Zyprexa (Olanzapine): Uses, Dosage, Side Effects, & More

What Is Zyprexa?

Zyprexa, also known by its generic name olanzapine, belongs to the drug class of atypical antipsychotics. It acts on the brain’s chemicals, including dopamine and serotonin, to help regulate their imbalances. FDA approval signifies that the U.S. Food and Drug Administration has reviewed clinical data and determined that a medication is safe and effective for a specific medical condition.

In the case of Zyprexa, it is FDA-approved for the treatment of bipolar I disorder and schizophrenia. Zyprexa works by alleviating symptoms associated with these mental health conditions, such as delusions, hallucinations, and mood disturbances.

How Does Zyprexa Work?

Zyprexa, or olanzapine, works by helping to balance certain chemicals in the brain that can be out of sync in conditions like schizophrenia and bipolar I disorder.¹ By doing so, it can reduce symptoms such as hallucinations, delusions, and mood swings, helping people to feel more stable and in control of their thoughts and emotions

What Is Zyprexa Used to Treat?

Zyprexa is FDA-approved to treat several psychiatric conditions. It is indicated for the treatment of schizophrenia, a severe mental disorder characterized by hallucinations, delusions, and disorganized thinking. Zyprexa is also approved for the management of bipolar I disorder, specifically for acute manic and mixed episodes.

FDA approval signifies that the U.S. Food and Drug Administration has reviewed clinical data and determined that a medication is safe and effective for specific medical conditions. While Zyprexa has these approved uses, it’s important to note that doctors may sometimes prescribe it off-label, which means using it for conditions not specifically approved by the FDA, if they believe it may offer therapeutic benefits to the patient. Some conditions olanzapine may be used off-label include depression, nausea in cancer patients, anorexia, and agitation in patients under the influence of substances.²

Will Zyprexa Calm Me Down if I Have Anxiety?

Zyprexa is usually not the go-to choice for treating anxiety itself. It’s primarily used to manage conditions like schizophrenia and bipolar I disorder. However, for people with these conditions who also experience anxiety as part of their symptoms, Zyprexa may indirectly help by stabilizing their overall mental health.

If you’re struggling with anxiety, it’s best to reach out to a healthcare professional who can suggest more suitable treatments like anti-anxiety medications or therapy for anxiety to address your specific needs.

Common Side Effects of Zyprexa

Common side effects of Zyprexa may include drowsiness, dizziness, increased appetite, constipation, weight gain, and dry mouth. Often these side effects are manageable and may improve over time. If you experience persistent dizziness when changing positions, such as when standing up, you should meet with your doctor to have your blood pressure checked. It’s important for individuals taking Zyprexa to discuss and monitor potential side effects with their healthcare provider to ensure safe and effective treatment.

Common side effects of Zyprexa include:*¹

• Drowsiness
• Weight gain
• Dry mouth
• Constipation
• Increased appetite
• Dizziness
• Tremors 

*All medications, including Zyprexa, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Serious Side Effects of Zyprexa

Serious side effects of Zyprexa can impact various areas of the body and require immediate medical attention. These effects can range in severity and may include symptoms such as rapid or irregular heartbeat, significant dizziness, difficulty breathing, or signs of high blood sugar.⁴ It is crucial to seek prompt medical care if any of these serious side effects occur while taking Zyprexa.

Serious side effects of Zyprexa include:¹

• Rapid or irregular heartbeat
• Difficulty breathing
• Severe dizziness
• High fever
• Muscle stiffness
• Uncontrollable movements
• Swelling of the hands or feet
• Fainting
• Falling

If any of these serious side effects occur, it is essential to seek immediate medical attention.

*All medications, including Zyprexa, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Zyprexa Warnings & Precautions

There are warnings and precautions that patients should be mindful of before starting treatment with Zyprexa. Some of these warnings include the potential for increased blood sugar levels, which may affect individuals with diabetes. Zyprexa can also lead to significant weight gain, particularly among younger patients. Precautions like monitoring for rare and serious side effects should be considered.

Orthostatic hypotension, causing dizziness upon standing, may also occur, and patients prone to falls should be aware of potential increased fall risk while taking olanzapine. These warnings and precautions aim to ensure the safe and effective use of Zyprexa and should be discussed with your healthcare provider.

