Pronunciation: zy-PREX-a, zy-PREX-a ZY-dis, zy-PREX-a RELL-prev
Generic name: Olanzapine
Dosage form: oral tablets, orally disintegrating tablets (Zyprexa Zydis), intramuscular injection (Zyprexa IM), long-acting intramuscular injection (Zyprexa Relprevv)
Drug class: Atypical antipsychotics

Medically reviewed by Carmen Pope, BPharm. Last updated on Apr 23, 2024.

What is Zyprexa?

Zyprexa (olanzapine) 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 for manic or mixed episodes, or in combination with lithium or valproate
• with fluoxetine for depressive episodes in people aged 10 and older.

For treatment-resistant depression, olanzapine is used in combination with fluoxetine (Symbyax).

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. Zyprexa Relprevv IM is only available through a restricted distribution program, and the prescriber, healthcare facility, patient, and pharmacy must all be enrolled in the Zyprexa Relprevv Patient Care Program.

Zyprexa may work by blocking certain receptors in the brain, notably dopamine and serotonin, although the exact way it works in schizophrenia and bipolar I disorder is unknown.

Zyprexa was FDA approved on September 30, 1996.

Zyprexa side effects

Zyprexa may cause serious side effects such as an increased risk of death or stroke in elderly patients with dementia, a higher risk of suicide when taken with fluoxetine, metabolic changes, tardive dyskinesia, low blood pressure, and blood cell disorders. See the warnings below for a full list of serious side effects.

Common side effects of Zyprexa that affect 5% or more people who take it include postural hypotension (a drop in blood pressure when going from a lying or sitting position to standing)

• Constipation
• Weight gain and increased appetite
• Dizziness
• Personality disorder
• Restlessness
• Sedation
• Headache
• Abdominal pain
• Pain in the extremities
• Tiredness or lack of energy
• Dry mouth
• Tremor.

Other side effects may include increased salivation, speech disorder, forgetfulness, and the feeling of pins and needles in your limbs.

Teenagers experienced greater increases in prolactin, liver enzymes, and sleepiness, when compared with adults.

Tell your doctor about any side effect that bothers you or does not go away.

These are not all the possible side effects of Zyprexa. For more information, ask your doctor or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Related/similar drugs

Vraylar, sertraline, trazodone, quetiapine, Lexapro, lamotrigine, Zoloft

Warnings

Zyprexa may cause serious side effects, including:

