Olanzapine Antipsychotic Medication Used in Dementia

Olanzapine (Zyprexa) is one of a group of newer antipsychotic medications called atypical antipsychotics. These types of medication are seen as a better choice for people with Alzheimer's than other older antipsychotic medications. However, Zyprexa is not approved by the US Food and Drug Administration for the treatment of psychosis in older adults with dementia.

Olanzapine belongs to a category of medications called psychotropics—drugs that affect the mind. Antipsychotic medicines are psychotropic medications that treat the symptoms of schizophrenia such as hallucinations, paranoia, and delusions.

What Are Atypical Antipsychotic Medications?

Atypical antipsychotic drugs are so-called to differentiate between these newer antipsychotics and other conventional antipsychotics, such as chlorpromazine (Thorazine, Ormazine) and haloperidol (Haldol). Atypical antipsychotic medications were first introduced in the 1980s. Zyprexa was approved by the Food and Drug Administration (FDA) in 1996.

Atypical antipsychotic medications have a number of distinct differences and have been marketed as drugs that have fewer major neurological side effects such as extrapyramidal symptoms and low rates of tardive dyskinesia. Atypical antipsychotics are approved for the treatment of schizophrenia but are also prescribed for people with bipolar disorder and in the treatment of agitation and psychosis in dementia.

Side Effects of Zyprexa

Common side effects include:

• Common cold or cough
• Diarrhea
• Dizziness
• Drowsiness or oversedation
• Dry mouth
• Increased appetite or weight gain
• Nausea or vomiting

More serious neurological side effects include:

• Extrapyramidal symptoms—tremor, dystonia, Parkinsonism, akinesia (losing voluntary movement), akathisia (restlessness, agitation)
• Tardive dyskinesia—involuntary movements of the mouth, tongue, face, trunk, and extremities. Risk increases with prolonged use.

Administration Options of Zyprexa

Zyprexa tablets are available as tablets that can be taken once a day, in strengths of 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, and 20 mg, . The medication can be taken with or without meals. No routine blood monitoring is required.

Zyprexa also is available in a formulation that dissolves in the mouth, in 5 mg, 10 mg, 15 mg, and 20 mg strengths, as well as via an intramuscular injection (shot).

Make sure you read the prescription instructions carefully. Ask your pharmacist or doctor about anything that you are not sure of.

Warning About Zyprexa and People With Dementia

People with dementia who take antipsychotic medications, including Zyprexa, have an increased risk of sudden death. Research has found that most of those deaths were related either to cardiovascular conditions (heart failure) or infections (pneumonia). However, prescribing those medications may still be appropriate for patients who pose a danger to themselves or others and are in profound distress.

Although Zyprexa is not approved to treat older adults with dementia-related psychosis, it sometimes is prescribed "off-label" (not as approved by the FDA) with the goal of reducing significant behavior problems or psychosis. If antipsychotic medication is used in this situation, it should be after other non-drug approaches are attempted and after confirming that the behaviors pose a danger to the person with dementia or those around them, or their paranoia and delusions are truly distressing for them.

Other Atypical Antipsychotic Medications

Other atypical antipsychotic medications include the following:

• quetiapine (Seroquel)
• risperidone (Risperdal)
• aripiprazole (Abilify)
• clozapine (Clozaril)
• pimavanserin (Nuplazid)

Each of these drugs has different effects and side effects for the general public as well as for those who have Alzheimer's disease.

General Conclusions

It is generally recognized that while more research is needed, avoidance—or use with careful monitoring by a physician—is called for when considering Zyprexa for people with dementia.