from the common to the rare; how long they last & how to deal with them
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About Side Effects
Potential side effects (adverse events in fancy pharmaceutical talk) are often used as a rationalization to not take Zyprexa (olanzapine). Many people will stop taking an otherwise working drug because of one or more side effects that are relatively minor and/or often temporary. There may even be ways to counter or mitigate the problematic effects.
It all comes down to a very simple equation: which sucks less?
There is no perfect drug. If you keep switching meds in the hopes of finding something with no side effect, or irrelevant side effects that don’t bug you as much, you could wind up treatment-resistant, and a med that worked before may work not as well as it did the first time, if at all.
Side Effects All Crazy Meds Have
No matter which neurological and/or psychiatric drug you take, you’ll probably get one or more of these side effects. These will usually be gone, or at least will diminish to the point where you barely notice it most of the time, within a week or two.
- Drowsiness / fatigue - even when taking stimulants in some circumstances.
- Insomnia, instead of or alternating with the drowsiness.
- Assorted other minor GI complaints (constipation, diarrhea, etc.)
- Generally feeling spacey / out of it
- Which can all add up to the ever-helpful ”flu-like symptoms” listed as an adverse event on the PI sheet of practically every medication on the planet used to treat almost any condition humans and other animals could have.
- All crazy meds can, and probably will affect your dreams as well. There is no way of telling if that will be good or bad, let alone if this side effect is permanent or temporary.
So don’t operate any heavy machinery and try to avoid driving the first couple of days. We always recommend1 starting a new med Friday night / Saturday morning (or whenever your day off is) so you have an idea of how it will affect you for the first week or two. Keep in mind: most side effects are usually temporary in nature.
Medicine Is The Best Medicine
Brain Cooties Aren’t Contagious
Zyprexa (olanzapine) Typical Side Effects
Most everyone gets at least one or two of these
- Weight gain
- Dry mouth
- Getting fat
- Putting on the pounds
- Especially excessive daytime sleepiness and general lethargy
- Not giving a damn about anything (emotional blunting)
- Combine the lethargy and blunting and you get what’s known as zombification
- Have I mentioned Excessive body weight gain (BWG)?
Here is one way to figure out how much weight you’ll gain from Zyprexa.2 It’s not really “how much” but “for how long” will you be gaining weight. That rather large study found 15% of people gained 4% or more of their pre-Zyprexa weight in two weeks or less. They went on gaining weight for 38–39 weeks. Everyone else gained a lot less weight, if any at all. What makes it extra sucky is the people who gained the most weight were in better shape to start with and the Zyprexa worked better for them! As weight gain is closely linked to how Zyprexa works, you’re hosed unless you start taking metformin along with the Zyprexa (see below).
That 80% (or more) people gain little, if any, weight comes up on several studies, including one where most of the data and money came from Eli Lilly. You don’t think a pharmaceutical company, especially Eli Lilly, would spin the numbers about a side effect, especially weight gain, concerning one of their meds, especially Zyprexa, would you?
However, given that the overwhelming majority of people who post about meds on teh interwebs do so to complain, and the majority of people who take Zyprexa don’t have access to the Internet, my money is on well over half the people who take Zyprexa gain little or no weight.
Because Zypexa is a potent anticholinergic the anticholinergic side effects like constipation and dry mouth will probably hang around, they just won’t be as bad as they are at first. That’s the price you pay for EPS, TD and other movement disorders being rare. Eventually the lethargy and daytime sleepiness go away.
Zyprexa (olanzapine) Uncommon Side Effects
You may or may not get one or more of these, so don’t be surprised either way
- Accidental injury
- Increased breast size (porno boobs or man boobs, take your pick)
- with or without Lactation
- Loss of libido
- a host of other sexual dysfunctions
- and other symptoms of too much prolactin (hyperprolactinemia)
- Irregular heartbeat
- Feeling faint after standing up
- and other symptoms of really low blood pressure (orthostatic hypotension).
- The orthostatic hypotension comes and goes with dosage increases.
Potentially Dangerous Side Effects of Zyprexa (olanzapine)
If you have one or more of these, call your doctor ASAP. Or now. Or get the hell off of the Internet and go to the ER NOW!