Here are reasons some patients need to avoid taking Zyprexa:¹

• Risk of death in elderly people with dementia-related psychosis: Zyprexa may increase the risk of heart-related issues, particularly in elderly patients with dementia.
• Neuroleptic malignant syndrome: Zyprexa can cause neuroleptic malignant syndrome, a life-threatening syndrome that can cause symptoms such as muscle stiffness, high fever, or kidney failure. If any of these symptoms occur while taking Zyprexa, contact your doctor or the nearest emergency room immediately.
• Serious skin reactions: Zyprexa can cause a serious skin reaction known as drug reaction with eosinophilia and systemic symptoms (DRESS). This can be a life-threatening condition. If you have a fever, rash, or skin blisters while taking Zyprexa, contact your doctor or the nearest emergency room immediately.
• Metabolic changes, especially with a history of diabetes: Zyprexa can cause metabolic changes including high blood sugar, high fats elevated prolactin levels, and weight gain. If you have diabetes, your healthcare provider will decide of Zyprexa is safe for you and how you will need to monitor your blood sugar levels.
• Tardive dyskinesia: Tardive dyskinesia is a potentially irreversible disorder that can cause involuntary muscle movements. It is commonly associated with antipsychotic treatments. The potential of experiencing tardive dyskinesia is increased with the longer the duration and higher the dose of Zyprexa therapy.
• Orthostatic hypotension and falls: Zyprexa may cause orthostatic hypotension or dizziness and fainting when standing up. When starting Zyprexa, let your healthcare provider know if you experience any dizziness or fainting. Dizziness and fainting can also increase the risk of falls, fractures, and other injuries.
• Potential for cognitive and motor impairment: Zyprexa can increase the risk for impaired thinking and decision skills as well as movement dysfunction.
• Allergic reactions: Some people may experience allergic reactions to Zyprexa, which can lead to symptoms like rash, itching, swelling, severe dizziness, or difficulty breathing.
• History of seizures: Zyprexa may lower the seizure threshold, so caution is needed in individuals with a history of seizures.
• History of low white blood cell count: Zyprexa may lead to a decrease in white blood cells, which can weaken the immune system. Individuals with a history of low white blood cell count should be monitored carefully.
• History of Alzheimer’s disease: Zyprexa should not be used in individuals who have Alzheimer’s disease. It can cause issues with swallowing, which can increase the risk of death in Alzheimer’s disease.
• Issues with regulating body temperature: Zyprexa can make it difficult to cool your body. If you are on other treatments or have conditions that may raise your body temperature, it may not be safe to take Zyprexa.

Zyprexa Dosages for FDA-Approved Treatment

Dosages of Zyprexa can vary depending on individual factors such as age, the specific condition being treated, and the patient’s overall health. The typical dosage range for Zyprexa can start at 5 mg per day and may increase based on the patient’s response to the medication.

For the treatment of schizophrenia, the recommended starting dose for adults is usually 10 mg per day, with a range of 5 to 20 mg per day. For bipolar disorder, the recommended starting dose typically ranges from 10 to 15 mg per day, with a maximum dose of 20 mg per day.¹ Physicians may adjust dosages based on individual responses and any potential side effects that may occur during treatment. Regular monitoring and consultation with a healthcare provider are essential to ensure the most effective and safe dosage for each patient.

Zyprexa Forms & Strengths

Zyprexa is available in various forms and strengths as oral tablets and injections. The forms and strengths chosen are based on individual patient needs, the condition being treated, and factors such as age, overall health, and response to the medication. Zyprexa is typically available in both regular-release and extended-release injectable forms.

Extended-release formulations provide a slow release of the medication over time, which can help reduce the frequency of dosing and improve patient compliance with schizophrenia. The time it takes for each form and strength to take effect may vary, with some patients experiencing relief within hours while others may take several days.

Zyprexa is also available in a dissolvable oral tablet form, allowing for easier administration in some cases, such as in patients with difficulty swallowing. Zyprexa Relprevv is a long-acting formulation FDA-approved for schizophrenia and is administered every 2 weeks. It is only available through a restricted distribution program.

