Zyprexa, Zyprexa Zydis

Written by Dedra Weiss, PharmD
Medically reviewed by Victor Nguyen, PharmD, MBA
Updated on June 28, 2023

The Food and Drug Administration (FDA) has approved olanzapine to treat:

• schizophrenia in adults and some children
• manic, mixed, or depressive episodes related to bipolar I disorder in adults and some children
• treatment-resistant depression in adults
• agitation related to schizophrenia or manic episodes of bipolar I disorder in adults

These approved uses differ based on the form of olanzapine your doctor prescribes. Olanzapine may be combined with other drugs to treat certain conditions.

This article describes olanzapine’s uses, side effects, and more. You’ll also find some coupon options to help save on the cost of olanzapine.

Boxed warning: Increased risk of death in certain older adults

Olanzapine has a boxed warning about an increased risk of death in certain older adults (ages 65 and older). Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

For details, see the “Interactions and warnings for olanzapine” section.

The Food and Drug Administration (FDA) approves prescription drugs such as olanzapine for certain conditions. Approved uses for olanzapine are described below. These uses differ based on the form of olanzapine prescribed.

Use for certain mental health conditions

Doctors may prescribe olanzapine oral tablet, oral disintegrating tablet (ODT),* or injection† for treating certain mental health conditions. It may be used for this purpose in adults and some children, depending on the condition.

Specifically, olanzapine oral tablet and ODT are prescribed to treat:

• schizophrenia in adults and children 13 years and older
• manic or mixed episodes related to bipolar I disorder in adults and children 13 years and older
• depressive episodes related to bipolar I disorder in adults and children 10 years and older
• treatment-resistant depression in adults

Olanzapine oral tablet and ODT are usually prescribed for long-term treatment.

Olanzapine injection is prescribed for agitation related to schizophrenia or manic episodes of bipolar I disorder in adults and children 13 years and older. Typically, the injection is only given as needed, when a doctor or healthcare professional determines that it’s needed for your symptoms.

With these mental health conditions, your feelings, thoughts, and behavior are affected. Symptoms vary depending on the condition you’re experiencing, but they may involve sudden changes in mood or behavior.

Olanzapine may be prescribed together with valproate or lithium for manic or mixed episodes related to bipolar I disorder. Olanzapine is prescribed together with fluoxetine for depressive episodes related to bipolar I disorder and treatment-resistant depression.

* The ODT is a tablet that dissolves on your tongue.
† A healthcare professional will give this form as an injection into a muscle.

Below you’ll find answers to a few commonly asked questions about olanzapine.

Can olanzapine be used for sleep or anxiety?

Olanzapine is not approved to treat anxiety or difficulty sleeping, such as insomnia, and doctors typically don’t prescribe it for these uses.

But some people with schizophrenia, depression, and bipolar I disorder may have anxiety or difficulty sleeping. When olanzapine is taken for one of these approved uses, it may have a sedative (relaxing) effect. This may help ease anxiety or help you sleep better.

Talk with your doctor to learn more about olanzapine’s approved uses. They can also recommend strategies and treatments to help ease symptoms of anxiety or trouble sleeping.

Is it safe to take olanzapine with fluoxetine?

Yes, doctors may prescribe olanzapine with fluoxetine to treat depressive episodes related to bipolar I disorder in adults and children 10 years and older. Doctors may also prescribe this combination for treatment-resistant depression in adults.

A medication that contains both olanzapine and fluoxetine is available. It’s an oral capsule that’s available as a generic drug and as the brand-name drug Symbyax. (A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.)

You can talk with your doctor for more information about Symbyax or its generic version. They can recommend a treatment that’s right for your condition.

What brand names are available for olanzapine?

Olanzapine is available as the brand-name drugs Zyprexa and Zyprexa Zydis:

• Zyprexa is the brand-name version of olanzapine oral tablet. This is a tablet that you swallow.
• Zyprexa Zydis is the brand-name version of olanzapine oral disintegrating tablet (ODT). This is a tablet that dissolves on your tongue.

Zyprexa and Zyprexa Zydis may come in different strengths than generic olanzapine.

There’s not currently a brand-name version of olanzapine injection. This form’s only available as a generic. It’s given as an injection into a muscle by a healthcare professional.

Talk with your doctor or pharmacist to learn more about olanzapine’s forms and brand-name versions.

How does olanzapine work? And how long does it take to start working?

The exact way olanzapine works isn’t fully understood. Studies show that the drug affects levels of dopamine and serotonin. These are chemicals in your brain that affect your mood.

An imbalance of these chemicals is thought to be involved in some mental health conditions. By changing your dopamine and serotonin levels, olanzapine might help improve functioning of certain pathways in your brain and reduce symptoms of certain mental health conditions.

Olanzapine starts working in your body right away. But it may take several weeks to notice a difference in your symptoms, depending on your condition.

If you don’t think your symptoms are well managed while you’re taking olanzapine, talk with your doctor. It’s important that you do not stop taking olanzapine without their guidance. Doing so can increase your risk of serious side effects.

If you’d like to know more about what to expect with olanzapine treatment, talk with your doctor or pharmacist.

Olanzapine may cause mild or serious side effects. More common mild side effects of olanzapine and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about olanzapine’s side effects, see this article or ask your doctor or pharmacist. You can also refer to the prescribing information for olanzapine listed in the “Article resources” section.

