over-the-counter products, herbal and nutritional supplements) and any drug allergies you have
  • Other non-drug treatment you are receiving, such as psychotherapy or substance abuse treatment. Your provider can explain how these different drug treatments work.
  • Tell your doctor if you exercise a lot or are in hot places frequently.
  • If you are pregnant, planning to become pregnant or are breastfeeding
  • If you smoke, drink alcohol, use or have used recreational drugs, or have used prescription drugs

How should I take olanzapine?

Olanzapine may help control your symptoms, but it will not cure your condition.

It may take several weeks before you feel the full effect of olanzapine.

Olanzapine tablets are usually taken once a day with or without food.

Patients usually start on a low dose of medication and the dose is slowly increased over several weeks.

The oral dose usually ranges from 5 mg to 20 mg. The injection dose usually ranges from 150mg to 405mg. Only your doctor can determine the correct dosage for you.

Olanzapine oral dissolution tablets must remain in the original package. Open the package with clean, dry hands before each dose. Do not try to put pills in a pillbox if you are taking orally disintegrating pills.
Olanzapine orally disintegrating tablets dissolve in the mouth within seconds and can be swallowed with or without liquid.

Use a calendar, medicine box, alarm clock, or cell phone alert to remind you to take your medicine. You can also ask a family member or friend to remind you or contact you to make sure you are taking your medication.

The long-acting injectable form of olanzapine is given every 2 to 4 weeks. It must be administered by your healthcare professional through an injection in the buttock area. A healthcare professional will keep you where you can be observed for at least 3 hours after each injection.

What happens if I miss a dose of olanzapine?

If you forget to take a dose of olanzapine, take it as soon as you remember unless it is closer to the time of your next dose. Discuss this with your doctor. Do not double the next dose or take more than prescribed. If you miss a dose of olanzapine long-acting injection, consult your doctor so you can get your dose as soon as possible.

What should I avoid while taking olanzapine?

Avoid drinking alcohol or using street drugs while taking olanzapine. They can decrease the benefits (eg, worsen your confusion) and increase the adverse effects (eg, sedation) of the medication.

What happens if I take an overdose of olanzapine?

If an overdose occurs, call your doctor or 911. You may need urgent medical attention. You may also contact the Poison Control Center at 1-800-222-1222.

There is no specific treatment to reverse the effects of olanzapine.

What are the possible side effects of olanzapine?

This is not a complete list. Talk to your health care provider for more information.

common side effects

Low blood pressure, drowsiness, extrapyramidal symptoms, restlessness, dizziness, headache, fatigue, insomnia, increased prolactin, weight gain, increased appetite, dry mouth, indigestion, constipation, abnormal liver function tests, weakness, accidental injury

Rare/serious side effects

Olanzapine can increase blood levels of a hormone called prolactin. Side effects of increased prolactin levels include loss of menstruation in women, production of breast milk and loss of sex drive in men or the possibility of erection problems. Elevated prolactin in the long term (months to years) can lead to osteoporosis or an increased risk of bone fractures.

Some people may develop muscle-related side effects while taking olanzapine. The technical terms for these are "extrapyramidal symptoms" (EPS) and "tardive dyskinesia" (TD). Symptoms of EPS include restlessness, tremor, and rigidity. Symptoms of TD include slow or jerky movements that one cannot control, usually starting in the mouth with tongue or chewing movements.

Temperature regulation: Impaired regulation of core body temperature may occur; beware of strenuous exercise, exposure to heat and dehydration.

Second-generation antipsychotics (SGA) increase the risk of weight gain, high blood sugar and high cholesterol. This is also known as metabolic syndrome. Your doctor may order a blood sample to check your cholesterol, blood sugar, and hemoglobin A1c (a measure of blood sugar over time) while you are taking this medication.

ASGs have been linked to an increased risk of death, stroke, and transient ischemic attacks (TIAs) in older adults with behavioral problems due to dementia.

All antipsychotics have been associated with the risk of sudden cardiac death due to arrhythmia (irregular heartbeat). To minimize this risk, antipsychotic medications should be used at the lowest effective dose when the benefits outweigh the risks. Your doctor may order an electrocardiogram to check for an irregular heartbeat.

Neuroleptic malignant syndrome is a rare and potentially fatal adverse effect of antipsychotics that occurs in <1% of patients. Symptoms include confusion, fever, extreme muscle stiffness and sweating. If you experience any of these symptoms, contact your doctor immediately.

All antipsychotics can cause sedation, dizziness, or orthostatic hypotension (a drop in blood pressure when standing up from a sitting or lying position). These side effects can lead to falls that can cause broken bones or other injuries. This risk is higher for people with conditions or other medications that can make these effects worse. If you fall or experience any of these symptoms, contact your doctor.

