Zyprexa Zydis Side Effects

Generic name: olanzapine

Medically reviewed by Drugs.com. Last updated on Apr 6, 2025.

Note: This document contains side effect information about olanzapine. Some dosage forms listed on this page may not apply to the brand name Zyprexa Zydis.

For healthcare professionals

Applies to olanzapine: intramuscular powder for injection, intramuscular powder for injection extended release, oral tablet, oral tablet disintegrating.

Nervous system adverse events

Oral formulations:

• Very common (10% or more): Somnolence (up to 52%), sedation (up to 48%), akathisia/akathisia events (up to 27%), tremor (up to 23%), parkinsonism/parkinsonism events (up to 20%), dizziness (up to 18%), headache (up to 17%), any extrapyramidal event (up to 10%)
• Common (1% to 10%): Abnormal gait, amnesia, articulation impairment, dyskinesia/dyskinetic events, dystonia/dystonic events, hypertonia, incoordination, mild/transient anticholinergic effects, paresthesia, speech disorder
• Uncommon (0.1% to 1%): Ataxia, cerebrovascular accident, dysarthria, restless legs syndrome, seizures, stupor, tardive dyskinesia
• Rare (0.01% to 0.1%): Coma, hangover effect, neuroleptic malignant syndrome
• Frequency not reported: Akinesia, choreoathetosis, cogwheel rigidity, dyskinesia, dystonia, extrapyramidal disorder, generalized spasm, hypersomnia, hypokinesia, masked facies, movement disorder, myoclonus, opisthotonos, tardive dyskinesia, twitching
• Postmarketing reports: Diabetic coma

Immediate-release IM injection:

• Very common (10% or more): Sedation (up to 44.1%)
• Common (1% to 10%): Abnormal gait, akathisia/akathisia events, any extrapyramidal events, dizziness, parkinsonism/parkinsonism events, somnolence, speech disorder, tremor
• Uncommon (0.1% to 1%): Amnesia, restless legs syndrome, syncope
• Frequency not reported: Akinesia, choreoathetosis, cogwheel rigidity, dyskinesia, dyskinetic events, dystonia, dystonic events, extrapyramidal disorder, generalized spasm, hyperkinesia, hypersomnia, hypertonia, hypokinesia, masked facies, movement disorder, myoclonus, opisthotonos, twitching
• Postmarketing reports: Diabetic coma, neuroleptic malignant syndrome, seizures

Extended-release IM injection:

• Very common (10% or more): Headache/tension headache (up to 18%), sedation/somnolence (up to 13%)
• Common (1% to 10%): Akathisia, dizziness, dysarthria, dyskinesia, hypersomnia, mild/transient anticholinergic effects, parkinsonism, tremor
• Uncommon (0.1% to 1%): Amnesia, dystonia, seizures, restless legs syndrome, tardive dyskinesia
• Rare (0.01% to 0.1%): Neuroleptic malignant syndrome
• Frequency not reported: Abnormal gait, ataxia, cerebrovascular adverse reactions, coma, convulsions, dystonia, extrapyramidal symptoms, speech disorder, tardive extrapyramidal syndromes
• Postmarketing reports: Diabetic coma^[Ref]

Post-Injection delirium/sedation syndrome, a collection of signs and symptoms consistent with olanzapine overdose has been reported following injections of the extended-release IM suspension. Events occurred in less than 0.1% of injections and in approximately 2% of patients receiving injections for up to 46 months. Onset of events ranged from soon after injection to greater than 3 hours later. The majority of patients were hospitalized and some required supportive care, including intubation. Two deaths have been reported occurring 3 to 4 days after receiving the appropriate dose of the extended-release IM suspension. In these patients, very high olanzapine blood levels were reported after death. A study undertaken to determine the cause of the elevated drug levels in these 2 deaths provides inconclusive results. As reported in a 3-23-2015 drug safety communication issued by the US Food and Drug Administration, a study in animals found much of the drug level increases could have occurred after death, but the possibility that the deaths were caused by a rapid, but delayed entry of the drug in to the bloodstream could not be ruled out.

