There are also several options for printing:

• Click "Print this page" on the left to print the whole section
• Download a handy PILL (Patient Information Leaflet), a two-page summary of the main questions and answers from here. This can then be printed.
• Download a handy QuILL (Quick Information Leaflet), a shorter, pictorial version of the PILL for the tablets, designed for younger people
• Download a handy BILL (Basic Information Leaflet), a one-page larger print summary of the really main questions and answers from here. This can then be printed.

There are many other Patient Information Leaflets (PILs) across the world for patients and carers. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets

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Olanzapine is usually used to help treat the symptoms of:

• Bipolar mood disorder, especially stopping mania coming back

• Bipolar mania or hypomania

• Psychiatry emergency, often as a melt-in-the-mouth tablet or by injection

• Psychosis

• Schizophrenia

Olanzapine can also be used to help some of the symptoms of:

• ADHD (Attention Deficit Hyperactivity Disorder), with other treatments

• Anxiety (GAD or Generalised Anxiety Disorder)

• Bipolar depression

• Dementia, although it isn't used much for this at the moment

• Depression

• Eating disorders

• Insomnia, if taken at night

• OCD (Obsessive Compulsive Disorder)

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The usual dose of olanzapine is around 5-20mg a day. The top dose is usually 20mg a day (and this includes the injection as well). The usual starting dose is 10mg a day, perhaps 15mg a day if someone is very high. The daily dose can be taken before, with or after food.

It is not recommended in children but this is only because it has not been studied fully rather than because of any concerns about safety.

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This will rather depend on what you are taking it for. To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:

• Psychiatric emergency - main options, main medicines
• ADHD - main options, main medicines and handy chart
• Anxiety - main options, main medicines and handy chart
• Bipolar mood disorder - main options, main medicines and handy chart
• Bipolar depression - main options, main medicines and handy chart
• Bipolar mania - main options, main medicines and handy chart
• Dementia - main options, main medicines and handy chart
• Depression - main options, main medicines and handy chart
• Eating disorders - main options, main medicines
• Insomnia - main options, main medicines and handy chart
• OCD - main options, main medicines and handy chart
• Psychosis - main options, main medicines and handy chart
• Schizophrenia - main options, main medicines and handy chart

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

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There is a naturally occurring chemical ('neurotransmitter') in the brain called dopamine. Dopamine is the chemical messenger in the brain mainly involved with thinking, emotions, behaviour and perception. In some illnesses, this dopamine may be overactive and upsets the normal balance of chemicals in the brain. This excess dopamine helps to produce some of the symptoms of the illness. The main effect that olanzapine has is to block some dopamine receptors in the brain, reducing the effect of having too much dopamine and correcting the imbalance. This reduces the symptoms caused by having too much dopamine. Olanzapine also has effects on other neurotransmitters in the brain e.g. serotonin (5-HT) receptors, and their beneficial effects may be related to these effects.

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Take your olanzapine as directed on the medicine label. Try to take it a regular time each day. Taking it at mealtimes may make it easier to remember as there is no problem about taking olanzapine with or after food. If the instructions say to take it once a day this is usually at bedtime as they may make you feel drowsy at first. They are not, however, sleeping tablets.

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Tablets:
Olanzapine tablets should be swallowed with at least half a glass of water whilst you are sitting or standing. This is to make sure that they reach the stomach and do not stick in your throat.
Melt-in-the-mouth tablets (Orodispersable or Velotabs®):
These should be placed on your tongue and allowed to dissolve. The fluid can then be swallowed. The other way ti take the orodispersible tablets is to pop them into a glass of water or other drink e.g. orange juice, apple juice, milk, or coffee, just before taking.
Short-acting injection:
If you need to have the short-acting injection this will be given to you by a nurse or doctor.
Longer-acting injection (Zypadhera®):
It is sometimes necessary or helpful for olanzapine to be given as 'depot' or long-acting injection (although this is not available in all countries at the moment). This is a long-acting injection usually given into a buttock. The injection releases drug over several weeks and so you will not have to remember to take tablets at a regular time each day. Depot injections are otherwise no more or less effective than tablets. If you are in hospital it will be given to you by a nurse. Outside hospital it may be given to you by a Community Psychiatric Nurse, as a day patient or by your G.P. or community nurse. You may need to have this injection every two to four weeks for some time. To start with you will be given a 'test dose' or tablets to make sure the medicine suits you. Then, if there are no problems, a couple of weeks later you will be given your first full dose injection which will then be repeated every two to four weeks. A nurse may need to stay with you for about 3 hours after the injection to make sure you are OK.