The regular-release injectable forms are only used in episodes of agitation, usually while the patient is hospitalized. The choice of delivery method depends on the specific needs and circumstances of the patient, with prescribers carefully considering the most appropriate form and strength to ensure effective treatment.

Zyprexa is available in the following forms and strengths:¹

• Oral tablet
  • 2.5 mg
  • 5 mg
  • 7.5 mg
  • 10 mg
  • 15 mg
  • 20 mg
• Orally dissolving tablet
  • 5 mg
  • 10 mg
  • 15 mg
  • 20 mg
• Intramuscular injection (Zyprexa Relprevv)
  • 10 mg per vial
• Extended-release intramuscular injection (Zyprexa Zydis)
  • 210 mg per vial
  • 300 mg per vial
  • 405 mg per vial

What’s the Most Effective Dose of Zyprexa?

The most effective dose of Zyprexa varies from person to person. There is no universal “one-size-fits-all” dose. Prescribers typically start with a lower dose and adjust it based on the patient’s progress and any side effects. The goal is to find the minimum effective dose that provides symptom relief while minimizing potential adverse effects. Regular monitoring and communication with a healthcare provider are essential to determine the most effective dose for each patient.

How Long Does it Take for Zyprexa to Work?

The time it takes for Zyprexa to start working can vary from person to person. Some individuals may experience an improvement in their symptoms within hours or a few days. It may take several weeks to achieve the full therapeutic effect. It’s important to continue taking the medication as prescribed, even if the effects are not immediately noticeable, and to discuss any concerns or lack of progress with a healthcare provider who can adjust the treatment plan if necessary.

How Should I Take Zyprexa?

To take Zyprexa effectively, follow your healthcare provider’s instructions precisely. It’s typically taken by mouth as an oral tablet, and the dosage will depend on your specific condition and needs. Zyprexa can be taken with or without food. If you are prescribed the dissolvable tablet, it should be placed on your tongue, where it will disintegrate, and then swallowed with water.

Because Zyprexa can cause sleepiness, it is recommended to be taken at bedtime. It’s important to follow the prescribed dose and schedule diligently and not to alter your dosage or discontinue the medication without consulting your healthcare provider, as this can affect its effectiveness and potentially lead to adverse effects.

Zyprexa is also available in injectable forms as Zyprexa Relprevv and Zyprexa Zydis. If you are using these forms of Zyprexa, your healthcare provider will help you learn how you will receive these injections.

What Happens If I Miss a Dose of Zyprexa?

If you miss a dose of Zyprexa, take it as soon as you remember. However, if it’s close to the time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for the missed one. Missing an occasional dose may slightly reduce the effectiveness of the medication, but it’s important not to significantly deviate from your prescribed regimen to avoid potential complications or abrupt changes in symptoms. Always consult your healthcare provider if you have concerns about missed doses.

Can You Overdose on Zyprexa?

Yes, it is possible to overdose on Zyprexa. Overdosing can lead to serious health risks, including extreme sedation, rapid heartbeat, dizziness, and in severe cases, coma or death (FN1). If you or someone you know shows signs of an overdose, such as extreme drowsiness, confusion, slurred speech, or uncontrollable movements, seek immediate medical attention. It’s essential to take Zyprexa strictly as prescribed and not to exceed the recommended dosage to prevent the risk of overdose and its associated health dangers.

What Should You Do If You Take Too Much Zyprexa?

If you suspect you have taken too much Zyprexa, it’s crucial to seek immediate medical help. Contact emergency services or go to the nearest emergency room. Be prepared to provide information about the amount of medication ingested, the time it was taken, and any symptoms you are experiencing. Prompt medical attention is vital to prevent potential complications and ensure appropriate treatment for an overdose.

What to Avoid When Taking Zyprexa

There are various substances that you should avoid when taking Zyprexa. It’s important to avoid alcohol and sedative medications, as they can increase drowsiness and affect your coordination when taken with Zyprexa. Mixing Zyprexa with alcohol or diazepam may also make you feel dizzy when you stand up.