• An increased risk of death, strokes, or “mini-strokes” called transient ischemic attacks (TIAs) in elderly people who are confused, have memory loss, and have lost touch with reality (dementia-related psychosis). These people should not be given Zyprexa
• A higher risk of suicide when Zyprexa is used in combination with fluoxetine for people with depression
• High blood sugar (hyperglycemia). This can happen if you have diabetes already or if you have never had diabetes. High blood sugar could lead to a build-up of acid in your blood due to ketones (ketoacidosis), coma, and death. Your doctor should do tests to check your blood sugar before you start taking Zyprexa and during treatment. Call your doctor if you have any of these symptoms of high blood sugar (hyperglycemia) while taking Zyprexa:
  • feel very thirsty
  • need to urinate more than usual
  • feel very hungry
  • feel weak or tired
  • feel sick to your stomach
  • feel confused or your breath smells fruity.
• High fat levels in your blood (increased cholesterol and triglycerides), especially in teenagers aged 13 to 17 or when used in combination with fluoxetine in children aged 10 to 17. Your healthcare provider should do blood tests to check your cholesterol and triglyceride levels before you start taking Zyprexa and during treatment
• Weight gain is very common in people who take Zyprexa, especially in teenagers aged 13 to 17 or when used in combination with fluoxetine in children aged 10 to 17. Some people gain a lot of weight. You and your doctor should check your weight regularly. Talk to your doctor about ways to control weight gain, such as eating a healthy, balanced diet, and exercising
• Neuroleptic Malignant Syndrome (NMS). This is a rare but very serious side effect of antipsychotics that may be fatal. NMS can cause death and must be treated in a hospital. Call your doctor right away if you become severely ill and have symptoms such as high fever, excessive sweating, rigid muscles, confusion, changes in your breathing, heartbeat, and blood pressure
• Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). This is a serious drug hypersensitivity syndrome with symptoms such as an extensive rash, fever, swollen lymph nodes, liver inflammation, and blood abnormalities. Tell your doctor immediately if you experience any of these signs
• Tardive Dyskinesia: This condition causes persistent body movements that usually affect the face and tongue which you cannot control. It may not go away even if you stop taking Zyprexa and may start after you stop taking Zyprexa. Tell your doctor if you get any body movements that you cannot control
• Decreased blood pressure when you go from a lying or sitting position to standing. Symptoms may include dizziness, fast or slow heartbeat, or fainting
• Difficulty swallowing, which may cause food or liquid to get stuck in your lungs
• Seizures. Tell your doctor if you have had a seizure before or if you have one during treatment with Zyprexa
• Changes in your blood cells. Your doctor will monitor your blood cell counts especially if you have a history of significantly low white blood cell counts or drug-induced leukopenia or neutropenia
• Problems with control of body temperature: You could become very hot, for instance when you exercise a lot or live or holiday in a very hot area. It is important for you to drink water to avoid dehydration. Call your doctor right away if you become severely ill and have any of these symptoms sweating too much or not at all, dry mouth, feeling very hot, feeling thirsty, or not able to produce enough urine.

May cause drowsiness and impair judgment, thinking, and motor skills. Use with caution when driving or operating machinery until you know how olanzapine affects you.

Zyprexa has not been approved for use in:

• children under 13 years of age when used to treat schizophrenia or bipolar I disorder
• children under 10 years of age when used in combination with fluoxetine for depressive episodes.

Zyprexa cost

The cost of prescription drugs varies depending on your insurance plan and which pharmacy you use. Refer to our price guide page for more information about the cost of Zyprexa or the cost of Zyprexa Zydis.

You may also be eligible for a Zyprexa coupon, or Zyprexa copay card. Ask your doctor or pharmacist if you qualify. Generic Zyprexa is available under the name olanzapine.

Before taking

Zyprexa may not be right for you. Before starting, tell your doctor if you have or had:

• heart problems
• seizures
• diabetes or high blood sugar levels (hyperglycemia)
• high cholesterol or triglyceride levels in your blood
• liver problems
• low or high blood pressure
• strokes or “mini-strokes” also called transient ischemic attacks (TIAs)
• Alzheimer’s disease
• narrow-angle glaucoma
• enlarged prostate in men
• bowel obstruction
• phenylketonuria, because Zyprexa Zydis contains phenylalanine.
• breast cancer
• thoughts of suicide or hurting yourself
• any other medical condition
• are pregnant or plan to become pregnant
• are breastfeeding or plan to breastfeed.

Tell your doctor if you exercise a lot or live or holiday in hot places.

Pregnancy

Taking antipsychotic medication, such as Zyprexa, in the last 3 months of pregnancy may cause breathing problems, feeding problems, or withdrawal symptoms in the newborn. If you get pregnant, tell your doctor right away but do not stop taking Zyprexa without your doctor's advice.

Talk to your healthcare provider about registering with the National Pregnancy Registry for Atypical Antipsychotics. You can register by calling 1-866-961-2388 or go to http://womensmentalhealth.org/clinical-andresearch-programs/pregnancyregistry/ 

Breastfeeding

Zyprexa passes into your breast milk. If you are breastfeeding, tell your doctor if you notice severe drowsiness, irritability, feeding problems, tremors, or unusual muscle movements in the nursing baby. Talk to your doctor about the best way to feed your baby if you take Zyprexa.

How should I take Zyprexa?