Multiorgan Hypersensitivity Reactions (Drug Reaction with Eosinophilia and Systemic Symptoms [DRESS]): Potentially serious, sometimes fatal, multiorgan hypersensitivity reactions have been reported. Symptoms may include rash, elevated levels of certain white blood cells (eosinophils), fever, and/or swollen/enlarged lymph nodes with systemic complications. If you suspect DRESS, contact your doctor immediately.

Are there any risks to taking olanzapine for long periods of time?

Tardive dyskinesia (TD) is a side effect that develops with prolonged use of antipsychotics. Medications such as olanzapine have been shown to have a lower risk of TD compared to older antipsychotics such as Haldol (haloperidol).] If you develop symptoms of TD such as grimacing, sucking and lip smacking or other movements that you cannot control, contact your healthcare provider immediately. All patients taking first- or second-generation antipsychotics should have an Abnormal Involuntary Movement Scale (AIMS) completed regularly by their physician to monitor TD.

Second-generation antipsychotics (SGA) increase the risk of diabetes, weight gain, high cholesterol and high triglycerides. (See the "Serious Side Effects" section for follow-up recommendations.)

What other medications may interact with olanzapine?

Tell your doctor about all medications you are taking, have recently taken, or plan to take, including prescription and over-the-counter drugs, vitamins, herbal products, and nutritional supplements. This medicine can affect how other medicines work and other medicines can affect how this medicine works.

Olanzapine may block the effects of agents used to treat Parkinson's disease, such as levodopa/carbidopa (Sinemet®), bromocriptine, pramipexole (Mirapex®), ropinirole (Requip®), and others.

Olanzapine may lower your blood pressure. Medications used to lower blood pressure can enhance this effect and increase the risk of falls. Propranolol (Inderal®) is an example of this type of medication.

Sedative medications, such as lorazepam (Ativan®) and diazepam (Valium®), may increase the risk of dizziness or drowsiness when used in combination with olanzapine. This risk increases when these drugs are given by injection.

The following medications mayincreasethe levels and effects of olanzapine: ciprofloxacin (Cipro®) and fluvoxamine (Luvox®)

Carbamazepine (Tegretol®) candecreasethe levels and effects of olanzapine.

Cigarette smoke (and other types of smoke) can decrease olanzapine levels. Tell your doctor if you start or stop smoking cigarettes. Nicotine patches do not affect olanzapine levels.

How long does it take for olanzapine to work?

It is very important that you tell your doctor how you feel in the first few weeks after you start taking olanzapine. It will likely take several weeks to see big enough changes in your symptoms to decide if olanzapine is the right medication for you.

Antipsychotic treatment is usually required for life for people with schizophrenia. Your doctor can best discuss the length of treatment you need based on your symptoms and condition.

  • Hallucinations, disorganized thinking, and delusions may improve in the first 1 to 2 weeks
  • Sometimes these symptoms do not go away completely.
  • Motivation and desire to be around other people may take at least 1 to 2 weeks to improve
  • Symptoms continue to improve the longer you take olanzapine
  • It may take 2 to 3 months before you get the full benefit of olanzapine.

Summary of FDA Black Box Warnings

Increased mortality in elderly patients with dementia-related psychosis

  • First-generation (typical) and second-generation (atypical) antipsychotics are associated with an increased risk of mortality in elderly patients when used for dementia-related psychosis.
  • Although there were multiple causes of death in the studies, the majority of deaths appeared to be due to cardiovascular causes (eg, sudden cardiac death) or infection (eg, pneumonia).
  • Antipsychotics are not indicated for the treatment of dementia-related psychosis.

Post-injection delirium/sedation syndrome

  • This rare reaction has been reported with Zyprexa Relprevv, the long-acting injectable form of olanzapine. This has not been reported with olanzapine tablets.
  • Signs and symptoms of delirium/post-injection sedation syndrome are similar to those of an olanzapine overdose and include sedation (including coma) and delirium (a confused state).
  • Zyprexa Relprevv (Olanzapine Long-Acting Injection) must be administered in a registered health facility with access to emergency care services.
  • After each injection, patients must be observed in the health center by a health professional for at least 3 hours.
  • Zyprexa Relprevv (long-acting olanzapine injection) is only available through a restricted distribution program called the Zyprexa Relprevv Patient Care Program

Provided by

Olanzapine (Zyprexa) | NAMI: National Alliance on Mental Illness (1)

(November 2022)

©2022The College of Psychiatric and Neurological Pharmacists(CPNP) and the National Alliance for Mental Illness (NAMI). CPNP and NAMI make this document available under theCreative Commons Attribution-No Derivatives 4.0 International License🇧🇷 Last update: January 2016.

This information is provided as a community effort by the College of Psychiatric and Neurological Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not a comprehensive review of drug information. Always seek the advice of a physician or other qualified medical professional with any questions you may have about medications or medical conditions. Never delay in seeking professional medical advice or disregard the advice of a medical professional as a result of the information provided in this document. The College of Psychiatric and Neurological Pharmacists disclaims any liability claimed as a result of the information provided in this document.

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