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Zyprexa® (olanzapine)

All FDA warnings are at the end of this fact sheet. Please consult them before taking this medication.

Brand and Generic Names

Brand Name: Zyprexa®, Zyprexa Zydis®, Zyprexa® Relprevv™
- Tablets: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg
- Rapidly disintegrating tablets (Zyprexa Zydis^®): 5 mg, 10 mg, 15 mg, 20 mg
- Injection (immediate acting): 10 mg vials
- Injection (extended release injection): 150 mg/2 weeks, 300 mg/4 weeks, 210 mg/2 weeks, 405 mg/4 weeks, 300 mg/2 weeks
Generic name: olanzapine

What is Zyprexa® and what does it treat?

Olanzapine is a second generation antipsychotic (SGA) medication approved for the treatment of schizophrenia and bipolar disorder. Bipolar disorder involves episodes of depression and/or mania. Olanzapine can improve symptoms of schizophrenia such as: hallucinations, delusions and disorganized thinking; in some people, improvement in social isolation, reduced speech productivity and motivation also occur. It can also help control the mood swings of bipolar mania. The remainder of this medication sheet will focus primarily on schizophrenia.

What is the most important information I should know about Zyprexa®?

Relapse is very common in schizophrenia and the most frequent cause is that patients stop taking their medication. Even when medication is taken exactly as prescribed, relapse may still occur for some people. Therefore it is recommended that you take your medication exactly as prescribed by your healthcare provider as this has been shown to decrease the risk of relapse.

Schizophrenia requires long-term treatment. Only your healthcare provider can determine the length of the olanzapine treatment that is right for you.
Do not stop taking olanzapine without talking to your healthcare provider first.
Some people may develop side effects on olanzapine such as extrapyramidal effects (restlessness, tremor, stiffness) or tardive dyskinesia (slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements). These symptoms are likely to be less severe and occur less often than with the older antipsychotic medications (e.g., Haldol® [haloperidol], Prolixin® [fluphenazine], Thorazine® [chlorpromazine]). If you develop movements that you cannot control, call your healthcare provider immediately.
Many second generation or atypical antipsychotics may cause an increase in weight, blood sugar levels, or lipid levels. If you gain more than 5% of your original weight during therapy, talk to your healthcare provider about whether switching to another antipsychotic medication should be considered.
Olanzapine treatment may be associated with strokes and/or transient ischemic attacks (TIAs) in elderly people with dementia and accompanying behavior problems. This safety concern has not been proven confidently, but there is some evidence. Talk with your health care provider if you are concerned or have questions.
Both older first and newer second generation antipsychotics have been associated with the risk of sudden cardiac death due to an arrhythmia (irregular conduction of an electrical impulse in the heart). To minimize this possibility, antipsychotic medications should be used in the smallest effective dose in situations where the benefits outweigh the risks such as schizophrenia or bipolar disorder. Often an EKG tracing may be ordered to monitor for conduction changes.
Olanzapine treatment must be monitored by a healthcare provider. Be sure to keep all of your scheduled appointments so that you stay healthy while on olanzapine.
You should not take illegal drugs or drink alcohol while taking olanzapine.

What should I discuss with my healthcare provide before taking Zyprexa®?

Symptoms of schizophrenia or bipolar disorder which are most bothersome to you.
The medications you have taken in the past for schizophrenia or bipolar disorder. It would be helpful for your provider to know which medications were effective and which were not.
Which side effects from previous medications were too uncomfortable for you to tolerate.
About any medication allergies you have.
All other prescription and non-prescription medications you are currently taking.
If you smoke cigarettes or plan to quit smoking, use illegal drugs, or drink alcohol.
If you are pregnant, plan to get pregnant, or are breast feeding.
If you or any family members have had breast cancer
What medical problems you have, especially diabetes, high cholesterol or triglycerides, increased body weight, irregular heart beats, or seizures.
If you have had any serious extrapyramidal symptoms (EPS) from other medications; such as (restlessness, tremor, stiffness) or tardive dyskinesia (slow or jerky movements that one cannot control).
Tell your doctor if you have thoughts of suicide.
If you have had neuroleptic malignant syndrome (NMS).