Take Zyprexa exactly as prescribed. Your doctor may need to change (adjust) the dose of Zyprexa until it is right for you.

The usual starting dose for adults with:

• schizophrenia is 5 mg to 10 mg once a day.
• bipolar I disorder is 10 mg to 15 mg once a day.

Zyprexa tablets

Zyprexa is usually taken once a day.

• It can be taken with or without food.

Zyprexa Zydis

Zyprexa Zydis is an orally disintegrating tablet that dissolves in your mouth without water.

• Before taking it, make sure that your hands are dry.
• Open the sachet and peel back the foil on the blister. Do not push the tablet through the foil.
• When you open the blister, remove the tablet and put it into your mouth.
• The tablet will disintegrate quickly in your saliva so that you can easily swallow it with or without drinking liquid.

Zyprexa IM injection

Zyprexa IM is a short-acting formulation that may be given to adults with schizophrenia or bipolar I mania if they have become agitated.

• The usual dosage is 10 mg (5 mg or 7.5 mg when clinically warranted).
• Up to a maximum of 3 doses may be given if needed, 2 to 4 hours apart.
• Your doctor should monitor you for low blood pressure on standing (orthostatic hypotension) before giving you another dose.

Zyprexa Relprevv IM injection

Zyprexa Relprevv is a long-acting formulation that may be administered by a healthcare provider every 2 to 4 weeks by deep intramuscular gluteal injection. It should only be administered once tolerance to oral olanzapine has been established.

• Note that side effects similar to an olanzapine overdose including sedation (ranging from mild in severity to coma) and delirium (including anxiety, agitation, confusion, disorientation, and cognitive impairment, have been reported following an injection of Zyprexa Relprevv.
• Other symptoms may include extrapyramidal symptoms, speech disorders, co-ordination difficulties, aggression, dizziness, weakness, high blood pressure, and seizures.
• Most symptoms occurred within the first hour and usually within 3 hours, although some have occurred later.
• Healthcare providers should monitor patients for 3 hours following the injection and accompany patients to their destination upon leaving the facility. For the remainder of the day of each injection, patients should not drive or operate heavy machinery. They should be advised to be vigilant for symptoms of post-injection delirium/sedation syndrome and be able to obtain medical assistance if needed. 

Zyprexa: Other information

You may need regular medical tests while you are taking Zyprexa to check your cholesterol levels.

If you are diabetic, check your blood sugar levels regularly, because Zyprexa can cause high blood sugar levels, even in people who are not diabetic.

Olanzapine may cause you to gain weight more easily. Be conscious of your weight and what you eat. Exercise regularly. Talk to your healthcare provider if you are putting on too much weight.

Call your healthcare provider if you do not think you are getting better or have any concerns about your condition while taking Zyprexa.

• The symptoms of bipolar I disorder, treatment-resistant depression, or schizophrenia may include thoughts of suicide or of hurting yourself or others. If you have these thoughts at any time, tell your doctor or go to an emergency room right away.

What should I avoid while taking Zyprexa?

Zyprexa can cause sleepiness and may affect your ability to make decisions, think clearly, or react quickly. You should not drive, operate heavy machinery, or do other dangerous activities until you know how it affects you.

Avoid drinking alcohol. Dangerous side effects could occur.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Avoid becoming overheated or dehydrated. Drink plenty of fluids, especially in hot weather and during exercise. It is easier to become dangerously overheated and dehydrated while you are taking Zyprexa.

Avoid stopping Zyprexa suddenly. You should never stop taking it without your doctor’s advice. When it comes time to stop Zyprexa, it should be withdrawn slowly over several weeks under a doctor’s supervision. One survey reported at least 72% of people taking antipsychotics such as olanzapine experienced withdrawal symptoms.

Zyprexa withdrawal

Common symptoms of Zyprexa withdrawal include nausea, headaches, dizziness, sleep disturbances, brain zaps, and psychological symptoms, such as anxiety, irritability, mood swings, and difficulty concentrating.