Some medications, like fluvoxamine or fluoxetine, can affect Zyprexa’s blood levels, so it’s important to discuss with your doctor if dose adjustments are necessary. Always communicate with your healthcare provider about any potential interactions with medications, supplements, or herbs for safe and effective medication management.

8 substances you should avoid while taking Zyprexa include: (FN1)

• Alcohol: Combining Zyprexa with alcohol can enhance the sedative effects of the medication and impair motor skills and mental alertness.
• Sedatives and sleep aids: These substances can intensify drowsiness and lead to excessive sleepiness when taken with Zyprexa.
• Anti-anxiety medications: Combining Zyprexa with benzodiazepines or other anti-anxiety drugs can lead to increased drowsiness and the potential for impaired cognitive function.
• Antihypertensive medications: Some blood pressure medications can interact with Zyprexa, leading to a drop in blood pressure and increased dizziness.
• Antihistamines: Over-the-counter antihistamines can intensify the sedative effects of Zyprexa, potentially causing excessive drowsiness.
• Other antipsychotic medications: Using Zyprexa alongside other antipsychotic drugs such as Seroquel (quetiapine) or Abilify (aripiprazole) can increase the risk of side effects, including sedation and movement disorders (FN5).
• Fluvoxamine: This medication can increase the levels of Zyprexa in the body, leading to an elevated risk of side effects.
• Parkinson’s medications: Some Parkinson’s medications, like Levodopa, may interact with Zyprexa, potentially leading to increased side effects such as drowsiness and impaired muscle movement.

This is not a comprehensive list of the possible interactions with Zyprexa. You should talk with your healthcare provider and your pharmacist about all prescription and over-the-counter medications, herbs, and supplements you take before starting Zyprexa.

How to Get a Prescription for Zyprexa

To obtain a prescription for Zyprexa, you must consult with a licensed healthcare professional. Typically, psychiatrists, psychiatric nurse practitioners, or primary care physicians can prescribe Zyprexa. The process involves a thorough evaluation of your mental health. This may include discussing your symptoms, medical history, testing, and any potential contraindications or interactions with other medications. The healthcare provider will determine if Zyprexa is a suitable treatment based on assessing your specific condition and overall health.

How Much Does Zyprexa Cost?

The cost of Zyprexa can vary widely depending on factors such as location, formulation, dosage, and whether you use the brand-name or generic version. Without insurance, a month’s supply can range from approximately $300 to $800 or more. (FN6)

Some individuals may be eligible for coupons, discounts, or patient assistance programs to help reduce out-of-pocket costs. Choosing the generic form, which is generally less expensive, can also contribute to cost savings. It’s advisable to discuss pricing options with your insurance company or pharmacist.

Questions to Ask Your Healthcare Provider About Zyprexa

Individuals may want to inquire about Zyprexa if they are diagnosed with conditions like schizophrenia or bipolar disorder. Questions for their healthcare team, including the doctor, psychiatrist, and therapist, could involve the safety and potential side effects of Zyprexa, the adjustment period, and how it may interact with existing medications. They may also ask about the optimal dosage to minimize side effects and inquire about lifestyle modification considerations. If you’re considering a change in prescribers, online psychiatry services can offer a convenient option for seeking guidance and adjusting treatment plans.

Questions to ask your care team about Zyprexa include:

• What are the potential side effects of Zyprexa?
• Are there any specific lifestyle changes or dietary considerations while taking Zyprexa?
• Can Zyprexa be taken with my current medications, and are there any potential drug interactions?
• What signs should I monitor for that might indicate the need for dosage adjustments?
• Are there any long-term effects or risks associated with Zyprexa use?
• How often will my mental health be monitored while on Zyprexa?
• Are there alternatives to Zyprexa that may be more suitable for me?
• If I experience any side effects or discomfort, what is the recommended course of action?

For Further Reading

• How Is Bipolar Disorder Diagnosed?
• How to Help Someone With Schizophrenia: 10 Tips From a Therapist
• Antipsychotics: Types, Side Effects, & Usages 
• Symbyax (Olanzapine-Fluoxetine): Uses, Dosage, Side Effects, & More
• Schizophrenia Symptoms & Signs