Neuroleptic malignant syndrome (NMS) is a life-threatening, neurological disorder most often caused by an adverse reaction to antipsychotic medications. Symptoms of NMS include sudden high fever, sweating, changing blood pressure, dizziness, fatigue, muscle stiffness, as well as changes in liver and kidney function. In most cases, the disorder develops within the first two weeks of medication treatment; however, the disorder may develop any time during the course of pharmacotherapy. Early identification of and treatment for individuals with neuroleptic malignant syndrome slows the progression and improves recovery from “NMS.” Sometimes a different antipsychotic can be reintroduced very slowly once recovery is complete, although there is a risk that the syndrome might recur. Generally, intensive care is needed to treat and appropriately diagnose neuroleptic malignant syndrome NMS, so notify your healthcare provider immediately if you suspect you are developing NMS.

Are there specific concerns about Zyprexa® and pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider so that he/she can best manage your medications. People living with schizophrenia who wish to become pregnant face important decisions, each with risks and benefits related to how the illness, medications and the risks to the fetus may interact. This is a complex decision as untreated schizophrenia has risks to the fetus as well as the mother. There are many dimensions to these choices, so be sure to confer with your doctor and caregivers.

Regarding breast-feeding, caution is advised since olanzapinedoes pass into breast milk. It is recommended that women taking olanzapine do not breast-feed.

What should I discuss with my healthcare provider before taking Zyprexa®?

Symptoms of schizophrenia which are bothersome to you.
If you had any serious side effects with other antipsychotic medications like muscle stiffness, muscle cramping, shaking, tardive dyskinesia, neuroleptic malignant syndrome, weight gain, or diabetes. (See the NAMI Hearts and Minds Program).
If you have had an allergic reaction to olanzapine or any other medication.
History of heart problems, such as heart rhythm problems, long QT syndrome, or heart attacks. These illnesses may make olanzapine unsafe for you to take.
Medical problems you have, especially diabetes, high cholesterol or triglycerides, increased body weight, seizures, or kidney disease or impairment.

How should I take Zyprexa®?

Olanzapine can be taken with or without food but should be taken with a full glass of water.
Olanzapine orally disintegrating tablets should be removed from the blister unit with dry hands and immediately placed on the tongue. They cannot be stored once removed from the blister unit and must be taken immediately. They disintegrate in the mouth within seconds and can be swallowed with or without liquid. Do not split the tablet.
Prior to receiving your first olanzapine extended-release injection, tolerability to the oral formulation of olanzapine must first be established. Olanzapine extended-release injections must be administered by a healthcare professional every two or four weeks by intramuscular gluteal injection. After receiving the injection, you must remain at the healthcare facility under observation for a period of at least 3 hours to ensure you do not display symptoms of overdose, such as excessive sedation and/or delirium (ie, confusion, agitation, aggressiveness). You cannot drive or operate heavy machinery the day of your injection and must be accompanied home.
Only your doctor can determine the correct dose for you. Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.
Use a calendar to help you remember when your next injection is due or ask a family member or friend to remind you when it is time to receive your next injection. If you are unsure when your next injection is due, call the healthcare facility that administers your injection to confirm the date.

What happens if I miss a dose?

If you miss a dose of oral olanzapine, take it as soon as you remember it, if it is not too close to when your next dose is due-discuss this with your health care provider. Do not double your next dose or take more than what is prescribed.

If you miss a dose of olanzapine extended release injection, schedule an appointment with your healthcare provider as soon as possible.

What should I avoid while taking Zyprexa®?

Olanzapine may cause dizziness or drowsiness, especially when first starting the medication. Make sure you know how you react to the medication before you drive, operate machinery, or plan other activities that may be dangerous if you are not alert.
After receiving your olanzapine long-acting injection, you must be accompanied to your destination upon leaving the healthcare facility. For the remainder of the day of each injection, you should not drive or operate heavy machinery.
Avoid drinking alcohol or using illegal drugs while receiving olanzapine long-acting injections.

What happens if I overdose?

If an overdose occurs, whether intentional or accidental, immediate medical attention may be necessary. Call your doctor or emergency medical service (911). You may also contact the poison control center at 1-800-222-1222.

What are the possible side effects of Zyprexa®?

What are the common side effects seen with olanzapine?

The most common side effects include headache, sedation, dizziness, weight gain, cough, diarrhea, back pain, nausea, somnolence, dry mouth, increased appetite or vomiting. Weight gain, increased prolactin levels and elevated triglycerides are more common in patients receiving higher dose. Increased blood levels of prolactin may result in females losing their period and males experiencing a loss of sex drive.

As with any injection, some pain is reported by patients receiving the olanzapine long-acting injection.

What are the more serious side effects of antipsychotics?

