Olanzapine - oral/IM (Zyprexa®)
Pronounce: oh-LANZ-a-peen
Classification: Atypical antipsychotic
About Olanzapine - oral/IM (Zyprexa®)
Olanzapine is an antipsychotic medication approved for the treatment of schizophrenia, bipolar I disorder, and depression that is resistant to other treatments. Olanzapine, given in lower doses than that used to treat mood disorders and when given with other anti-nausea medications, can also be used to treat nausea and vomiting caused by cancer treatments.
Olanzapine targets receptors in the brain that have been linked to nausea and vomiting. This medication sheet will focus on the use of olanzapine as an anti-nausea (antiemetic) medication.
How this Medication Comes
This medication comes in oral tablets, orally disintegrating tablets (ODT), and as an intramuscular (IM) injection. When using olanzapine to prevent nausea and vomiting due to cancer treatments, it is given orally (by mouth).
How to Take This Medication
This medication is usually given once daily. If you are taking the orally disintegrating tablet version, peel back the foil on the blister pack (do not push tablet through the foil) and remove it from the blister pack with dry hands. The whole disintegrating tablet should be placed on your tongue and allowed to disintegrate (melt or dissolve) without chewing or crushing it. Once it has disintegrated, you should swallow the saliva in your mouth. The oral tablet can be taken with or without food.
The dose and how often you take olanzapine depends on the cancer treatment you are getting. Most times, olanzapine is given for 4 days while you are receiving treatment. It is often given with 3 or 4 other medications used to prevent or treat nausea and vomiting. Ask your provider if olanzapine will be a part of your treatment plan and how/when you should take it.
Tell your provider about any medications or supplements you take. Olanzapine can interact with other medications and supplements, including buprenorphine, carbamazepine, diazepam, fluvoxamine, levodopa/dopamine agonists, lorazepam, metoclopramide, and medications that lower blood pressure, among others. If you take any medications that affect the central nervous system (CNS), be sure to tell your care team before taking olanzapine.
You should not drink alcohol while taking olanzapine. You should not drive a car or operate heavy machinery until you know how olanzapine affects you.
Storage and Handling
Store your medication in the original container with the label. If you want to use a pillbox, talk to your pharmacist. Keep it in a dry place at room temperature unless your provider or pharmacist tells you otherwise. Keep containers out of reach of children and pets.
If a caregiver prepares your dose for you, they should consider wearing gloves or pour the pills directly from their container into the cap, a small cup, or directly into your hand. They should avoid touching the pills. They should always wash their hands before and after giving you the medication. Pregnant or nursing people should not prepare the dose for you. Ask your provider where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.
Where Do I Get This Medication?
Some cancer medications are only available through specialty pharmacies. Your provider or pharmacist will start this process. Your insurance plan may also affect where you can get your medication. Call your prescription plan provider to find out which specialty pharmacies are in-network.
Insurance Information
This medication may be covered by your prescription plan. If you qualify, you may be able to get financial help through patient assistance programs (PAP). Co-pay cards may also be available to lower your out-of-pocket cost if you have commercial (not Medicare/Medicaid/Tricare) insurance. Your pharmacist, social worker, or navigator can help find resources for financial support.
Possible Side Effects of Olanzapine
This medication is given to manage and/or prevent side effects of your cancer treatment. If you are having side effects from this medication, you should talk to your team about if this medication is necessary to your treatment or if there are other options to help manage the side effect this medication is treating. These are some of the most common side effects:
Increased Risk in Elderly Patients with Dementia
Elderly patients who have a history of dementia should not take olanzapine. These patients have an increased risk of death and heart problems, including blood clots and stroke. Symptoms can include: swelling, redness or pain in an extremity, chest pain or pressure, pain in your arm, back, neck or jaw, shortness of breath, numbness or weakness on one side of the body, trouble talking, confusion or mental status changes. If you experience any of these symptoms, you should contact your oncology care team immediately or go to an emergency room.
Central Nervous System (CNS) Effects
Because of how this medication works and its effects on neurotransmitters in the brain, olanzapine may cause drowsiness, fatigue, sedation, dizziness, and weakness. If these effects make it hard to carry out daily life, talk with your provider. Again, you should not drink alcohol while taking olanzapine. You should not drive a car or operate heavy machinery until you know how olanzapine affects you.
Xerostomia (Dry Mouth)
Xerostomia is dry mouth. Dry mouth can be uncomfortable and affect your speech, swallowing, and dental health. Here are some ways to manage:
- Brush your teeth often with fluoride toothpaste.
- Floss once a day, if your provider says you can.
- Chew sugar-free gum or suck on sugar-free candy to help make saliva.
- Rinse your mouth often to keep it moist.
- Ask about gels and rinses that help you make more saliva.
Talk to your provider if you start or continue to have xerostomia.
Increased Appetite
Olanzapine may increase your appetite. Because you will likely be taking olanzapine only for a few days during treatment, weight gain should not be an issue. With prolonged chronic use, you may gain weight. Talk with your healthcare team if you have concerns about this.
Hypotension (Low Blood Pressure)
Olanzapine can lower your blood pressure, especially when going from lying or sitting to standing. Call your provider if you feel dizzy or lightheaded. Take your time when going from a lying to a sitting and standing position. Your provider may suggest taking your dose in the evenings to lower this risk.
Reproductive Concerns
Talk with your provider before becoming pregnant or having a child while on this medication. Talk with your provider before breastfeeding while receiving this medication. Olanzapine may impair fertility in men and women with reproductive potential. Talk to your provider about these risks.
Important but Less Common Side Effects
High Blood Sugar
This medication can cause high blood sugar in patients with and without diabetes. Symptoms can be:
- Feeling more thirsty.
- More frequent urination.
- Feeling hungrier.
- Blurry vision.
- Headaches.
- Breath smelling like fruit.
All patients will have their blood sugar checked with blood tests. If you have diabetes and your blood sugars are higher than normal, talk to your provider. Tell your provider if you have any of these symptoms.
Increased Blood Lipid Levels
This medication can cause higher levels of lipids (fats) in your blood. Your provider will monitor these levels with blood work.
Seizures
Tell your provider if you have a history of seizures, or if you take medication to prevent seizures.
Tardive Dyskinesia
In rare cases, this medication can cause tardive dyskinesia. This can lead to abnormal muscle movements, often in the face, including grimacing, sticking out the tongue, and smacking of the lips. Alert your healthcare team immediately if you notice or develop any of these symptoms.
Neuroleptic Malignant Syndrome
Neuroleptic Malignant Syndrome is rare but serious. It can cause high fever, stiff or rigid muscles, confusion, fast heart rate, and sweating. Call your provider right away if you have any of these symptoms.