Zyprexa (olanzapine) is used to treat schizophrenia. It may also be used alone or with other medicines (eg, lithium or valproate) to treat mania or mixed episodes that is part of bipolar disorder (manic-depressive illness). Zyprexa is an atypical antipsychotic that may be used to treat adults and adolescents aged 13 and older with schizophrenia or bipolar I disorder. For bipolar I disorder, it may be used: alone or in combination with lithium or valproate with fluoxetine for depressive.
Zyprexa is available as oral tablets, orally disintegrating tablets, or an injection that is given into a muscle (intramuscular [IM]). The Zyprexa IM preparation is only for acute agitation associated with schizophrenia and bipolar I mania in adults.
Side Effects
What are the most common side effects of olanzapine?
The most common side effects of olanzapine are listed below. Tell your healthcare provider if you have any of these side effects that bother you.
- Lack of energy and sleepiness
- Dry mouth
- Constipation
- Increased appetite
- Tremor (shakes)
- Restlessness
- Dizziness
- Change in behavior
Teenagers (age 13-17) may experience these additional side effects.
- Headache
- Pain in stomach area or arms and legs
- Tiredness
There may be other side effects of olanzapine that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine.
What are the serious side effects of olanzapine?
While less common, the most serious side effects of olanzapine are described below, along with what to do if they happen.
High Blood Sugar. Olanzapine may increase your blood sugar levels. Talk to your healthcare provider about how to maintain healthy blood sugar levels, especially if you have diabetes. Call your healthcare provider if you have any of these symptoms of high blood sugar.
- Increased thirst
- Increased urination (peeing)
- Increased hunger
- Feeling weak or tired
- Feeling sick to your stomach
- Feeling confused
- Having breath that smells fruity
High Fats (Cholesterol and Triglycerides) in Your Blood. Olanzapine may cause high cholesterol and triglyceride levels, especially in children or teenagers. You may not have symptoms of high cholesterol or triglycerides. Your healthcare provider may check your cholesterol levels before you start olanzapine and while you are taking it.
Weight Gain. Olanzapine can increase your appetite and may cause weight gain, especially in children or teenagers. Check your weight regularly and tell your healthcare provider if you experience weight gain. Talk with your healthcare provider about how to help limit weight gain, such as by exercising and eating a healthy and balanced diet.
Movement Problems. Olanzapine may rarely cause movement problems that you cannot control in your face, tongue, or body, including shakiness, stiffness, or jerkiness. This condition is called tardive dyskinesia (TD). Call your healthcare provider right away if you develop any unusual or uncontrolled movements.
Low Blood Pressure Upon Standing (Orthostatic Hypotension) and Falls. Olanzapine may cause a sudden drop in blood pressure when standing up from a seated or lying position. To help prevent this, be careful not to get up too quickly. If you feel dizzy, sit or lie down right away until the dizziness stops, then take your time getting up again. Tell your healthcare provider right away if you have any of the following symptoms of orthostatic hypotension.
- Dizziness, feeling lightheaded, or fainting upon standing
- Blurred vision
- Confusion
- Feeling weak
Trouble Swallowing. Olanzapine may cause difficulty swallowing liquids or food. Contact your healthcare provider if you experience these symptoms. This could make you more likely to get food or liquids into your lungs.
Seizures. Some people who have taken olanzapine have reported having seizures. There are many different types of seizures and some of them are not easy to recognize. Stop taking olanzapine and call your healthcare provider if you experience any of the following signs that a seizure is happening or could happen.
- Muscle twitching, jerking, spasms, tremors, or other uncontrolled movements
- Stiffening of your arms and legs
- Feeling anxious, nervous, confused, or a sense of dread
- Feeling dizzy or lightheaded
- Falling or losing consciousness
Decreased Alertness or Coordination. Olanzapine can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how olanzapine affects you.
Blood Disorders. Olanzapine can cause blood disorders, such as low white blood cell levels (leukopenia, neutropenia, or agranulocytosis). Stop using olanzapine and get help right away if you have any of the following symptoms of blood disorders.
- Fever
- Shortness of breath
- Pale or yellowish skin
- Easy bruising or bleeding
- Frequent infection
- Unusual weakness or tiredness
- Dizziness, lightheadedness, or feeling like you are about to pass out
- Headache
- Fast or abnormal heartbeat
Body Temperature Regulation. Olanzapine can affect your ability to regulate your body temperature. This could make you become very hot, especially in hot weather or after exercising a lot. You should drink water and avoid overheating and dehydration. Call your healthcare provider right away if you are severely ill and have the following symptoms of dehydration.
- Excessive or no sweating
- Dry mouth
- Feeling very hot
- Feeling thirsty
- Not able to pee
Neuroleptic Malignant Syndrome (NMS). Olanzapine may cause a rare but serious condition called neuroleptic malignant syndrome, which may cause muscle stiffness and a high fever. Stop taking olanzapine and contact your healthcare provider right away if you experience any of the following symptoms.
- High fever
- Muscle stiffness or rigidity, where it is hard to move
- Confusion
- Changes in your breathing or heart rate
- Increased sweating
Excessive Prolactin (Hyperprolactinemia). Olanzapine may cause an increased level of a hormone called prolactin in your blood. These increased levels of prolactin could lead to reproductive or bone issues. Contact your healthcare provider if you experience any of the following symptoms.
