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Precautions and Warnings With Olanzapine

Some Precautions and Warnings With Olanzapine

Some warnings and precautions to be aware of with olanzapine include:
  • The U.S. Food and Drug Administration (FDA) has issued a special warning (a "black box warning") about the use of olanzapine in elderly people with dementia (a condition involving confusion; disorientation; and a loss of memory, intellect, and judgment) or psychosis. Elderly people with dementia (Alzheimer's disease is the most common form of dementia) who are treated with antipsychotics -- including olanzapine -- are more likely to die (of various causes) than those who were not treated with those medications. Olanzapine is not approved to treat dementia or dementia-related psychosis, and caution should be used before using olanzapine in elderly people with dementia.
  • Olanzapine can cause a life-threatening condition called neuroleptic malignant syndrome (NMS). Some symptoms of NMS include:


    • A high fever
    • Stiff muscles
    • Confusion
    • Irregular pulse or blood pressure
    • A fast heart rate (tachycardia)
    • Sweating
    • Irregular heart rhythms (arrhythmias).

Tell your healthcare provider right away if think you might have NMS.

  • Olanzapine can cause tardive dyskinesia, a condition involving unusual uncontrollable body or face movements. The condition can become permanent (even if olanzapine is stopped). The best way to prevent it from becoming permanent is to tell your healthcare provider right away if you notice any abnormal movements (including abnormal movements of the tongue).


  • There is an increased risk of stroke in elderly people who take olanzapine for dementia. Olanzapine is not approved for the treatment of dementia in the elderly. However, it may sometimes be prescribed "off-label" for the treatment of behavior problems in elderly people with dementia.


  • The long-acting injectable form of this medication (Zyprexa Relprevv™) can cause a serious condition known as post-injection delirium/sedation syndrome. This usually occurs shortly after an injection and may result in symptoms such as:
    • Dizziness
    • Confusion
    • Disorientation
    • Slurred speech
    • Altered walking pattern or difficulty walking
    • Weakness
    • Agitation
    • Abnormal muscle movements
    • High blood pressure
    • Seizures
    • Decreased levels of consciousness, ranging from mild sleepiness to a coma.
Because of this risk, Zyprexa Relprevv can be given only through specially registered healthcare providers and only in facilities that have emergency response services. You must stay at the facility (under the supervision of your healthcare provider) for at least three hours after each injection. 
  • Olanzapine can cause an increase in blood sugar levels and can increase the risk of developing diabetes. Tell your healthcare provider if you develop signs of diabetes while taking olanzapine. Signs of diabetes can include increased thirst, increased urination, and hunger. If you have diabetes, your blood sugar should be monitored carefully and regularly to make sure your diabetes is not becoming more severe (see Zyprexa and Diabetes).
  • Olanzapine can cause a drop in blood pressure when going from a sitting or lying position to standing (known medically as orthostatic hypotension). This can cause a person to have lightheadedness or dizziness, or to faint. Tell your healthcare provider if you have any of these symptoms when standing.
  • Olanzapine may increase the risk of seizures. Tell your healthcare provider if you have epilepsy or a history of seizures before starting olanzapine.
  • Olanzapine can cause difficultly swallowing, which can lead to inhalation of food (which can cause pneumonia). Tell your healthcare provider if you notice any problems swallowing while taking olanzapine.
  • Olanzapine can increase the level of a certain hormone (prolactin) in the blood. Increased prolactin can cause breast enlargement in men and women, impotence (erectile dysfunction or ED) in men, unusual breast discharge in women, and menstrual changes in women. Tell your healthcare provider if you have any of these side effects during treatment with olanzapine. High prolactin levels may increase the risk of osteoporosis (see High Prolactin Levels and Osteoporosis) and may stimulate the growth of certain breast cancers.
  • Olanzapine can cause an increase in liver enzymes. Usually, this increase is harmless -- though liver damage could occur. Talk with your healthcare provider before taking olanzapine if you have liver problems.
  • Olanzapine is considered a pregnancy Category C medication. This means that it may not be safe to take during pregnancy. Be sure to talk with your healthcare provider about the risks and benefits of using olanzapine during pregnancy (see Zyprexa and Pregnancy).
  • Olanzapine passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about using olanzapine (see Zyprexa and Breastfeeding for more information).
  • Olanzapine can make certain medical conditions worse, including glaucoma (a condition of the eye), bowel blockages or bowel obstruction, and enlarged prostate (benign prostatic hyperplasia or BPH). Talk with your healthcare provider if you have any of these conditions.
  • Olanzapine has not been fully studied in people with liver, kidney, or heart problems. Talk with your healthcare provider if you have any of these conditions.
  • Generally, alcohol should be avoided while taking olanzapine (see Alcohol and Zyprexa).
  • People with phenylketonuria (a certain genetic disorder) should be aware that Zyprexa Zydis tablets contain phenylalanine. Regular olanzapine tablets do not contain phenylalanine.
  • Olanzapine can interact with certain other medications (see Drug Interactions With Olanzapine).
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Olanzapine (Zyprexa)

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