Side effects of zyprexa

Zyprexa

Generic Name: olanzapine (oral) (oh LANZ a peen)
Brand Names: ZyPREXA, ZyPREXA Zydis

Medically reviewed by Sanjai Sinha, MD Last updated on Jan 23, 2019.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Tips
  • Interactions
  • More

What is Zyprexa?

Zyprexa (olanzapine) is an antipsychotic medication that affects chemicals in the brain.

Zyprexa is used to treat the symptoms of psychotic conditions such as schizophrenia and the symptoms of mood disorders such as bipolar disorder (manic depression) in adults and children who are at least 13 years old.

Zyprexa is sometimes used together with other antipsychotic medications or antidepressants.

Zyprexa may also be used for purposes not listed in this medication guide.

Important information

Zyprexa may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid drinking alcohol while taking Zyprexa.

Zyprexa is not approved for use in psychotic behavior related to dementia. Olanzapine may increase the risk of death in older adults with dementia-related conditions.

You may gain weight or have high cholesterol and triglycerides (types of fat) while taking this medicine, especially if you are a teenager. Your blood may need to be tested often. Visit your doctor regularly.

Zyprexa can cause high blood sugar (hyperglycemia). If you are diabetic, check your blood sugar levels on a regular basis while you are taking Zyprexa.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Dizziness or severe drowsiness can cause falls, fractures, or other injuries. Get up slowly and steady yourself to prevent a fall.

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.

Before taking this medicine

You should not take Zyprexa if you are allergic to olanzapine.

Zyprexa is not approved for use in psychotic conditions related to dementia. Olanzapine may increase the risk of death in older adults with dementia-related conditions.

Long-term use of Zyprexa can cause a serious movement disorder that may not be reversible. Symptoms include uncontrollable muscle movements of your lips, tongue, eyes, face, arms, or legs. The longer you take olanzapine, the more likely you are to develop this movement disorder. The risk of this side effect is higher in women and older adults.

To make sure Zyprexa is safe for you, tell your doctor if you have ever had:

  • liver disease;

  • heart disease, high or low blood pressure;

  • low white blood cell (WBC) counts;

  • high cholesterol or triglycerides;

  • heart failure, heart attack, or stroke;

  • breast cancer;

  • seizures or epilepsy;

  • diabetes;

  • an enlarged prostate or difficulty urinating;

  • bowel problems; or

  • narrow-angle glaucoma.

Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

Taking antipsychotic medication during the last 3 months of pregnancy may cause problems in the newborn, such as withdrawal symptoms, breathing problems, feeding problems, fussiness, tremors, and limp or stiff muscles. However, you may have withdrawal symptoms or other problems if you stop taking your medicine during pregnancy. If you become pregnant while taking Zyprexa, do not stop taking it without your doctor’s advice.

Olanzapine can pass into breast milk and may harm a nursing baby. You should not breast-feed while using Zyprexa.

The olanzapine orally disintegrating tablet (Zyprexa Zydis) may contain phenylalanine. Talk to your doctor before using this form of olanzapine if you have phenylketonuria (PKU).

How should I take Zyprexa?

Take Zyprexa exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Zyprexa can be taken with or without food.

Zyprexa is usually taken once a day. Olanzapine may be only part of a complete program of treatment that also includes counseling and other psychological support programs. Follow your doctor’s instructions.

To take olanzapine orally disintegrating tablet (Zyprexa Zydis):

  • Keep the tablet in its blister pack until you are ready to take it. Open the package and peel back the foil from the tablet blister. Do not push a tablet through the foil or you may damage the tablet.

  • Using dry hands, place it in your mouth. It will begin to dissolve right away.

  • Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.

  • Swallow several times as the tablet dissolves. If desired, you may drink liquid to help swallow the dissolved tablet.

Call your doctor if your symptoms do not improve, or if they get worse while using Zyprexa.

Do not stop using Zyprexa suddenly, even if you feel fine. Stopping suddenly may cause serious side effects.

Zyprexa can cause high blood sugar (hyperglycemia). If you are diabetic, check your blood sugar levels on a regular basis while you are taking this medicine.

You may gain weight or have high cholesterol and triglycerides (types of fat) while taking this medicine, especially if you are a teenager. Your blood may need to be tested often. Visit your doctor regularly.

If you are taking a combination of drugs, use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor’s advice.