With newer second generation antipsychotics (SGA), more commonly seen are diabetes/weight gain/increased cholesterol and triglycerides as noted in stronger warning mandated by the FDA in individual drug labeling. For the relative risk of weight gain and diabetes seen with the various drugs, see Table 2 in the Consensus Conference on Antipsychotic Drugs. These guidelines make recommendations for the monitoring of cardiac risk factors while on atypical antipsychotics.

Please also consult the Metabolic and Diabetes tab on the Hearts and Minds section for the current monitoring information regarding triglycerides, cholesterol, fasting blood glucose, etc. to help plan preventative interventions.
Less commonly seen, but important, is the early death/dementia risk as noted in the FDA boxed warning. In some clinical trials, it was determined that elderly people developed strokes at a higher rate than those on placebo medication (sugar pill). The SGA group has less tardive dyskinesia (TD), neuroleptic malignant syndrome, seizures and changes in heart rhythm than FGA drugs but not zero.
Specifically with the olanzapine long-acting injection, there is a very small risk of developing sedation that can range from mild to severe, including coma. Additionally, there is a very small risk of developing confusion, trouble thinking, agitation and anxiety. These symptoms most commonly occur 1-3 hours after the injection and usually resolve in 72 hours. Because of this, the patient must be monitored at the healthcare facility for at least three hours after the injection.

What do I do about the more serious risks?

Please let your doctor know if you have any medical conditions prior to starting olanzapine: history of heart disease, low white blood cell counts, liver disease or allergy to olanzapine.

It is important to be aware of prevention with attention to nutrition, exercise and reducing your plate size is necessary (because the medications may reduce your ability to feel full after eating). For more ideas, see the NAMI Hearts and Minds Program.

Also, obtain Abnormal Involuntary Movement testing (AIMS) to monitor for TD. While it is less common with newer SGA, it has been reported. If you are taking an older FGA, then regular AIMS testing is needed for monitoring, so you can make good choices about the use of the drug when weighing the risks and benefits.

Are there any risks for taking this medication for long periods of time?

Tardive dyskinesia (TD) is a side effect that may develop with prolonged use of antipsychotics. Medications such as olanzapine have been shown to have a much lower risk of TD compared to older antipsychotics, such as Haldol® (haloperidol). Should you develop symptoms of TD, such as grimacing, sucking and smacking of lips and other movements that you cannot control, contact your healthcare provider immediately.

No one can predict how much weight a person will gain on any medicine, but an approach that includes exercise and diet and monitoring for weight gain and diabetes is recommended.

What other drugs interact with this medication?

Some antidepressants such as fluoxetine (Prozac®) and fluvoxamine (Luvox®), may increase the blood levels of olanzapine. Some anti-infective medications may also increase the blood levels of olanzapine. These medications include atazanivir (Reyataz®), ciprofloxacin (Cipro®), erythromycin (Ery-Tab®) and isoniazid (INH). It is possible that patients taking olanzapine with any of these medications may experience a change in side effects. Please tell your healthcare provider if you begin or discontinue any of these treatments.

Anti-viral and anti-infective medications, such as darunavir/ritonavir (Prezista®), lopinavir/ritonavir (Kaletra®), rifampin (Rifadin®) and ritonavir (Norvir®) may decrease the blood levels of olanzapine. In addition, anticonvulsants and other medications may also decrease olanzapine blood levels including: carbamazepine (Tegretol®), phenobarbital, phenytoin (Dilantin®) and St. John's Wort. It is possible that you may experience a decreased effect from olanzapine if you also take one of these medications. Please tell your healthcare provider if you begin or discontinue any of these treatments.

Cigarette smoking may reduce blood levels of olanzapine in your body. If you are a smoker and you stop smoking, your dose of olanzapine may need to be decreased.

How long does it take for Zyprexa® to work?

Olanzapine works by rebalancing dopamine and serotonin in your brain to improve thinking, mood and behavior. Improvement of some symptoms may be noticed in some patients within a few weeks. The full benefit of olanzapine may not be seen for 6-12 weeks or longer.

FDA ALERT [06/0606]

Both conventional and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia-related psychosis.

Antipsychotics are not indicated for the treatment of dementia-related psychosis.

Updated by
Tiffany-Jade Kreys, Pharm.D., & Kara Lee Shirley, Pharm.D., CGP, BCPS, BCPP
December 2010

NAMI wishes to thank the College of Psychiatric and Neurologic Pharmacists for producing this fact sheet.

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