- Diabetes mellitus
- Increased cholesterol
- and other problems associated with excessive weight gain
Zyprexa Freaky Rare Side Effects
You won’t get these. Unless you already have and that’s why you’re here
- Getting intoxicated from water (#points!)
- Getting hung over with no previous intoxicating effects from the Zyprexa. Or anything else. (#FML)
- Fecal incontinence
- Priapism (the never-ending hard-on)
- The first reported case: an old guy with MS.
- It seems to happen with APs in general. Zyprexa, Seroquel, or Risperdal, whatever he took he got hard as a rock. The irony being he has a history of public nudity. He didn’t need surgery, but he did need…I’ll let you read the article if you think you can handle it.
- There have been other reports of this freaky, perhaps not especially rare, side effect when mixing Zyprexa with other meds:
- Zyprexa + lithium = that one may have required surgery
- Zyprexa + Neurontin = and I thought my life sucked. Looks like suicide can be very painful after all.
Kids, don’t try this at home. Zyprexa is not a Viagra substitute. Although who can honestly resist the temptation of being constantly drunk, hard, smoking on the sly, and always taking a dump whether you want to or not? Zyprexa is a manly med for manly men. And adventuresome women, as Zyprexa can cause clitoral priapism as well!
Maybe I should rethink not taking Zyprexa just because I couldn’t get out of bed all day on 1.25 mg.
Be very careful. Reading the PI sheet for a drug you haven’t been prescribed, or even discussed with your doctor, can often be an exercise in the fear of medications (pharmacophobia).
Medicine Is The Best Medicine
Vaccines Cause Immunity
Mental Illness is NOT Contagious
Medicated For Your Protection
Ways to Counter/Minimize/Deal with Some Side Effects of Zyprexa (olanzapine)
In Zyprexa’s case the only side effect most people care about is weight gain. Usually in the form of “what pill can I take.” Fortunately there is an answer to that question. Metformin is currently the first-line medication to add for antipsychotic-induced weight gain. Topamax is used, but only if Metformin and/or eating less and exercising more didn’t work.
The results from the real world give it about a fifty-fifty chance, but I think it might be better than that. Being crazy, fat, and taking meds for both is a triple stigmata that no one wants to admit to, even anonymously. The one drawback is metformin works best if you take it soon. Soon being defined as a 5–7% gain in your baseline (i.e. pre-any-med) weight. While controlling your weight usually takes care of things like diabetes and high cholesterol, that’s not always the case when you’re taking an antipsychotic.
Here’s some of the science. Let’s start with an examination of any studies using metformin to treat Zyprexa-induced weight gain up through 2010.3 These sorts of studies, a meta-analysis, aren’t always clear. But when the data are fairly straight-forward (weight up or not, lipids up or not, e.g.), they’re worth looking at. Science says, “Metformin isn’t a miracle drug, but it can work.”
There are some studies not included in the above meta-analysis that I think are worth looking. Here’s what happens when starting treatment on a Zyprexa and metformin cocktail.
RESULTS: Of the 40 patients who were randomly assigned, 37 (92.5%) completed treatments. The weight, body mass index, waist circumference, and waist-to-hip ratio levels increased less in the olanzapine plus metformin group relative to the olanzapine plus placebo group during the 12-week follow-up period. The insulin and insulin resistance index values of the olanzapine plus placebo group increased significantly at weeks 8 and 12. In contrast, the insulin and insulin resistance index levels of the olanzapine plus metformin group remained unchanged. Significantly fewer patients in the olanzapine plus metformin group relative to patients in the olanzapine plus placebo group increased their baseline weight by more than 7%, which was the cutoff for clinically meaningful weight gain. There was a significant decrease in SAPS and SANS scores within each group from baseline to week 12, with no between-group differences. Metformin was tolerated well by all patients. CONCLUSIONS: Metformin was effective and safe in attenuating olanzapine-induced weight gain and insulin resistance in drug-naive first-episode schizophrenia patients. Patients displayed good adherence to this type of preventive intervention. --Metformin Addition Attenuates Olanzapine-Induced Weight Gain in Drug-Naive First-Episode Schizophrenia Patients: A Double-Blind, Placebo-Controlled Study
In English: These were people who never took any meds before. Half were started on a cocktail of Zyprexa and metformin, half took Zyprexa and a placebo. Of the ones who took the metformin didn’t have any changes in their insulin levels and fewer of them gained any weight. The Zyprexa worked just as well in both groups. It sorta worked better in the group also taking metformin, in that they had better med compliance and follow-up.