Akathisia most commonly occurred with oral doses of 15 mg/day; akathisia events included akathisia and hyperkinesia.

Dyskinetic events included buccoglossal syndrome, choreoathetosis, dyskinesia, and tardive dyskinesia.

Dystonic events included dystonia, generalized spasm, neck rigidity, oculogyric crisis, opisthotonos, and torticollis.

Parkinsonism/parkinsonism events most commonly occurred with oral doses of 15 mg/day and included akinesia, cogwheel rigidity, extrapyramidal syndrome, hypertonia, hypokinesia, masked facies, and tremor.

Sedation most commonly occurred in adolescent patients given oral doses at least 2.5 mg/day over 3 weeks; sedation included hypersomnia, lethargy, sedation, and somnolence.

Somnolence and tremor most commonly occurred with oral doses given with lithium or valproate.^[Ref]

Cardiovascular

Oral formulations:

• Common (1% to 10%): Chest pain, edema, hypertension, peripheral edema, postural/orthostatic hypotension, tachycardia
• Uncommon (0.1% to 1%): Bradycardia, deep vein thrombosis, QT prolongation, vasodilation
• Rare (0.01% to 0.1%): Ventricular tachycardia/fibrillation
• Postmarketing reports: Cardiac arrest, torsade de pointes, venous thromboembolic events, venous thromboembolism, ventricular arrhythmia

Immediate-release IM injection:

• Common (1% to 10%): Bradycardia, hypotension, peripheral edema, postural/orthostatic hypotension, tachycardia
• Uncommon (0.1% to 1%): Photosensitivity reaction
• Postmarketing reports: Deep vein thrombosis, cardiac arrest, QT prolongation, torsade de pointes, venous thromboembolic events, venous thromboembolism, ventricular arrhythmia

Extended-release IM injection:

• Common (1% to 10%): Bradycardia with/without hypotension/syncope, edema, electrocardiogram QT-corrected interval prolonged, hypertension, hypotension, orthostatic hypotension, peripheral edema, tachycardia
• Uncommon (0.1% to 1%): Deep vein thrombosis, thromboembolism
• Rare (0.01% to 0.1%): Ventricular tachycardia/fibrillation
• Postmarketing reports: Cardiac arrest, deep vein thrombosis, torsades de pointes, venous thromboembolic events/venous thromboembolism^[Ref]

Collective data gathered from 17 placebo-controlled clinical studies (n=5106) involving the use of atypical antipsychotic agents, including olanzapine, for the treatment of behavioral disorders in the elderly patient with dementia showed a risk of death 1.6 to 1.7 times greater in the drug treated patient than in the placebo treated patient. The average length of duration for the trials was 10 weeks with the cause of death in the majority of cases, though not all, reported as either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Olanzapine is not approved by the FDA for use in the treatment of behavioral disorders in elderly patients with dementia.^[Ref]

Metabolic

Oral formulations:

• Very common (10% or more): Weight gain/increased weight greater than/equal to 7% of baseline body weight (up to 89.4%), fasting borderline to high triglycerides (up to 59.5%), fasting borderline to high total cholesterol (up to 38.9%), increased appetite (up to 29%), fasting normal to high triglycerides (up to 26.9%), fasting borderline to high glucose (up to 14.3%) thirst (up to 10%)
• Common (1% to 10%): Fasting normal to high glucose, fasting normal to high total cholesterol, high uric acid, hyperglycemia, increased alkaline phosphatase, increased triglyceride levels, weight gain greater than/equal to 15% of baseline body weight
• Uncommon (0.1% to 1%): Development/exacerbation of diabetes with/without ketoacidosis or coma (sometimes fatal)
• Postmarketing reports: Diabetic ketoacidosis, hypertriglyceridemia, random cholesterol levels of 240 mg/dL or higher, random triglyceride levels of 1000 mg/dL or higher

Immediate-release IM injection:

• Very common (10% or more): Weight gain/increased weight greater than/equal to 7% of baseline body weight (up to 89.4%), fasting borderline to high triglycerides/hypertriglyceridemia (up to 70.7%), fasting borderline to high total cholesterol/hypercholesterolemia (up to 55.2%), fasting borderline to high glucose/hyperglycemia (up to 26%)
• Common (1% to 10%): Increased appetite, weight gain greater than/equal to 15% of baseline body weight
• Postmarketing reports: Diabetic ketoacidosis, pre-existing diabetes exacerbation, random cholesterol levels of 240 mg/dL or higher, random triglyceride levels of 1000 mg/dL or higher

Extended-release IM injection:

• Very common (10% or more): Weight gain/increased weight greater than/equal to 7% of baseline body weight (up to 64.4%)
• Common (1% to 10%): Fasting borderline to high cholesterol/glucose/triglycerides, fasting normal to high cholesterol/triglycerides/glucose, high uric acid, increased alkaline phosphatase, increased appetite, weight gain greater than/equal to 15% of baseline body weight
• Uncommon (0.1% to 1%): Development/exacerbation of diabetes with/without ketoacidosis or coma (sometimes fatal)
• Frequency not reported: Changes in cholesterol/LDL/triglycerides/sodium
• Postmarketing reports: Diabetic ketoacidosis, hyperglycemia, random cholesterol levels of 6.21 mmol/L or higher, random triglyceride levels of 11.29 mmol/L or higher^[Ref]

Olanzapine appears to have a greater association than some other atypical antipsychotics for increasing glucose levels. Mean increases of up to 15 mg/dL have been reported. The differences in mean changes in serum glucose were higher in patients with evidence of glucose dysregulation at baseline. In an analysis of patients who completed 9 to 12 months of therapy, the rate on increase in mean blood glucose slowed after approximately 6 months.

Clinically significant alterations in lipids have been observed including serum triglyceride elevations greater than 500 mg/dL. In long-term studies of at least 48-weeks in adults, increased from baseline in mean fasting cholesterol, LDL, triglycerides were 5.6 mg/dL, 2.5 mg/dL, and 18.7 mg/dL, respectively. Mean increases in fasting lipid values (total cholesterol, LDL and triglycerides) were greater in patients without evidence of lipid dysregulation at baseline.

In 13 placebo-controlled monotherapy trials, olanzapine-treated patients gained an average of 2.6 kg compared to an average 0.3 kg weight loss in placebo patients; 22.5% gained at least 7% of their baseline weight, 4.2% at least 15% of their baseline (compared to 3% and 0.3% in placebo). Clinically significant weight gain was observed across all baseline BMIs. With longer term exposure (at least 24 weeks), weight gain of 7%, 15%, or 25% or more were reported in 89.4%, 55.3%, and 29.1%, respectively. Weight gain and increased appetite were reported in 40.6%, 7.1%, and 2.5% of adolescents receiving this drug in short term treatment (approximately 22 days), respectively.^[Ref]

Gastrointestinal

Oral formulations:

• Very common (10% or more): Dry mouth (up to 32%), constipation (up to 11%), dyspepsia (up to 11%)
• Common (1% to 10%): Abdominal pain, diarrhea, dyspepsia, increased salivation, nausea, vomiting
• Uncommon (0.1% to 1%): Abdominal distention, tongue edema
• Rare (0.01% to 0.1%): Ileus, intestinal obstruction, pancreatitis
• Frequency not reported: Buccoglossal syndrome, lower/upper abdominal pain

Immediate-release IM injection:

• Common (1% to 10%): Constipation, dry mouth
• Uncommon (0.1% to 1%): Abdominal distention, nausea
• Frequency not reported: Buccoglossal syndrome
• Postmarketing reports: Pancreatitis, vomiting

Extended-release IM injection:

• Common (1% to 10%): Abdominal pain/upper abdominal pain, constipation, diarrhea, dry mouth, flatulence, nausea, toothache, tooth infection/abscess, vomiting
• Uncommon (0.1% to 1%): Abdominal distention
• Rare (0.01% to 0.1%): Pancreatitis^[Ref]

Abdominal pain included abdominal pain, lower abdominal pain, and upper abdominal pain.

