What are the risks of taking olanzapine (Zypreza, Zypraxa Zydis, Zyprexa Relprevv)?
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Olanzapine can cause serious health problems in certain groups of people. You should talk to your doctor or pharmacist if you have any concerns or questions about other treatment option
Other risks of olanzapine use include:- Increased risk of stroke and death:
Risk factors: older adults with dementia-related psychosis
Boxed warning: Olanzapine is not approved for use in older adults with dementia-related psychosis.
Dementia-related psychosis is when patients with dementia sometimes have schizophrenia symptoms such as hallucinations. When this occurs to elderly patients 65 years and older, it should not be treated with olanzapine, as it can cause stroke or even death. You should let your doctor know if you or your loved one have dementia before olanzapine treatment. - Suicidal thoughts and behaviors:
Like other antipsychotic drugs, olanzapine can worsen suicidal thoughts or behavior. You should watch for signs of new or worsening depression, suicidal thoughts, or unusual behaviors, especially during the first few months of olanzapine treatment or after dose adjustment. Let your healthcare provider know if you experience any unusual changes in your mood and behaviors. - Neuroleptic malignant syndrome (NMS):
NMS is a rare but life-threatening condition. NMS can present with stiff or rigid muscles, confusion, high-grade fever, excessive sweating, tremor, fast or irregular heartbeats, fainting. You should seek emergency medical care immediately if you experience any NMS symptoms. - Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS):
Olanzapine may cause a rare but severe skin reaction that spreads to cover much of the body. Seek medical care immediately if you experience any of the following symptoms: skin rash, fever, swollen lymph nodes, swelling in the face. - Serious systemic complications:
Olanzapine can cause serious drug reactions involving other body organs such as the liver, heart, and kidneys. You should watch out for symptoms such as fever, rash, muscle aches, swelling of the face, jaundice (yellowing of the skin or the whites of the eyes). You should let your healthcare provider know and seek medical care immediately if you experience these symptoms. - Metabolic changes including high blood sugar, high cholesterol, and weight gain:
Risk factors: history of diabetes; history of high cholesterol
Olanzapine can cause an increase in appetite, elevate blood sugar and blood cholesterol, all of which can lead to weight gain. Lab work should be completed regularly to check your blood sugar and cholesterol to ensure they are still within an acceptable range. - Tardive dyskinesia (Involuntary or uncontrollable body movements):
Risk factors: High doses of olanzapine; long-term use of olanzapine; female elderly patients
Like other antipsychotic drugs, olanzapine can cause involuntary or uncontrollable movements in your face, tongue, and other parts of the body. This disorder involves tongue-twisting, lip-smacking, cheek puffing, change in gait, jerky limb movement, shrugging, shaking, muscle stiffness, or restlessness. Let your doctor know immediately if you experience any of these symptoms since they may be irreversible. Treatment of this movement disorder includes dose adjustment, changing to a different atypical antipsychotic, or discontinuation of therapy. - Leukopenia/neutropenia (low white blood cell count):
Risk factor: history of low white blood cell count
White blood cells are part of your immune system that fight off infections. Olanzapine can cause a drop in white blood cell count. Signs and symptoms of low white blood cell count are fever, chills, cough, sore throat, skin sores, mouth sores. Let your healthcare provider know if you get sick more easily or have wounds or sores that would not heal. Blood tests are usually done before starting olanzapine therapy to ensure that your baseline white blood cell count is within normal limits. - Dysphagia (difficulty swallowing):
Risk factor: Elderly patients with Alzheimer’s dementia
Olanzapine can cause swallowing problems that make it hard to swallow solids or liquids. Make sure you chew slowly and thoroughly if you notice difficulty swallowing. Pay attention to your loved ones for signs of difficulty swallowing. This can be dangerous if food or liquids get into the lungs and cause breathing problems. - Anticholinergic effects:
Dry mouth, fast heart rate, difficulty urinating, and constipation are some of the signs of anticholinergic effects. These side effects are mild for most people. However, if you already have certain medical conditions, anticholinergic effects can worsen your existing symptoms. Inform your healthcare provider if you notice any of these symptoms. - Orthostatic hypotension:
Risk factors: history of heart disease or stroke; concomitant administration of other medications that lower blood pressure; dehydration.
Orthostatic hypotension is a sudden drop in blood pressure when you change positions, from laying down to sitting or from sitting to standing. Olanzapine can cause this sudden drop in blood pressure that can lead to dizziness, falls, and injuries. To avoid dizziness and falls, especially at the beginning of olanzapine therapy, you should change positions slowly and hold on to the bed rail, chair, or table if needed. Especially if you are prone to have hypotensive reactions, please monitor blood pressure regularly to have an idea that your blood pressure usually runs. - Seizures:
Risk factors: history of seizures; other health conditions that can cause seizures.
Olanzapine can increase the risk of having seizures. Let your doctor know before starting olanzapine if you have a history of seizures or other medical conditions that make it easier for you to get seizures. - Potential for cognitive and motor impairment:
Risk factor: taking CNS depressant (central nervous system depressant)
Olanzapine can lower your ability to think clearly and focus. Take caution if you have to drive, operate hazardous machinery, or perform any activities that require mental alertness, especially at the beginning of therapy when you don’t know how your body would react to olanzapine. - Falls:
Risk factors: having other medical conditions or taking other medications that increase the risk of falls.