Mild side effects

More common mild side effects reported with some forms of olanzapine are listed below. These side effects may differ based on the form of olanzapine you take.

This article doesn’t include all possible mild side effects of the drug. To learn more about olanzapine’s side effects based on the form, refer to the prescribing information for olanzapine listed in the “Article resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Side effects of olanzapine’s oral forms include:

• dizziness
• dry mouth
• difficulty sleeping, such as insomnia
• constipation
• mild allergic reaction*

Olanzapine injection’s† mild side effects include:

• extreme sleepiness
• dizziness
• low blood pressure
• weakness or lack of energy
• mild allergic reaction*

Talk with your doctor to learn more about the common side effects of the form of olanzapine you are prescribed.

* For details about this side effect, see the “Interactions and warnings for olanzapine” section.
† A healthcare professional will give this form as an injection into a muscle.

Serious side effects

Serious side effects of olanzapine are listed below. These side effects may differ based on the form of olanzapine you take.

This article doesn’t include all possible serious side effects of the drug. To learn more about olanzapine’s side effects based on the form, refer to the prescribing information for olanzapine listed in the “Article resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, olanzapine’s serious side effects include:

• dizziness or fainting when standing caused by a sudden decrease in blood pressure
• seizures
• body movements you can’t control
• high blood sugar level
• high cholesterol level
• low white blood cell count
• neuroleptic malignant syndrome
• difficulty swallowing
• problems regulating your body temperature
• high level of the hormone prolactin
• risk of suicidal thoughts and behaviors
• difficulty thinking and making judgments
• slow reaction times
• drug rash with eosinophilia and systemic symptoms (DRESS, a severe drug reaction that can be life threatening)
• boxed warning: increased risk of death in certain older adults*
• severe allergic reaction*

* For details about this side effect, see the “Interactions and warnings for olanzapine” section.

Suicide prevention

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

• Call the 988 Suicide and Crisis Lifeline at 988.
• Text HOME to the Crisis Textline at 741741.
• Not in the United States? Find a helpline in your country with Befrienders Worldwide.
• Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

Below, you’ll find information about olanzapine’s possible interactions and warnings.

Interactions of olanzapine

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you take olanzapine, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, talk with your doctor.

Warnings for olanzapine

Some people should not take olanzapine, and others should take it cautiously.

Boxed warning: Increased risk of death in certain older adults

Olanzapine has a boxed warning about the increased risk of death in certain older adults. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

Adults ages 65 years and older with dementia-related psychosis have an increased risk of death while taking olanzapine. Specifically, these adults have an increased risk of stroke and transient ischemic attack (TIA) with olanzapine.

Some stroke symptoms and TIA symptoms may include:

• dizziness
• numbness or weakness in the face, arm, and leg (especially on one side of your body)
• trouble speaking, seeing, or walking
• loss of balance
• confusion

This list doesn’t include all possible signs of a stroke and TIA. If you’re a caregiver or someone 65 years or older with dementia-related psychosis, be sure that you’re aware of other symptoms to watch for. Your doctor can provide more information about this.

If you experience symptoms of a stroke or TIA, especially if you’re an older adult with dementia-related psychosis, call your doctor right away. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Other warnings

Olanzapine could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether olanzapine is a safe option for you. These warnings may differ based on the form of olanzapine you take.

Ask your doctor about specific warnings for olanzapine, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Olanzapine can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to olanzapine or any of its ingredients, your doctor will likely not prescribe olanzapine. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to olanzapine, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Overdose of olanzapine

If you take olanzapine by mouth, you should not take more olanzapine than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much olanzapine, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and olanzapine

Information about olanzapine and pregnancy and breastfeeding is described below.

Olanzapine and pregnancy

It’s not known whether olanzapine should be taken during pregnancy. If you’re planning a pregnancy or can become pregnant, talk with your doctor before taking this medication.

If you’re pregnant and you take olanzapine, you can consider talking with your doctor about joining the National Pregnancy Registry for Psychiatric Medications. The registry monitors the safety of taking certain drugs such as olanzapine while pregnant. You can also call 866-961-2388 to learn more or sign up.

Olanzapine and breastfeeding

There are risks to taking olanzapine while breastfeeding. But there are also risks with having unmanaged mental health conditions during this time. (Keep in mind that olanzapine is used for managing certain mental health conditions.)

For instance, olanzapine may cause irritability and poor feeding in a breastfed child.

If you’re planning to breastfeed, talk with your doctor about your treatment options. Together, you can discuss the risks and benefits of your treatment options and decide whether you should take olanzapine during this time. Your doctor may recommend other healthy ways to feed your child.

This article describes olanzapine’s uses and side effects, ways to save on cost, and more. Let your doctor know if you have questions about olanzapine or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• What side effects should I know about when taking olanzapine with fluoxetine?
• Are there other medications available for my condition?
• How do the costs compare for olanzapine and Symbyax?

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• MGH Center for Women’s Mental Health. (n.d.). National pregnancy registry for psychiatric medications. http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/
• Olanzapine — olanzapine tablet, film coated. (2021). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/c26391b1-fc43-4e9e-be05-0c47ab635939/spl-doc
• Olanzapine — olanzapine injection, powder, for solution. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/c1387008-6dc4-4f1e-ae29-fa7a0f0be684/spl-doc
• Olanzapine — olanzapine tablet, orally disintegrating. (2021). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/ed93d6b9-912a-444a-a695-439d0bfb877a/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.