As for taking metformin after you’ve been taking Zyprexa for a while:
RESULTS: The metformin group lost 1.4±3.2 kg (p=0.01) and tended to decrease its leptin levels, whereas the placebo group maintained a stable weight: −0.18±2.8 kg (p=0.7). The HOMA-IR significantly increased after placebo (p=0.006) and did not change after metformin (p=0.8). No ostensible differences were observed in the other variables, even though metformin did not improve the lipid profile and the Hb1c levels. --Metformin as an adjunctive treatment to control body weight and metabolic dysfunction during olanzapine administration: a multicentric, double-blind, placebo-controlled trial
In English: 40 people who’ve been on Zyprexa for some time. Over the course of four months the people taking metformin with their Zyprexa lost an average of about three pounds in a range of losing 10 pounds to some people gaining up to five pounds. The people taking the placebo didn’t have any real change in their weight. No change in cholesterol and this time it didn’t make any difference in one type of insulin. Still works better than anything else.
Another reason why I give metformin a fifty-fifty chance is it failed in this study. Although it was started after everyone gained their hypothetical limit of packing on the poundage.
With a relatively low dosage of olanzapine (10 mg daily for 14 weeks), mean BWG in all patients was 5.9, SD 2.8 kg. This figure is congruent with Allison and others’ meta-analysis of a broad olanzapine dosage range showing a BWG of 4.1 kg in 10 weeks.
Metformin did not prevent increases in BWG or WC. Triglycerides also significantly increased. Total cholesterol levels decreased and HDL levels significantly increased under metformin. HDL levels significantly decreased under the placebo as well. The HOMA-IR index decreased in both groups. Three patients with high fasting glucose improved under metformin, while glucose levels deteriorated in 3 placebo patients. Thus, with the exception of the triglyceride levels, metformin displayed a positive metabolic effect that appears dissociated from its ability to prevent olanzapine-induced BWG. Metformin was well tolerated and did not interfere with clinical improvement.
In patients with type 2 diabetes, metformin improves insulin resistance and lipid profile and either has a neutral effect or decreases body weight. We thus hypothesize that olanzapine-induced BWG is mainly associated with direct appetite stimulation (1), a mechanism that is not primarily influenced by metformin. Appetite was, unfortunately, not measured. This hypothesis requires further evaluation. Since BWG during olanzapine treatment reaches a plateau after 39 weeks, it remains unclear whether metformin could exert a positive effect on BWG beyond 14 weeks with olanzapine dosages above 10 mg daily and a larger sample size. -- Metformin for Prevention of Weight Gain and Insulin Resistance With Olanzapine: A Double-Blind Placebo-Controlled Trial
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1 If you have the luxury of both a job and being able to cope with your symptoms not being dealt with for however many days you need to wait in order to do this. Read enough of this site and you can tell I live in a fantasy world.
2 That doesn't involve expensive gene testing or a fearless self-examination of your lifestyle.
3 Any study with over 100 people involved.
If you have any questions not answered here, please see the Crazymeds Zyprexa discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.net)
|Last modified on Saturday, 19 April, 2014 at 13:35:51 by JerodPoore||Page Author Jerod Poore||Date created Wednesday, 20 July 2011 at 11:21:11|
|“Zyprexa (olanzapine): a Review for the Educated Consumer.” by Jerod Poore is copyright © 2011 Jerod Poore||Published online 2011/07/20|
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|Plain text:||Poore, Jerod. “Zyprexa (olanzapine): a Review for the Educated Consumer.” Crazymeds (crazymeds.net). (2011).|
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Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, and 2015 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList,
NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!
‘Everything is true, nothing is permitted.’ - Jerod Poore
1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.