• Nearly half of people describe these symptoms as severe, especially during the early stage of withdrawal.
• The length of time withdrawal symptoms from Zyprexa last varies; some report symptoms last two weeks or less, while others experience symptoms for years. This appears to correlate with the length of time people have taken the medication.
• If you want to stop taking Zyprexa, talk to your healthcare provider about the best way to come off it. This may involve slowly reducing your dose, switching to another medication that might be easier to withdraw from, or taking other medications to help with your withdrawal symptoms.

What happens if I miss a dose?

If you miss a dose of Zyprexa, take the missed dose as soon as you remember. If it is almost time for the next dose, just skip the missed dose and take your next dose at the regular time. Do not take two doses at the same time.

What happens if I overdose?

If you take too much Zyprexa, call your doctor or poison control center at 1-800-222­-1222 right away, or get emergency treatment.

Overdose symptoms may include drowsiness, agitation, aggression, slurred speech, confusion, increased heart rate, jerky or uncontrolled muscle movements, trouble breathing, or fainting.

What other drugs will affect Zyprexa?

Tell your doctor about all the medicines that you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Zyprexa and some medicines may interact with each other and may not work as well, or cause possible serious side effects. Your doctor can tell you if it is safe to take Zyprexa with your other medicines. Do not start or stop any medicine while taking Zyprexa without talking to your doctor first. Especially tell your doctor if you take:

• Diazepam, lorazepam, or other benzodiazepines. This may make some side effects such as orthostatic hypotension worse
• Carbamazepine. May reduce the effect of olanzapine.
• Fluvoxamine. May increase levels of olanzapine and make side effects worse
• Fluoxetine. This may increase the risk of suicidal thoughts and behaviors
• Other medications that effect the brain, such as sedatives or sedating antihistamines. These can make side effects worse, especially when combined with alcohol
• Heart medications that lower blood pressure. Olanzapine may cause an enhanced effect
• Levodopa and dopamine Agonists. Olanzapine may counteract the effects of these drugs.

Anticholinergics (antimuscarinics), such as benztropine.  Use with caution in patients with urinary retention, prostatic conditions, constipation, and some other conditions

Alcohol may also make side effects such as sleepiness and orthostatic hypotension worse.

Taking Zyprexa with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

This is not a complete list of interactions. Talk to your healthcare provider or pharmacist for a full list of interactions.

Storage

Store Zyprexa at room temperature, between 68°F to 77°F (20°C to 25°C), away from light. Keep it dry and away from moisture.

Keep out of the reach of children.

Ingredients

Zyprexa tablets

Active ingredient: olanzapine.

Inactive ingredients: carnauba wax, crospovidone, hydroxypropyl cellulose, hypromellose, lactose, magnesium stearate, microcrystalline cellulose, and other inactive ingredients.

Color coating: Titanium Dioxide, FD&C Blue No. 2 Aluminum Lake, or Synthetic Red Iron Oxide.

Zyprexa is available as 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, and 20 mg tablets. Tablets are not scored.

Zyprexa Zydis

Active ingredient: olanzapine.

Inactive ingredients: gelatin, mannitol, aspartame, sodium methyl paraben, and sodium propylparaben.

Zyprexa Zydis orally disintegrating tablets are available as 5 mg, 10 mg, 15 mg, and 20 mg tablets. Tablets are not scored.

Zyprexa injection

Active ingredient: olanzapine.

Inactive ingredients: lactose monohydrate, tartaric acid, hydrochloric acid, sodium hydroxide.

Zyprexa injection is available as a 10 mg vial.

Zyprexa Relprevv injection

Active ingredient: olanzapine pamoate.

Inactive ingredients: carboxymethylcellulose sodium, unspecified, polysorbate 80, hydrochloric acid, sodium hydroxide, water. 

Manufacturer

Eli Lilly and Company.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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