Olanzapine can cause drowsiness, orthostatic hypotension, and motor impairments, leading to falls, fractures, and injuries. If you have other conditions that cause gait instability or take other medications that increase the risk of falls, your healthcare provider would usually perform a fall risk assessment before starting olanzapine. - High prolactin levels:
High prolactin levels can cause fertility issues, sexual dysfunction, enlarged male breasts, absent or irregular menstruation in females, and weak bones. Olanzapine can cause an increase in prolactin levels. Your healthcare provider will order regular blood tests to make sure your prolactin levels are within normal range. - Problems with regulating body temperature:
Like other antipsychotic drugs, olanzapine makes it hard for your body to cool down when it’s hot. This can lead to dehydration. Dehydration can cause acute kidney injury. Let your doctor know if you produce a lot less urine or sweat or if you notice dark-colored urine. - Withdrawal risk to the newborn after delivery:
There are not enough clinical trials on the effects of olanzapine on major birth defects, miscarriage, or other adverse maternal or fetal outcomes. However, there is evidence that exposure to antipsychotic drugs, including olanzapine during the third trimester, leads to an increased risk of withdrawal and extrapyramidal symptoms following delivery. Let your healthcare provider know if you are pregnant or planning to get pregnant as a discussion regarding the risks versus the benefits is essential for the safety and efficacy of the treatment.
Speak to your doctor or pharmacist about other treatment options if you are at high risk for the above complications.
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What should I tell my doctor before starting olanzapine (Zypreza, Zypraxa Zydis, Zyprexa Relprevv)?
You should not take olanzapine if you are allergic to it.
Olanzapine has a boxed warning for the increased risk of stroke and death in elderly patients with dementia-related psychosis. For this reason, olanzapine is not approved for this use.
Taking antipsychotic drugs, including olanzapine, can cause extrapyramidal or withdrawal symptoms, breathing problems, and feeding problems in the newborn following delivery. Tell your doctor if you are pregnant or planning to get pregnant. Do not stop taking olanzapine without your doctor’s instruction. Sudden discontinuation of olanzapine can exacerbate the symptoms of your mental illness.
National Pregnancy Registry for Psychiatric Medications is a registry that monitors the safety of certain medications during pregnancy. If you are pregnant and taking olanzapine, it is highly recommended that you enroll in this registry.
Olanzapine can pass into breast milk. Let your doctor know if you are breastfeeding or planning to breastfeed. If you are breastfeeding your baby while taking olanzapine, let your healthcare provider know if your baby starts to have any feeding problems, irritability, severe drowsiness, tremors, or unusual muscle movement.
The olanzapine orally disintegrating tablets (Zyprexa Zydis) may contain phenylalanine. Phenylalanine is not a concern for most people. However, if you have phenylketonuria (PKU), phenylalanine can cause a serious medical problem. Let your doctor know if you have phenylketonuria (PKU). The regular oral tablet is the safer option for you.
To make sure olanzapine is safe, tell your healthcare provider if you or your loved one have:
- Renal or hepatic impairment (kidney or liver disease)
- Alzheimer’s disease
- Breast cancer
- Heart disease
- High or low blood pressure
- High cholesterol, high triglycerides
- A stroke or TIA (transient ischemic attack), also known as a mini-stroke
- Diabetes
- Seizures
- Narrow-angle glaucoma
- An enlarged prostate
- Bowel problems
What precautions should I take while on olanzapine (Zypreza, Zypraxa Zydis, Zyprexa Relprevv)?
- Keep all your doctor and blood work appointments to ensure the safety and efficacy of olanzapine therapy. Like other antipsychotic drugs, olanzapine plasma concentrations are rarely monitored. However, blood works are important to check your blood sugar, cholesterol, triglycerides, and other electrolytes.
- Check your blood sugar and blood pressure regularly as directed by your healthcare provider
- Avoid drinking alcohol; this combination can lead to dangerous adverse effects.
- Olanzapine can cause dizziness or drowsiness; avoid driving or operating hazardous machinery until you know how your body reacts to olanzapine.
- Avoid getting up quickly from lying down or sitting down to avoid a sudden drop in blood pressure. This drop in blood pressure can cause dizziness and lightheadedness, leading to falls, fractures, and injuries. You should monitor your blood pressure regularly to see what it usually runs.
- Olanzapine can cause dehydration. Drink plenty of fluid during exercise and hot weather to avoid being overheated.
- Keep all your healthcare providers updated on all of your medications to avoid drug interactions.
What drugs can interact with olanzapine (Zypreza, Zypraxa Zydis, Zyprexa Relprevv)?
Taking olanzapine with other drugs that can cause respiratory depression can slow your breathing even more. This side effect is dangerous and even potentially life-threatening. Other drugs that can cause respiratory depression are opioid pain medications, sleeping pills, muscle relaxers, medicines for depression, anxiety, or seizures.
This is not a complete list. Other drugs, including prescriptions, over-the-counter products, herbal supplements, and vitamins, may interact with olanzapine. Not all potential drug interactions are listed in this guide. It is highly recommended to keep a list of all the drug products you are using (prescriptions, over-the-counter products, herbal supplements, natural products, and vitamins) and share it with your doctor and pharmacist.
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