What Is Zyprexa?

Olanzapine's Uses, Benefits, and Side Effects

Author:

Emma Loker

B.S

Editor:

Ashley Pena

LCSW

If you’ve been prescribed Olanzapine (brand name Zyprexa), you probably have some questions. For starters, what is Zyprexa? How does it work? And how will it affect you?

Though medication for mental health conditions can be transformational, it can also be a difficult journey. Starting and stopping your meds, experiencing side effects, and wondering whether there are better alternative treatments can end up being a very stressful experience.

To clarify what you can expect from this medication, this page will explain:

What Olanzapine is used to treat
How Olanzapine works in the body
Common and rare side effects, and how to manage them
The experience of withdrawing from Olanzapine, and how to do it safely
Alternative treatments
Some frequently asked questions about Olanzapine

Let’s dive in.

What is Olanzapine Used For?

Olanzapine is a type of atypical antipsychotic medication. Its FDA-approved uses include treating patients aged over 13 with schizophrenia and patients with bipolar disorder (whether episodes are mixed or manic). It’s also approved to be used with fluoxetine (an SSRI) for patients with treatment-resistant depression and those with depression associated with bipolar type ^1.

Its off-label uses include treating delirium, acute agitation, anorexia nervosa, and nausea caused by chemotherapy.¹

When using Zyprexa for bipolar disorder, research finds that treatment is enhanced by also prescribing lithium or valproate. This may be something your doctor suggests for you, particularly if you suffer from bipolar depression or acute mania, or if you want to prevent manic relapse.²

Zyprexa for schizophrenia is a widely used approach. It’s suggested that Olanzapine could be the best first-line treatment for patients with schizophrenia, if efficacy were the only consideration. As we’ll explore later, Olanzapine comes with adverse side effects which stand in the way of it being the most popular option. Currently, clinicians may opt to prescribe you another antipsychotic that has a less risky side effect profile.³

You might be given Olanzapine in tablet form (either those that can be swallowed or disintegrated in water) or via injection.

How Does Olanzapine Work?

Like other atypical antipsychotic medications, Olanzapine works by acting on dopamine and serotonin receptors. By blocking action at these receptors, patients experience reduced hallucinations and delusions, and an improvement of disorganized speech, behavior, and thought. The blocking of serotonin receptors also helps to reduce patient’s flat affect and improve their attention.¹

If you’re looking for signs Zyprexa is working for you, you might experience those listed above, as well as an improvement in mood and anxiety. Olanzapine could be superior to other antipsychotics because whilst it stabilizes mood, it can also improve your cognition.²

Olanzapine Side Effects

Aside from the positive changes mentioned above, you may also experience some adverse effects from taking Olanzapine. The most common is weight gain, as Olanzapine (and other atypical antipsychotics) causes an increase in appetite.

To mitigate the risk around Olanzapine and weight gain, your doctor will be cautious if you are obese, do not exercise regularly, or don’t have a lot of control over your food intake. You should be informed about appropriate exercise and diet to mitigate this side effect. In addition, your doctor might also prescribe samidorphan, as this can lessen the risk of weight gain caused by Olanzapine.¹

Common side effects you may experience include:

Increased appetite
Drowsiness
Restlessness
Constipation
Dry mouth
Breast enlargement or discharge
Late or missed periods⁴

Olanzapine may cause other side effects too, so it’s important to speak with your doctor about what you can expect.

Another side effect to be aware of is impaired glucose tolerance, which is a precursor to diabetes. Other rare risks include developing tardive dyskinesia and NMS (conditions that impact your extrapyramidal nervous system).¹

Olanzapine and Sleep

When considering taking a prescription for any antipsychotic medication, patients may be concerned about how their sleep will be affected. This is understandable; severe sleep issues can hugely impact day-to-day life, work, school, relationships, and simply looking after your own well-being.

Compared to traditional antipsychotic medications, the impact on sleepiness is less pronounced with Olanzapine. It causes less sedation while still treating agitation and psychosis. While Olanzapine and sleepiness is a valid concern, both chronic insomnia and sedation can be treated by your doctor. You might like to speak with them about possible alternative treatments if your sleep is significantly affected.⁵

Long-Term Use of Olanzapine

There are both positive and negative outcomes associated with using Olanzapine long term. On one hand, the majority of patients with schizophrenia treated with Olanzapine are satisfied and likely to remain on it long term. This goes for patients taking oral tablets and the long-acting injectable form. However, around 40% of patients taking Olanzapine long term are likely to suffer significant weight gain.⁶ Unfortunately, that’s not the only long-term impact on health.