Store at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

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

What should I avoid while taking Zyprexa?

Zyprexa may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Avoid drinking alcohol. Dangerous side effects could occur.

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.

Zyprexa side effects

Get emergency medical help if you have any signs of an allergic reaction to Zyprexa: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Seek medical treatment if you have symptoms of a serious drug reaction that can affect many parts of your body. Symptoms may include: skin rash, fever, swollen glands, flu-like symptoms, unusual bruising, or jaundice (yellowing of your skin or eyes).

Call your doctor at once if you have:

  • uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement);

  • trouble speaking or swallowing;

  • swelling in your hands or feet;

  • confusion, unusual thoughts or behavior, hallucinations, or thoughts about hurting yourself;

  • sudden weakness or ill feeling, fever, chills, sore throat, swollen gums, painful mouth sores, pain when swallowing, skin sores, cold or flu symptoms, cough;

  • signs of dehydration – feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin;

  • liver problems – upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

  • high blood sugar – increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, weight loss; or

  • severe nervous system reaction – very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

Common Zyprexa side effects may include:

  • weight gain (more likely in teenagers), increased appetite;

  • headache, dizziness, drowsiness, feeling tired or restless;

  • problems with speech or memory;

  • tremors or shaking, numbness or tingly feeling;

  • changes in personality;

  • dry mouth, or increased salivation;

  • stomach pain, constipation; or

  • pain in your arms or legs.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Zyprexa?

Using Zyprexa with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures. They can add to the side effects of Zyprexa.

Tell your doctor about all other medicines you use, especially:

Other drugs may interact with olanzapine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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

Copyright 1996-2020 Cerner Multum, Inc. Version: 15.03.

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More about Zyprexa (olanzapine)

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  • Drug class: atypical antipsychotics
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Consumer resources

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Professional resources

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Other Formulations

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Olanzapine

Before taking olanzapine,

  • tell your doctor and pharmacist if you are allergic to olanzapine or any other medications.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antidepressants; antihistamines; carbamazepine (Tegretol); dopamine agonists such as bromocriptine (Parlodel), cabergoline (Dostinex), levodopa (Dopar, Larodopa), pergolide (Permax), and ropinirole (Requip); fluoroquinolone antibiotics including ciprofloxacin (Cipro), gatifloxacin (Tequin) (not available in the United States), levofloxacin (Levaquin), norfloxacin (Noroxin), ofloxacin (Floxin), others; fluvoxamine (Luvox); ipratropium (Atrovent); medications for anxiety, high blood pressure, irritable bowel disease, mental illness, motion sickness, Parkinson’s disease, seizures, ulcers, or urinary problems; omeprazole (Prilosec); rifampin (Rifadin); sedatives; sleeping pills; ticlopidine (Ticlid); and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you use or have ever used street drugs or have overused prescription medications and if you have or have ever had a stroke, a mini-stroke, heart disease or a heart attack, an irregular heartbeat, seizures, breast cancer, any condition that makes it difficult for you to swallow, trouble keeping your balance, high or low blood pressure, a high level of fats (cholesterol and triglycerides) in your blood, a low number of white blood cells, liver or prostate disease, paralytic ileus (condition in which food cannot move through the intestine); glaucoma (an eye condition), or high blood sugar, or if you or anyone in your family has or has ever had diabetes. Tell your doctor if you have severe vomiting or diarrhea or signs of dehydration now, or if you develop these symptoms at any time during your treatment. Also tell your doctor if you have ever had to stop taking a medication for mental illness because of severe side effects.
  • tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy, or if you plan to become pregnant or are breast-feeding. If you become pregnant while taking olanzapine, call your doctor. Olanzapine may cause problems in newborns following delivery if it is taken during the last months of pregnancy.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking olanzapine.
  • you should know that olanzapine may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
  • you should know that alcohol can add to the drowsiness caused by this medication. Do not drink alcohol while taking olanzapine.
  • tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of this medication.
  • you should know that you may experience hyperglycemia (increases in your blood sugar) while you are taking this medication, even if you do not already have diabetes. If you have schizophrenia, you are more likely to develop diabetes than people who do not have schizophrenia, and taking olanzapine or similar medications may increase this risk. Tell your doctor immediately if you have any of the following symptoms while you are taking olanzapine: extreme thirst, frequent urination, extreme hunger, blurred vision, or weakness. It is very important to call your doctor as soon as you have any of these symptoms, because high blood sugar can cause a serious condition called ketoacidosis. Ketoacidosis may become life-threatening if it is not treated at an early stage. Symptoms of ketoacidosis include: dry mouth, nausea and vomiting, shortness of breath, breath that smells fruity, and decreased consciousness.
  • you should know that olanzapine may cause fast or slow heartbeat, dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking olanzapine. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
  • you should know that olanzapine may make it harder for your body to cool down when it gets very hot. Tell your doctor if you plan to do vigorous exercise or be exposed to extreme heat.
  • if you have phenylketonuria (PKU, an inherited condition in which a special diet must be followed to prevent mental retardation), you should know that the orally disintegrating tablets contain aspartame that forms phenylalanine.
  • you should know that when olanzapine is used to treat teenagers, it must be used as part of a total treatment program that may include counseling and educational support. Make sure that your child follows all of the doctor’s and/or therapist’s instructions.