- Vaginal dryness
- Irregular or no periods
- Production of breast milk when not pregnant or nursing
- Inability to get or keep an erection
- Enlarged breast size (gynecomastia)
- Decreased muscle and body hair
Severe Allergic Reactions. Olanzapine may cause allergic reactions, including a serious specific type of allergic reaction called DRESS. DRESS stands for Drug Reaction with Eosinophilia and Systemic Symptoms. It is also sometimes called multi-organ hypersensitivity. This is a reaction that can affect multiple parts of the body including your liver, kidneys, and heart. Stop taking olanzapine and get help right away if you have any of the following symptoms of a serious allergic reaction.
- Breathing problems or wheezing
- Racing heart
- Fever or general ill feeling
- Swollen lymph nodes
- Swelling of the face, lips, mouth, tongue, throat, feet, ankles, or legs
- Trouble swallowing or throat tightness
- Itching, skin rash, or pale red bumps on the skin called hives
- Nausea or vomiting
- Dizziness, feeling lightheaded, or fainting
- Stomach cramps
- Joint pain
- Dark-colored pee
- Your skin or the whites of your eyes turning yellowish in color (also called jaundice)
Post-Injection Drowsiness (Zyprexa Relprevv). When long-acting olanzapine is injected into the muscle, it may cause you to be delirious or feel sleepy. The long-acting injection must be given by a healthcare provider and you will need to wait at least 3 hours at the clinic where you got the injection to be observed for safety.
Warnings & Precautions:
Who should not use olanzapine?
Allergies to Ingredients. People who are allergic to any of the following should not take olanzapine.
- Olanzapine
- Zyprexa
- Zyprexa Relprevv
- Zyprexa Zydis
- Symbyax
- Any of the ingredients in the specific product dispensed
Your pharmacist can tell you all of the ingredients in the specific olanzapine products they stock.
What should I know about olanzapine before using it?
Do not take olanzapine unless it has been prescribed to you by a healthcare provider. Take it as prescribed. Do not share olanzapine with other people, even if they have the same condition as you. It may harm them. Keep olanzapine out of the reach of children.
If you are prescribed olanzapine orally disintegrating tablets, do not take the tablet out and store it in a different container (such as a pill organizer) for future use. Make sure your hands are dry when handling the tablets. Place the tablet on your tongue and let it melt (no water is needed).
Injectable long-acting olanzapine (Zyprexa Relprevv) will be given by a healthcare provider and you will need to wait for observation for at least 3 hours after the injection. You and your healthcare provider will also need to be enrolled in the Zyprexa Relprevv Patient Care Program.
Olanzapine can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how olanzapine affects you. If you receive the long-acting olanzapine injection (Zyprexa Relprevv), do not drive after your injection and for the rest of the day.
Adolescents can be at greater risk for some side effects from olanzapine. Talk to your healthcare provider about your risks if you are in this age group.
What should I tell my healthcare provider before using olanzapine?
Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if olanzapine is right for you.
Current and Past Health Conditions. In particular, tell your healthcare provider if you have any of the following.
- Heart problems
- High or low blood pressure
- Diabetes
- High cholesterol or triglyceride levels
- Alzheimer’s disease
- Enlarged prostate
- Stroke or “mini-stroke”
- Blockage in your bowels
- Breast cancer
- Seizures
- Liver problems
- Thoughts of suicide
- Glaucoma
Psychosis Related to Dementia. There is a higher risk of death, stroke, or mini-stroke in older adults who take olanzapine or another antipsychotic and have memory loss or psychosis related to dementia. Olanzapine is not approved to treat dementia-related psychosis.
Pregnancy. Olanzapine taken later in pregnancy may lead to an increased risk of certain problems in your newborn. Tell your healthcare provider if you are or plan to become pregnant while taking olanzapine. Your healthcare provider will advise you if you should take olanzapine while you are pregnant or trying to get pregnant. If you become pregnant while taking olanzapine, you can register with the National Pregnancy Registry for Atypical Antipsychotics by calling 866-961-2388 or at womensmentalhealth.org/research/pregnancy registry. This registry collects safety information about the use of psychiatric medicines during pregnancy.
Breastfeeding. Olanzapine passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take olanzapine while breastfeeding.
Phenylketonuria (PKU). Olanzapine orally disintegrating tablets (Zyprexa Zydis) contain phenylalanine, which can be dangerous for people with phenylketonuria (PKU). Tell your healthcare provider and your pharmacist if you have PKU and are prescribed olanzapine orally disintegrating tablets.
Other Medicines and Supplements. Olanzapine may interact with other medicines and supplements. Before taking olanzapine, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.
Interactions:
Does olanzapine interact with foods or drinks?
There are no known interactions between olanzapine and foods or nonalcoholic drinks. Avoid drinking alcohol while taking olanzapine. Drinking alcohol while taking olanzapine could increase your risk of sleepiness, dizziness, feeling lightheaded, or fainting upon standing.
Does olanzapine interact with other medicines (drug interactions)?
Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.
In particular, make sure that you discuss if you are using any of the following before taking olanzapine.
- Carbamazepine, which is a medicine commonly used for seizures
- Fluvoxamine, which is a medicine commonly used for mood disorders
- Carbidopa/levodopa, which is a medicine used for movement disorders
- A dopamine agonist, such as pramipexole (Mirapex) or ropinirole (Requip), which is a medicine commonly used for Parkinson’s disease, restless legs syndrome, and other conditions
- A medicine for high blood pressure
- An anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems
- Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, and medicines for anxiety
Some other medicines may alter the blood levels of olanzapine. Tell your healthcare provider about all medicines that you take or have recently taken. Do not take additional medications that contain olanzapine, such as Symbyax (fluoxetine and olanzapine). This may not be a complete list of medicines that can interact with olanzapine. Always check with your healthcare provider.
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