With an increased risk of developing EPS (extrapyramidal symptoms), diabetes, and tardive dyskinesia, it’s understandable if you don’t want to take Olanzapine for a long time. With the help of your doctor, it’s important to balance the potential negatives with what you might stand to gain. Relief from your mental health condition cannot be overstated, so long-term use may be preferred.

However, there are quite a few antipsychotic medications to choose from, each offering a slightly different profile. Depending on your unique circumstances and condition, you might choose an alternative treatment for long term use.

Taking Olanzapine long term also means you’ll have to be more careful when withdrawing, which we’ll explore now.

Stopping Zyprexa Safely

If you’re thinking about withdrawing from Olanzapine, we recommend speaking to your doctor about how to do so. You have a right to withdraw from antipsychotics; but, to give you the best experience possible, it’s vital to be aware of what to expect from withdrawal.

Some reported Olanzapine withdrawal symptoms include:

Nausea
Tremors
Anxiety and agitation
Headaches
Insomnia
Nervousness
Extreme feelings
The emergence of involuntary movement disorders

In addition, 18% of patients who withdraw report psychosis (some who did not suffer psychosis before treatment), and around 26% report having more energy and clearer thinking.

24% of people take over a year to withdraw from Olanzapine completely, and people report withdrawal symptoms lasting between 2 weeks to several years.⁷

Since there are risks to discontinuing your prescription, tapering off Zyprexa should happen gradually.1 You can do this by gradually reducing your dose over several weeks or months, keeping the increments as small as possible.

Alternatives to Olanzapine

If you’re seeking treatment for schizophrenia or bipolar disorder, there are several alternative antipsychotic medications that might work for you.

One common comparison is Olanzapine vs Quetiapine (brand name, Seroquel). Research has found these medications equally effective at treating patients with psychosis and violent behavior.⁸

Olanzapine seems to cause more weight gain than Quetiapine and Aripiprazole, and less sexual dysfunction than Risperidone. Olanzapine also carries a higher risk of causing diabetes than Aripiprazole, Quetiapine, and Risperidone. In terms of sedative effects, Olanzapine carries less risk than Clozapine but more than Aripiprazole and Risperidone.⁹

Evidently, comparing side effects is complex as each antipsychotic medication has a unique profile. If you feel strongly about changing your treatment, speak to your doctor and share your concerns. They will be able to evaluate your circumstances and make a recommendation.

Olanzapine FAQs

How Long Does Zyprexa Take to Work?

Your experience with Olanzapine may be unique, so we can’t be certain about when you’ll feel it working. However, if you’re taking it daily, Olanzapine should reach a steady concentration in your body within one week.¹

Is Olanzapine a Strong Sedative?

Yes, compared to other atypical antipsychotic medications, Olanzapine has the highest affinity for histamine receptors in the brain (which are involved with sleep regulation and wakefulness). It has a relatively large sedative effect which may make other medications more appealing to you.⁵

Does Olanzapine Affect Sexual Function?

While many antipsychotics are known to increase levels of prolactin, Olanzapine is known as a prolactin-sparing drug. Out of the many antipsychotics available, research finds Olanzapine to be the least risky in terms of sexual dysfunction.¹⁰

What Should I Avoid While Taking Olanzapine?

Though you should always ask your doctor about drug interactions, you must avoid taking benzodiazepines with Olanzapine, such as Valium and Xanax.1 You should also be careful about:

Taking fluvoxamine and other psychotropics
Smoking tobacco
Smoking marijuana¹¹

Does Olanzapine Reduce Anger?

Yes, Olanzapine is effective at reducing hostility and aggression because it stabilizes mood swings, reduces impulsivity, and lowers irritability.¹²

Is Olanzapine the Same as Lithium?

Though both Olanzapine and lithium are used to treat bipolar disorder, they are different types of drugs. While Olanzapine is classed as an antipsychotic, lithium is known as a mood stabilizer and we don’t fully understand how it works in the body. Research finds that while both are similarly effective at treating depression, Olanzapine is superior at preventing the recurrence of manic and mixed episodes.¹³

Can I Take Olanzapine While Pregnant or Breastfeeding?

Though there are risks to babies exposed to Olanzapine in the third trimester, there are also risks to both mother and child if mothers are not treated for schizophrenia or bipolar. Consequently, pregnant women can be prescribed Olanzapine but clinicians will carefully assess risks vs benefits in each unique case. Olanzapine has been deemed acceptable during breastfeeding, though infants are likely to be impacted in some ways.¹

You should speak to your doctor about how you can manage your treatment and being pregnant.