Generic Name: Olanzapine (oh-LAN-za-pean)

Drug Class: Atypical antipsychotic, Thienobenzodiazepines

Table of Contents

  • Overview
  • How to Take It
  • Side Effects
  • Warnings & Precautions
  • Drug Interactions
  • Dosage & Missing a Dose
  • Storage
  • Pregnancy or Nursing
  • More Information

Overview

Zyprexa (olanzapine) is an atypical antipsychotic medication used to treat symptoms of psychotic conditions such as bipolar disorder (manic depression) and schizophrenia. It used to treat adults and children who are at least 13 years old. Olanzapine may also be used to prevent vomiting or nausea caused by chemotherapy, a cancer drug treatment.

It is sometimes used in combination with other antidepressants or antipsychotic medications.

This information is for educational purposes only. Not every known side effect, adverse effect, or drug interaction is in this database. If you have questions about your medicines, talk to your health care provider.

This drug restores an imbalance of two important nerve transmitters (dopamine and serotonin).

How to Take It

This medicine should be taken at the same time everyday. This medicine can be crushed and taken with food. You should not drink grapefruit juice while taking this medicine.

Side Effects

Side effects that may occur while taking this medicine include:

  • changes in weight, weight gain
  • agitation
  • back pain
  • constipation
  • drowsiness
  • lightheadedness
  • dizziness
  • stomach upset
  • dry mouth
  • abnormal gait

Contact your doctor immediately if you experience:

  • edema (fluid retention)
  • bloody or cloudy urine
  • pounding in the ears
  • difficulty speaking
  • headache
  • increased blinking or eyelid spasms
  • muscle trembling, jerking, or stiffness
  • bladder pain
  • memory loss
  • arm / leg weakness
  • tightness in the chest

Warnings & Precautions

  • DO NOT take olanzapine if you have had an allergic reaction while taking it before.
  • Tell your doctor if you use tobacco products. Cigarette smoking might decrease this medicine’s effectiveness.
  • Tell your doctor if you have a history of breast cancer, seizure disorder, difficulty urinating, liver disease, low blood pressure, heart disease, narrow angle glaucoma, or if you have problems swallowing.
  • You should NOT drive and your activities should be restricted due to drowsiness or dizziness that may be caused by taking this medicine.
  • Drink plenty of water each day while taking this medicine.
  • DO NOT spend prolonged time in the sun; this medicine may make you prone to heat stroke. Drink plenty of fluids when the weather is hot, and dress lightly.
  • If you plan to have surgery under general or spinal anesthesia in the near future, talk to your doctor first.
  • For an overdose, seek medical attention immediately. For non-emergencies, contact your local or regional poison control center at 1-800-222-1222.

Drug Interactions

Taking other sedative medications with olanzapine may result in added drowsy effects. Carbamazepine (Tegretol) can cause up to a 50% removal of olanzapine from the body. Certain antibiotics, (fluroquinolones), fluvoxamine (Luvox) can cause olanzapine toxicity. Medicines that decrease the effects of olanzapine are omeprazole (Prilosec) and rifampin. Talk to your doctor or pharmacist if you are taking lithium or have further questions about drug interactions with this medicine.

Dosage & Missed Dose

Zyprexa may be taken on a full or empty stomach and should be taken exactly as prescribed by your doctor.

It is available tablet form in increments of 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg and 20 mg.

It is also available as a disintegrating tablet in 5 mg, 10 mg, 15 mg, 20 mg. This tablet dissolves in the mouth.