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This may depend on what you are taking olanzapine for. Click the link below for the answer for that condition:

• ADHD
• Anxiety (GAD or Generalised Anxiety Disorder)
• Bipolar mood disorder
• Bipolar depression
• Bipolar mania or hypomania
• Dementia
• Depression
• Eating disorders
• Insomnia
• Obsessive Compulsive Disorder
• Psychiatric emergency
• Psychosis
• Schizophrenia

Some of the effects of olanzapine appear soon after taking it, for example the drowsiness. The most important action, however, to help the symptoms of your illness may take weeks or even months of regular medication to become fully effective. In the same way if your dose or treatment is changed it may take an equally long period of time before you notice the effects of such a change.

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This will depend on why you are taking olanzapine. Click the links below for the appropriate answer if you are taking olanzapine for:

• Anxiety
• ADHD
• Bipolar mood disorder
• Bipolar depression
• Bipolar mania or hypomania
• Dementia
• Depression
• Eating disorders
• Insomnia
• OCD (Obsessive Compulsive Disorder)
• Psychiatric emergency
• Psychosis
• Schizophrenia

^{Updated 10.11}

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This will depend on why you are taking the medication. Click the links below for the appropriate answer if you are taking olanzapine for:

• Psychiatric emergency

• Anxiety

• ADHD

• Bipolar mood disorder

• Bipolar depression

• Bipolar mania or hypomania

• Dementia

• Depression

• Obsessive Compulsive Disorder

• Psychosis

• Schizophrenia

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Olanzapine is not really addictive. If you have taken it for a long time you may get some mild effects if you stop it suddenly. The main problem would be your symptoms coming back, which can happen within a few days.

For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation. Olanzapine has none of these and so is not addictive. Any discontinuation effects are probably more of an "adjustment" reaction from sudden removal of a drug rather than "withdrawal".

Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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Start again as soon as you remember unless it is nearly time for your next dose then take the next dose as normal. Do not try to catch up by taking two or more doses at once as you may get more side-effects. You should tell your doctor about this next time you meet. Missing the occasional dose (e.g. once a week) isn't usually a big problem.

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices that can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, in a car etc.

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It is unwise to stop taking them suddenly, even if you feel better. Your symptoms can return if treatment is stopped too early. This may occur some weeks or even many months after the drug has been stopped. You could also experience some mild withdrawal symptoms (as explained above). When the time comes your doctor will usually withdraw the drug by a gradual reduction in the dose taken over a period of several weeks. You should discuss this fully with your doctor.

If you are having the long-acting injection, then it can be stopped suddenly because the amount in your body will slowly reduce. You should not then get any problems.

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The table below will show you some of the main side effects you might get from olanzapine.

Side effect	What happens	What to do about it
VERY COMMON (more than about 1 in 10 people might get these)
Sleepiness	Feeling sleepy, drowsy or sluggish. It can last for a few hours after taking your dose.	Don't drive or use machinery.
Weight gain	Eating more and putting on weight, especially just after you start olanzapine.	A diet full of vegetables and fibre may help prevent weight gain. Some people find they gain less weight if they have the melt-in-the-mouth (Orodispersible) olanzapine tablets, although no one knows why.   See the separate section below and click here to see a section on helping you to feel less hungry.
COMMON (less than about 1 in 10 people might get these)
Hypotension	A low blood pressure - this can make you feel dizzy, especially when you stand up.	Try not to stand up too quickly. If you feel dizzy, don't drive. This dizziness is not dangerous. It usually wears off in a few days.
Dry mouth	Not much saliva or spit.	Suck sugar-free boiled sweets. If it is bad, your doctor can give you a mouth spray. It usually wears off in a few days.
Constipation	When you want to poop but can't (the opposite of diarrhoea). You can't pass a motion.	Make sure you eat enough fibre or bran or fruit. Make sure you are drinking enough fluid. Make sure you keep active and get some exercise e.g. walking. If this does not help, ask your doctor or pharmacist for a mild laxative. It usually wears off in a few weeks.
Peripheral oedema	When your ankles swell up.	Discuss with your doctor.
Diabetes	You lose weight, pass lots of urine, and feel thirsty and hungry all the time.	Tell your doctor if you get these symptoms. You can then have some simple tests to see if you are getting diabetes.
RARE  (less than about 1 in 100 people might get these)
Altered liver function	Your liver is not working as normal. You should not feel any symptoms. This is only discovered if your doctor does a blood test.	Continue to take your olanzapine. Your liver should return to normal after a while. Your doctor will probably want to do regular blood tests to make sure your liver is O.K. Serious liver problems don't occur with olanzapine, so don't worry too much.
Photosensitivity	Skin goes blotchy in the sun.	Avoid direct sunlight or sun-lamps. Use a high factor sun block cream.

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

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Olanzapine may make you feel drowsy or sleepy, especially to start with. You should not drive (see below) or operate machinery until you know how it affects you. You should be careful as it may affect your reaction times or reflexes. It is not, however, sleeping tablets, although if you take it at night they may help you get to sleep.

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Weight gain with olanzapine is possible in about half the people who take it. Of the people who gain weight, most is gained during the first 2 months of treatment, then slows down in months 2-4, but can still carry on after that. It is not possible to say what the effect on your own weight may be because each person will be different.

