As with all neuroleptic drugs, olanzapine can cause tardive dyskinesia and rare, but life-threatening, neuroleptic malignant syndrome.
Other recognised side effects may include:
- akathisia inability to remain still
- dry mouth
- urinary retention
- orthostatic hypotension
- weight gain (90% of users experience weight gain ) (see below)
- increased appetite
- runny nose
- low blood pressure
- impaired judgment, thinking, and motor skills
- impaired spatial orientation
- impaired responses to senses
- trouble swallowing
- dental problems and discoloration of teeth
- missed periods
- problems with keeping body temperature regulated
- apathy, lack of emotion
- Endocrine side effects have included hyperprolactinemia, hyperglycemia, and diabetes mellitus
- Hyperprolactinemia causing sexual dysfunction, menstrual irregularities, and osteoporosis
The Food and Drug Administration requires all atypical antipsychotics to include a warning about the risk of developing hyperglycemia and diabetes, both of which are factors in the metabolic syndrome. These effects may be related to the drugs' ability to induce weight gain, although there are some reports of metabolic changes in the absence of weight gain. Of all the atypical antipsychotics, olanzapine is one of the most likely to induce weight gain based on various measures. The effect is not dose dependent. Olanzapine may directly affect adipocyte function, promoting fat deposition. There are some case reports of olanzapine-induced diabetic ketoacidosis. Olanzapine may decrease insulin sensitivity though one 3-week study seems to refute this. It may also increase triglyceride levels. One small, open-label, non-randomized study suggest that taking olanzapine by orally dissolving tablets may induce less weight gain, but this has not been substantiated in a blinded experimental setting.
In a placebo-compared study of six Macaque monkeys receiving olanzapine between 17 and 27 months, a significant brain volume and weight decreases (8-11%) were detected. In latter studies of the stored samples, the changes were attributed to astrocyte and oligodendrocyte loss, with the neurons spared but positioned more closely compared to the controls.
However according to this study the neurons does not seem to be completeley spared. The gray matter shrinking found was 14.6%, but the neuron density increase was only 10.2% which corresponds to approximately a loss of 5% of the neurons.
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