An immediate-release injection is also available, and it comes in 10 mg vials.

The tablet or disintegrating tablet should be taken at the same time, once per day.

Dry your hands thoroughly before handling the disintegrating tablet. Peel back the foil packaging and place the pill directly onto your tongue. Don’t try to push the pill through the foil. The tablet will dissolve quickly; you do not need to drink any liquid.

Take your next dose as soon as you remember. If it is time for your next dose, skip the missed dose and go back to your regular schedule. Do not double doses or take extra medicine to make up for the missed dose.

Storage

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (preferably not in the bathroom). Throw away any medication that is outdated or no longer needed.

Pregnancy/Nursing

Do not take this medicine if you are pregnant or thinking of becoming pregnant or while breastfeeding. Talk to your doctor or pharmacist for more information.

More Information

For more information, talk to your doctor, pharmacist or health care provider, or you can visit this website, https://www.nlm.nih.gov/medlineplus/druginfo/meds/a601213.html for additional information from the manufacturer of this drug.

Zyprexa

What is Zyprexa?

Zyprexa is a medication known as an atypical antipsychotic that is used to treat symptoms of schizophrenia. The drug is also sometimes prescribed to treat symptoms of bipolar disorder.

When did the U.S. Food and Drug Administration (FDA) approve the medication?

Zyprexa was first approved by the FDA in 1996.

Is there a generic version of Zyprexa?

Yes, olanzapine is the generic version of Zyprexa and is available in the United States.

Are there any major differences between Zyprexa and other antipsychotics used to treat Zyprexa?

Zyprexa belongs to the class of medications known as atypical antipsychotics or second generation psychotics. Talk to your doctor about what might work best for you and the costs and benefits of taking the medication. Some people may need to try several different antipsychotics before they find the most effective with the fewest side effects.

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Can children take Zyprexa?

Zyprexa has been approved to treat schizophrenia in teenagers ages 13 and older. Teens taking the medication are at higher risk for weight gain, liver problems, sleepiness, breast enlargement, and increased levels of fat in their blood. Talk to your child’s doctor about the risks of using the medication.

Are there potential interaction issues for people taking Zyprexa and any other drugs?

There are hundreds of other drugs which are known to interact with Zyprexa in major, moderate, or mild ways, so let your doctor know what other medications you are taking before you begin taking the medication. Some of these include antidepressants, antihistamines, carbamazepine, dopamine agonists, fluoroquinolone antibiotics, fluvoxamine, ipratropium, medications for anxiety, high blood pressure, irritable bowel disease, mental illness, motion sickness, Parkinson’s disease, seizures, ulcers, or urinary problems, omeprazole, rifampin, sedatives, sleep medication, ticlopidine, and tranquilizers.

Are there any other medical conditions that would make someone ineligible for Zyprexa therapy?

Talk to your doctor about other medical conditions before you take Zyprexa, such as dementia, stroke, heart conditions, seizures, neuroleptic malignant syndrome (NMS), diabetes, liver problems, glaucoma, high blood pressure, high cholesterol, breast cancer, a history of suicidal thoughts, or tardive dyskinesia.

What is the typical starting dose that would be prescribed to someone taking Zyprexa?

Typical starting dosage for treating schizophrenia in adults is 5 to 10 mg taken once daily.

What do I do if I miss a dose?

Take the dose of Zyprexa when you remember, but skip the missed dose if it’s almost time for your next dose. You should never take extra doses of the medication to make up for missed doses.

What are common side effects of Zyprexa?

The common side effects of Zyprexa can include:

  • Drowsiness
  • Restlessness
  • Dizziness
  • Depression
  • Trouble sleeping
  • Unusual behavior
  • Constipation
  • Trouble walking
  • Weight gain
  • Dry mouth
  • Weakness
  • Pain in arms, legs, or joints
  • Decreased sexual ability
  • Late or missed menstrual periods
  • Breast enlargement.

Doctors recommend that you not drink alcohol while on the medication. It also is recommended that you wait to drive or operate machinery until you know how the medication affects you. Report major side effects to your doctor immediately, which can include sweating, stiff muscles, fast or irregular heartbeat, redness or rash, hives, trouble breathing or swallowing, sore throat, fever, unusual movements, swelling, changes in vision, seizures, You can also report side effects to the FDA at 1-800-FDA-1088 or online.