If you do start to put on weight or have problems with your weight, you should tell your doctor as soon as possible. He or she may be able to adjust your medicine or the dose to reduce this effect. Your doctor can also arrange for you to see a dietician for advice. If you do gain weight it is possible to lose it while you are still taking this medication, with expert advice about diet. In some people this can be a serious problem. If it causes you distress make sure your doctor knows about this.

Weight gain can be part of the so-called ”metabolic syndrome”. You might want to read a bit more about this.

Click here for a few tips on how to help you feel less hungry and lose weight.

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Olanzapine is not thought to have a major effect on any of these stages. If this happens, however, you should discuss this with your doctor, as a change in dose or medicine may help minimise the problem.

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You should have no problem with any foods or drinks with olanzapine, other than alcohol (see separate question).

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. asthma or a chest infection (as alcohol can make it harder to breathe), epilepsy
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

If you drink alcohol while taking olanzapine it may make you feel more sleepy. It may increase your heart rate. If you get more sleepy, you will need to take extra care if you need to drive or operate machinery. You must seek advice on this.  

It is not safe to drive after drinking alcohol, with or without olanzapine. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

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Olanzapine has only a few interactions with other medicines:

• The effects of olanzapine can sometimes be increased by fluvoxamine
• The effect of olanzapine can be decreased by smoking
• If olanzapine is taken with benzodiazepines (e.g. diazepam, lorazepam, temazepam), or alcohol, it will cause more drowsiness.

This does not necessarily mean that this will happen in everyone or that some of these medicines can not be used together. It is just that you may need to follow your doctor's instructions very carefully. There are many other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking.

Olanzapine is one of those medicines. The amount of olanzapine in the body can drop by up to a fifth (20%) if you smoke, giving less effect or meaning you might need a higher dose to get the same effect. It also means that if you stop smoking, the levels will rise so you might get more side effects.

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, there are no extra problems with smoking cannabis, other than the smoking itself (see above). But, it might make you feel a bit more drowsy and may have more dry mouth, blurred vision and finding it hard to pass water (wee). Also, don't forget that cannabis can make psychotic symptoms worse.

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, there are no reports of extra problems with olanzapine and cocaine, although this doesn't mean it's safe. All antipsychotics can reduce the stimulant effects of cocaine.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with olanzapine and ecstasy, but again this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). However, there are no extra problems reported from taking opiates (e.g. heroin, methadone, codeine) with olanzapine, although you might feel more drowsy.

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You should have no problems with "The Pill" and olanzapine.

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking olanzapine, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain (the tuberoinfundibular system if you want to know). This area of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain. This is just what we want to help reduce some of the symptoms caused by too much dopamine e.g. psychosis, paranoia. However, if these medicines also block dopamine in the area of the brain that keeps prolactin under control, prolactin can get out of control and increase. Higher than usual levels of prolactin in the brain and blood will stop your periods (or at least make them irregular or unpredictable). Much higher levels can lead to your breasts leaking milk or lactating (the medical term is galactorrhoea). The name of the hormone (prolactin) might help you guess this anyway i.e. pro- (meaning for) -lactin (as in lactation).  High prolactin can make it more difficult to become pregnant, and over many years can have an effect on your sex-life, and maybe even your bones.

Olanzapine is one of those medicines that can increase prolactin. It usually only happens for a couple of months after you start it and then the effect reduces a bit. However, it can go on for longer. If this happens you should see your doctor to have a test to see if your prolactin is in fact high. So, if your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find if there are any other causes. If it is caused by olanzapine then you should talk to your doctor about the options e.g. reduce the dose (which doesn't often help much), or switch to a medicine that has less effect on prolactin. Sometimes adding another medication can help if nothing else works.

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

Olanzapine is classified as "C". There is little human information available, but so far no problems have been reported. You should, however, seek personal advice from your GP, who may then if necessary seek further specialist advice. 

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.
• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.
• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter
• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit
• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half
• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

We know that olanzapine gets into breast milk, but probably only enough to give the baby small amounts via the milk (around 1%). There are many reports of mums breast-feeding with no problems while taking olanzapine. However, there is one report where the baby got very drowsy. So, taking olanzapine while breast-feeding is not recommended. But you should discuss this with your doctor, nurse or health visitor because you being ill might be more harmful to your baby than a small amount of olanzapine. They will be able to make regular checks on your baby to make sure there are no problems.

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Olanzapine can affect your driving e.g. you may feel drowsy. Until this wears off, or you know how your olanzapine affects you, do not drive or operate machinery. You should be careful as it may affect your reaction times or reflexes even though you feel well.

If you are taking any medicines, the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

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You may sometimes need to have a blood test, to check on some possible side effects e.g. blood sugar or cholesterol levels. You should also have checks on your weight.

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