Find Out More About Olanzapine Today

At Mission Connection, we treat people with schizophrenia, bipolar, depression, and psychosis. If you’re prescribed an antipsychotic, we’ll work closely with you and your family to ensure your treatment is best fitted to your unique needs and monitor your experience for the best results. Medication aside, we also offer a range of talking therapies.

Call us or get in contact via email or contact form to schedule your personalized consultation.

References

Thomas, K., & Saadabadi, A. (2023). Olanzapine. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532903/
Narasimhan, M., Bruce, T. O., & Prakash Masand. (2007). Review of olanzapine in the management of bipolar disorders. Neuropsychiatric Disease and Treatment, 3(5), 579. https://pmc.ncbi.nlm.nih.gov/articles/PMC2656294/
Citrome, L., McEvoy, J. P., Todtenkopf, M. S., McDonnell, D., & Weiden, P. J. (2019). A commentary on the efficacy of olanzapine for the treatment of schizophrenia: the past, present, and future. Neuropsychiatric Disease and Treatment, 15(15), 2559–2569. https://pmc.ncbi.nlm.nih.gov/articles/PMC6733343/
Medline Plus. (2019, October). Olanzapine: MedlinePlus drug information. Medlineplus.gov. https://medlineplus.gov/druginfo/meds/a601213.html
Miller, D. D. (2024). Atypical Antipsychotics: Sleep, Sedation, and Efficacy. Primary Care Companion to the Journal of Clinical Psychiatry, 6(suppl 2), 3. https://pmc.ncbi.nlm.nih.gov/articles/PMC487011/
McDonnell, D. P., Landry, J., & Detke, H. C. (2014). Long-term safety and efficacy of olanzapine long-acting injection in patients with schizophrenia or schizoaffective disorder. International Clinical Psychopharmacology, 29(6), 322–331. https://pmc.ncbi.nlm.nih.gov/articles/PMC4186735/
Read, J. (2022). The experiences of 585 people when they tried to withdraw from antipsychotic drugs. Addictive Behaviors Reports, 15. https://doi.org/10.1016/j.abrep.2022.100421
Gobbi, G., Comai, S., & Debonnel, G. (2014). Effects of quetiapine and olanzapine in patients with psychosis and violent behavior: a pilot randomized, open-label, comparative study. Neuropsychiatric Disease and Treatment, 10, 757–765. https://pmc.ncbi.nlm.nih.gov/articles/PMC4019623/
Muench, J., & Hamer, A. M. (2010). Adverse Effects of Antipsychotic Medications. American Family Physician, 81(5), 617–622. ‌https://www.aafp.org/pubs/afp/issues/2010/0301/p617.html
Park, Y. W., Kim, Y., & Lee, J. H. (2012). Antipsychotic-Induced Sexual Dysfunction and Its Management. The World Journal of Men’s Health, 30(3), 153. https://pmc.ncbi.nlm.nih.gov/articles/PMC3623530/
Kolli, P., Kelley, G., Rosales, M., Faden, J., & Serdenes, R. (2023). Olanzapine Pharmacokinetics: A Clinical Review of Current Insights and Remaining Questions. Pharmacogenomics and Personalized Medicine, 16(1), 1097–1108. ‌https://pmc.ncbi.nlm.nih.gov/articles/PMC10749543/#s0007
Volavka, J., Czobor, P., Citrome, L., & Van Dorn, R. A. (2013). Effectiveness of antipsychotic drugs against hostility in patients with schizophrenia in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. CNS Spectrums, 19(5), 374–381. ‌https://pmc.ncbi.nlm.nih.gov/articles/PMC4076388/
Tohen, M., Greil, W., Calabrese, J. R., Sachs, G. S., Yatham, L. N., Oerlinghausen, B. M., Koukopoulos, A., Cassano, G. B., Grunze, H., Licht, R. W., Dell’Osso, L., Evans, A. R., Risser, R., Baker, R. W., Crane, H., Dossenbach, M. R., & Bowden, C. L. (2005). Olanzapine Versus Lithium in the Maintenance Treatment of Bipolar Disorder: A 12-Month, Randomized, Double-Blind, Controlled Clinical Trial. American Journal of Psychiatry, 162(7), 1281–1290. https://pubmed.ncbi.nlm.nih.gov/15994710/