Nausea and dry mouth have been reported to be dose related. Dry mouth was more commonly reported when given orally with lithium or valproate.^[Ref]

Hepatic

Oral formulations:

• Very common (10% or more): AST elevated (up to 27.6%), decreased total bilirubin (up to 22.1%), ALT 3-times upper limit of normal (3 x ULN) (up to 12.1%)
• Common (1% to 10%): Asymptomatic liver enzyme elevations (ALT, AST), high gamma glutamyltransferase (GGT)
• Uncommon (0.1% to 1%): Bilirubinemia/increased total bilirubin
• Rare (0.01% to 0.1%): Fatty liver deposit
• Frequency not reported: Hepatitis, hepatocellular/cholestatic hepatitis, mixed liver injury
• Postmarketing reports: Jaundice

Immediate-release IM injection:

• Very common (10% or more): AST elevated (up to 27.6%), decreased total bilirubin (up to 22.1%), ALT 3 x ULN (up to 12.1%)
• Postmarketing reports: Cholestatic/mixed liver injury, jaundice, total bilirubin increased

Extended-release IM injection:

• Common (1% to 10%): ALT 3 x ULN, High GGT levels, asymptomatic liver enzyme elevations (ALT, AST), increased hepatic enzymes (AST, ALT, GGT), low total bilirubin
• Uncommon (0.1% to 1%): ALT elevation greater than 200 international units/L, increased total bilirubin
• Rare (0.01% to 0.1%): Hepatocellular/cholestatic hepatitis, mixed liver injury
• Frequency not reported: Changes in direct bilirubin/GGT
• Postmarketing reports: Jaundice^[Ref]

Transient, asymptomatic elevations of hepatic transaminases were commonly seen, especially early in treatment.^[Ref]

Respiratory

Oral formulations:

• Common (1% to 10%): Dyspnea, increased cough, nasopharyngitis, pharyngitis, respiratory tract infection, rhinitis, sinusitis
• Uncommon (0.1% to 1%): Epistaxis, pulmonary embolism
• Rare (0.01% to 0.1%): Lung edema
• Frequency not reported: Lower respiratory tract infection, pneumonia, upper respiratory tract infection, viral respiratory tract infection, viral upper respiratory tract infection

Immediate-release IM injection:

• Common (1% to 10%): Pneumonia
• Uncommon (0.1% to 1%): Epistaxis
• Postmarketing reports: Pulmonary embolism

Extended-release IM injection:

• Common (1% to 10%): Cough, nasal/sinus congestion, nasopharyngitis, pharyngolaryngeal pain, sneezing, upper respiratory tract infection
• Uncommon (0.1% to 1%): Epistaxis, pulmonary embolism

Rare (0.01% to 0.1%):

• Frequency not reported: Pneumonia^[Ref]

Endocrine

Oral formulations:

• Very common (10% or more): Prolactin level elevation (up to 47.4%)
• Uncommon (0.1% to 1%): Gynecomastia/male breast enlargement

Immediate-release IM injection:

• Very common (10% or more): Increased prolactin (up to 47.4%)
• Uncommon (0.1% to 1%): Gynecomastia/male breast enlargement

Extended-release IM injection:

• Very common (10% or more): Plasma prolactin level elevation (up to 30%)
• Uncommon (0.1% to 1%): Gynecomastia/male breast enlargement^[Ref]

In clinical studies, changes in prolactin levels were found to be statistically significantly different based on dose, higher doses were associated with higher levels of prolactin. In a study of up to 12 weeks, plasma prolactin concentrations exceeded the upper limit of normal (ULN) in approximately 30% of patients who had normal baseline prolactin values. The majority of these elevations were mild, and remained below 2 x ULN.

