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Zyprexa is the third new medicine to treat schizophrenia, following Clozaril (clozapine) and Risperdal (risperidone).

Unlike older anti-psychotic drugs such as Thorazine (chlorpromazine) and Haldol (haloperidol), which just treated "positive" symptoms such as hallucinations, disorganized thinking, and delusions, the new medications also help against "negative" symptoms. These include apathy, diminished emotion, and social withdrawal.

The goal of the new treatments is to help bring patients back into family life and community activities. While not everyone can benefit, there have been some amazing "awakening-type" success stories.

Side Effects and Interactions

Some people starting on Zyprexa may find that they feel dizzy or faint if they stand up suddenly. They should take care to avoid falling when they first get up.

Zyprexa may cause drowsiness, dizziness, headache, nervousness, agitation, sleeping difficulties, constipation, dry mouth, increased appetite, weight gain, runny nose, tremor, rapid heart rate, and fever.

Less common adverse events include joint pain, fluid retention, personality disorder, involuntary muscle movements, salivation, urinary problems, shortness of breath, and flu-like symptoms. Report any symptoms to your physician promptly.

Zyprexa may interact with other medications, but most of the potential interactions have not yet been carefully studied.

Alcohol should be avoided by patients taking this drug. Blood pressure medicines may increase the trouble with feeling faint upon standing up (orthostatic hypotension). Activated charcoal pills for gas problems prevent normal absorption of Zyprexa and should be avoided.

Tegretol (carbamazepine) appears to alter normal processing of Zyprexa and may require a physician to make a dosage adjustment. Luvox may also interfere with normal metabolism, but more research is called for to resolve this question.

Many drugs affect liver enzymes that process Zyprexa, but this medicine is still so new that there are few if any reports as of this writing.

Capsaicin (cayenne) inhibits liver enzymes (CYP1A2) and thus slows the metabolism of Zyprexa.

Check with your doctor and pharmacist to make sure Zyprexa is safe in combination with any other drugs you take.

Special Precautions

Some people may be more sensitive to Zyprexa. Those over 65 appear to get higher blood levels from standard doses than younger people. Consequently, older people may require lower doses.

Women and people of Japanese heritage may also achieve higher blood levels than Caucasian men.

Drowsiness and incoordination are significant risks associated with Zyprexa. This drug may impair judgment and motor skills and make driving or operating machinery very hazardous.

Dizziness is a potentially serious side effect during early treatment. It can be especially troublesome when someone gets out of bed or stands suddenly. This complication (orthostatic hypotension) could be dangerous for people with underlying heart disease or cardiovascular problems.

Alcohol, sedatives, or blood pressure medications can make this adverse effect more serious. No one should consume alcoholic beverages while taking Zyprexa.

Anyone with a history or susceptibility to seizures may be at increased risk while taking Zyprexa. Therefore the drug should be used very cautiously, if at all, with such patients.

People with liver disease should only receive Zyprexa under carefully monitored conditions. Periodic liver enzyme tests are essential.

Women should not breast feed while taking Zyprexa. People with glaucoma and men with enlarged prostates should only receive Zyprexa under very careful supervision as the drug may make these problems worse.

A rare, but extremely serious complication of antipsychotic drugs is known as NMS (Neuroleptic Malignant Syndrome). If symptoms such as fever, palpitations, rapid pulse, confusion, muscle rigidity, or sweating occur, it is essential that a physician be contacted immediately. This can be a life-threatening condition. Involuntary muscle movements must also be reported promptly.

Taking the Medicine

Zyprexa is usually administered only once a day and may be taken with or without meals.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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