What are the potential long-term effects of taking Zyprexa?

Your doctor should monitor for progression of potential long-term side effect of Zyprexa, which can include weight gain, high blood sugar, tardive dyskinesia, and high-fat levels in the blood.

Is it safe for a woman who is pregnant, about to become pregnant, or nursing to take Zyprexa?

There have been no controlled human pregnancy studies on the effects of Zyprexa. The drug can be transferred via human breast milk and potentially harm a baby. Therefore, talk to your doctor if you are pregnant, planning to become pregnant, or are nursing before you take Zyprexa.

Can symptoms occur if Zyprexa is discontinued?

It’s important not to discontinue the drug if you feel better. Maintain contact with your doctor and seek medical attention if necessary when discontinuing the drug. Talk to your doctor about how to mitigate potential withdrawal symptoms, which can include agitation, anxiety, diarrhea, psychotic symptoms, trouble sleeping, muscle pain, nausea, sweating, and restlessness.

What should I do if I overdose on Zyprexa?

Seek immediate help or call the Poison Help Line at 1-800-222-1222 if you overdose, as it can be fatal. Symptoms may include agitation, fast heartbeat, drowsiness, slurred speech, sudden and uncontrollable movements, and coma.

Is Zyprexa habit-forming?
Zyprexa has no habit-forming potential, but it is not recommended that you discontinue use of the drug before talking with your doctor, as withdrawal symptoms can occur.

How much does Zyprexa cost?

According to goodrx.com, 30 tablets of 5mg Zyprexa cost approximately $400 for 30 tablets of 5 mg generic olanzapine cost approximately $50.

Are there any disadvantages to Zyprexa?

The biggest disadvantages of Zyprexa are the potential long-term side effects, which can include tardive dyskinesia, increased blood sugar, and weight gain.

DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. This article mentions drugs that were FDA-approved and available at the time of publication and may not include all possible drug interactions or all FDA warnings or alerts. The author of this page explicitly does not endorse this drug or any specific treatment method. If you have health questions or concerns about interactions, please check with your physician or go to the FDA site for a comprehensive list of warnings.

Article Sources Last Updated: Nov 19, 2018

Olanzapine: what I wish I had known

Naturally, the fact I was an inpatient at the time could partially explain my improvement, but I think it was also to do with the medication. I have used olanzapine several times since, successfully starting it and stopping it without any real issue.

Starting a drug can be scary, especially one that comes with various negative associations, but if I could go back and tell myself one thing or do one thing, it would be to ignore any assumptions I had about the drug before taking it. I wish that I could have listened to my desire to get better over the fear of a name and a couple of side effects.

I know I couldn’t have started taking olanzapine any earlier than I did, that mentally the fear of the medication was too strong for me to fight on top of the illness I was battling, but looking back, stable in recovery, I am glad that the option was pretty much removed. No, it didn’t make me ‘better’ – I did that – but it gave me the rest and space I needed so desperately at that time.

Sleep architecture and cognitive changes in olanzapine-treated patients with depression: A double blind randomized placebo controlled trial

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Pre-publication history

  1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/14/202/prepub

If you often have trouble falling or staying asleep, you have insomnia. It can get in the way of working, driving, and even thinking. And it can cause health problems.

To treat insomnia, doctors sometimes prescribe drugs called antipsychotics. The U.S. Food and Drug Administration (FDA) has approved these drugs to treat mental illness, but not to treat insomnia. However, doctors can legally prescribe them. This is called “off-label” prescribing.

But these drugs should not be the first treatment for sleep problems, according to the American Psychiatric Association. Here’s why:

Antipsychotics don’t help much.

These drugs are known as atypical antipsychotics. They include aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and others. The drugs often make people drowsy, but there is little evidence that they actually help you fall or stay asleep. Antipsychotics don’t have clear benefits, and the risks can be serious.

Antipsychotics can have serious risks.

Many people who start taking an antipsychotic drug, stop because of side effects:

  • Dizziness, drowsiness, confusion, and a higher risk of falls and injuries.
  • Weight gain.
  • Diabetes.
  • High cholesterol.
  • Muscle twitches, tremors, and spasms. These may not go away even when the drug is stopped.
  • Blood clots. These can lead to serious problems and death if not treated.

Other approaches often work better.

It is almost always best to try other approaches first.