Approximately 47% of treated adolescent patients had significantly higher prolactin levels compared to adults.^[Ref]

Hematologic

Oral formulations:

• Common (1% to 10%): Eosinophilia, leukopenia, neutropenia
• Uncommon (0.1% to 1%): Thrombocytopenia, thromboembolism

Immediate-release IM injection:

• Common (1% to 10%): Eosinophilia, leukopenia, neutropenia
• Postmarketing reports: Thrombocytopenia

Extended-release IM injection:

• Common (1% to 10%): Eosinophilia, leukopenia, neutropenia
• Rare (0.01% to 0.1%): Thrombocytopenia
• Frequency not reported: Changes in monocytes/eosinophils, high leukocyte count, treatment-emergent low platelet count^[Ref]

Ocular

Oral formulations:

• Common (1% to 10%): Amblyopia, abnormal vision
• Uncommon (0.1% to 1%): Accommodation abnormality, dry eyes, oculogyration
• Rare (0.01% to 0.1%): Mydriasis
• Frequency not reported: Oculogyric crisis

Immediate-release IM injection:

• Frequency not reported: Oculogyric crisis

Extended-release IM injection:

• Uncommon (0.1% to 1%): Oculogyration^[Ref]

Other

Oral formulations:

• Very common (10% or more): Asthenia (up to 20%), fatigue (up to 14%), accidental injury (up to 12%)
• Common (1% to 10%): Fever/pyrexia, extremity pain (other than joint), lethargy, residual events, nonspecific events
• Uncommon (0.1% to 1%): Chills
• Rare (0.01% to 0.1%): Chills and fever, hypothermia, sudden death/sudden unexplained death
• Frequency not reported: Falls, increased body temperature, neonatal drug withdrawal syndrome

Immediate-release IM injection:

• Common (1% to 10%): Asthenia, fatigue, pyrexia, residual events
• Frequency not reported: Falls, lethargy
• Postmarketing reports: Sudden unexplained death

Extended-release IM injection:

• Common (1% to 10%): Asthenia, ear pain, fatigue, fever/pyrexia, overdose, pain, procedural pain
• Rare (0.01% to 0.1%): Hypothermia
• Frequency not reported: Death, falls, increased body temperature, lethargy, neonatal drug withdrawal syndrome, sudden death/sudden unexplained death, weakness^[Ref]

Asthenia most frequently occurred in oral doses of 15 mg/day.

Residual events included movement disorder, myoclonus, and twitching.^[Ref]

Hypersensitivity

Oral formulations:

• Uncommon (0.1% to 1%): Hypersensitivity
• Postmarketing reports: Allergic reaction, anaphylactoid reaction, angioedema

Immediate-release IM injection:

• Postmarketing reports: Allergic reaction, anaphylactoid reaction, angioedema

Extended-release IM injection:

• Uncommon (0.1% to 1%): Hypersensitivity
• Postmarketing reports: Allergic reaction, anaphylactoid reaction, angioedema^[Ref]

Genitourinary

Oral formulations:

• Common (1% to 10%): Dysmenorrhea, erectile dysfunction, glucosuria, urinary incontinence, urinary tract infection, vaginitis
• Uncommon (0.1% to 1%): Amenorrhea, breast enlargement/pain, decreased menstruation, galactorrhea, impaired urination, impotence, increased menstruation, menorrhagia, metrorrhagia, polyuria, urinary frequency, urinary hesitation, urinary retention, urinary urgency
• Rare (0.01% to 0.1%): Priapism

Immediate-release IM injection:

• Common (1% to 10%): Erectile dysfunction, urinary incontinence
• Uncommon (0.1% to 1%): Amenorrhea, breast enlargement, galactorrhea
• Postmarketing reports: Priapism, urinary hesitation, urinary retention

Extended-release IM injection:

• Common (1% to 10%): Erectile dysfunction, vaginal discharge
• Uncommon (0.1% to 1%): Amenorrhea, breast enlargement, galactorrhea, urinary hesitation, urinary incontinence, urinary retention
• Rare (0.01% to 0.1%): Priapism^[Ref]