Get short-term relief. If you need help sleeping for only a night or two, ask your doctor about an over the counter sleep aid. A low dose of Melatonin taken three hours before bedtime can help, especially if you have jet lag.

Talk to a doctor. You may have a medical problem if you often have trouble sleeping—three or more nights a week for a month or more. Your doctor may be able to help treat insomnia caused by arthritis pain, hot flashes, anxiety, depression, and medications. Other treatable causes may include:

  • Sleep apnea—severe snoring.
  • Restless legs syndrome—a strong urge to move your legs.
  • Urinating often at night—this may be a sign of diabetes, enlarged prostate, or a urinary tract infection.
  • Gastroesophageal reflux disease (GERD) — frequent heartburn.

Behavioral therapy. A therapist who specializes in insomnia can often help you “cure” it. Pills only treat symptoms.

When should you consider antipsychotics for insomnia?

The FDA has approved these drugs to treat adults with bipolar disorder, schizophrenia, and—in some cases—depression. Consider them if:

  • You have a serious mental illness, such as bipolar disorder with mania, which is keeping you from sleeping.
  • Other steps, including prescription sleep drugs, have failed.
  • You are very distressed due to lack of sleep.

Start the drug at the lowest possible dose. Check with your doctor that there are no serious side effects. Stop the drug if it is not helping or you no longer need it, but don’t do this on your own. Talk to your doctor.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2018 Consumer Consumer Reports. Developed in cooperation with the American Psychiatric Association.

Antipsychotics for Insomnia

Mental illness and insomnia are often co-morbid (happen at the same time), and indeed insomnia is a symptom of most mental illnesses. This type of insomnia is properly secondary insomnia – the doctor knows the cause, the mental illness, and the insomnia will be relieved if the underlying illness is cleared up. Antipsychotic medicines are powerful drugs that affect the brain. They are rarely used just to treat a patient’s insomnia – there are many better general purpose sleeping pills – but if the attending physician feels antipsychotic drugs are called for due to other conditions, they often end up being the main treatment for the insomnia.

When people without mental illness take antipsychotics, there is no effect on sleep. But when people with schizophrenia take them, there is an increase in sleep time, including an increase in time spent in slow-wave deep sleep. REM efficiency – the unbrokeness of REM periods – also improves.

The antipsychotic drugs are usually tranquilizers and allow the body to rest and become ready for sleep in addition to the effects they have on the brain. Second-generation antipsychotics are the ones in use today and like other prescription drugs they are approved by the FDA and “labeled” for specific illnesses, or “indications”. Doctors have the freedom to prescribe them off-label, and experienced psychiatrists often do so.

Quetiapine is a schizoprehia drug sold under the brand name Seroquel by AstraZeneca. The patent expired in 2011 so generics should be available. AstraZeneca is also trying to market a controlled release version. Like other antipyschotics, quetiapine is a dopamine receptor agonist and also influences other neurotransmitters.

Olanzapine is a widely used psychiatric drug. Eli Lilly held the patent until 2011 and sold it (and still sells it) under the name Zyprexa. It is not given to people with dementia because it has been implicated in an increased risk of stroke. Eli Lilly had to pay a fine for marketing it for Alzheimer’s Disease even though they had no evidence it worked for that condition. Like the other antipsychotic drugs, olanzapine is rarely prescribed just for insomnia, although doctors have the option of doing so if they feel it is warranted. When prescribed for sleep problems, the dosage is much lower than for psychosis.

Riseridone (brand name Risperol) is approved for a number of psychiatric conditions and used fairly widely. The side effects of cognitive impairment are more prevalent in older people with dementia. It also causes weight gain in addition to the side effects that most antipsychotics cause (pain, digestive upset). Some patients find it actually makes their insomnia worse.

Risperidone was the subject of a public health warning in 2011. It was being confused with the similar sounding drug ropinirole (brand names Risperdal and Requip) and patients were being harmed.

These drugs are in pill form (oral delivery) and stay in the body relatively long times before they are broken down. This is another difference from conventional sleeping pills (the Z-drugs) which have half-lives such that the patient is not too groggy the next day.

Antipsychotics can leave the person feeling drugged and not alert enough to drive, which is one more reason they are rarely used for just insomnia. There is also the question of how long a patient stays on an antipsychotic if the main problem is insomnia. Some doctors may prescribe this type of drug at first to “get the brain back on track” and then switch to another medicine.

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