Musculoskeletal

Oral formulations:

• Common (1% to 10%): Arthralgia, back pain, high creatine/creatinine phosphokinase, joint pain, musculoskeletal stiffness
• Rare (0.01% to 0.1%): Osteoporosis, rhabdomyolysis
• Frequency not reported: Neck rigidity, torticollis

Immediate-release IM injection:

• Common (1% to 10%): Arthralgia
• Uncommon (0.1% to 1%): Increased creatinine phosphokinase
• Rare (0.01% to 0.1%): Elevated creatine kinase levels
• Frequency not reported: Neck rigidity, torticollis
• Postmarketing reports: Rhabdomyolysis

Extended-release IM injection:

• Common (1% to 10%): Arthralgia, back pain, high creatine phosphokinase, muscle spasms, musculoskeletal spasms
• Rare (0.01% to 0.1%): Rhabdomyolysis^[Ref]

Dermatologic

Oral formulations:

• Common (1% to 10%): Acne, dry skin, ecchymosis, rash, sweating/diaphoresis
• Uncommon (0.1% to 1%): Alopecia, face edema, photosensitivity reaction
• Frequency not reported: Drug reaction with eosinophilia and systemic symptoms (DRESS), erythema, pruritus, urticaria

Immediate-release IM injection:

• Postmarketing reports: Alopecia, drug reaction with eosinophilia and systemic symptoms (DRESS), pruritus, rash, sweating/diaphoresis, urticaria

Extended-release IM injection:

• Common (1% to 10%): Acne, rash
• Uncommon (0.1% to 1%): Alopecia, photosensitivity reaction
• Frequency not reported: Diaphoresis/sweating, erythema
• Postmarketing reports: Drug reaction with eosinophilia and systemic symptoms (DRESS), pruritus, urticaria^[Ref]

Psychiatric

Oral formulations:

• Very common (10% or more): Depression (up to 18%), insomnia (up to 12%)
• Common (1% to 10%): Apathy, confusion, decreased libido, euphoria, personality disorder, restlessness
• Uncommon (0.1% to 1%): Suicide attempt
• Rare (0.01% to 0.1%): Discontinuation symptoms
• Frequency not reported: Anxiety, visual hallucinations/hallucinations
• Postmarketing reports: Discontinuation reaction

Immediate-release IM injection:

• Common (1% to 10%): Decreased libido
• Frequency not reported: Hallucinations
• Postmarketing reports: Anxiety, discontinuation reaction, insomnia

Extended-release IM injection:

• Common (1% to 10%): Abnormal dreams, abnormal thinking, auditory hallucinations, decreased libido, restlessness, sleep disorder
• Rare (0.01% to 0.1%): Discontinuation reaction/symptoms
• Frequency not reported: Aggression, agitation, anxiety, confusion, delirium, hallucinations, insomnia, other cognitive impairment, visual hallucinations^[Ref]

For the collection of adverse reactions, the term personality disorder was used to collect data on nonaggressive objectionable behavior.

Depression most commonly occurred with oral doses given with lithium or valproate.^[Ref]

Local

Immediate-release IM injection:

• Common (1% to 10%): Injection site pain

Extended-release IM injection:

• Common (1% to 10%): Anesthesia, bruising, buttock pain, hemorrhage, induration, injection site induration/mass/pain, irritation
• Rare (0.01% to 0.1%): Injection site abscess requiring/not requiring surgical intervention
• Frequency not reported: Edema-type reaction, erythema-type reaction, nodule-type reaction, non-specific injection-site reaction^[Ref]

Immunologic

Extended-release IM injection:

• Common (1% to 10%): Viral infection^[Ref]

Renal

Oral formulations:

• Common (1% to 10%): Glycosuria

Immediate-release IM injection:

• Common (1% to 10%): Glycosuria

Extended-release IM injection:

• Common (1% to 10%): Glycosuria^[Ref]

See also:

Frequently asked questions

• What drugs cause tardive dyskinesia?

Further information

Zyprexa Zydis side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer