Abilify vs. Zyprexa
See how Abilify and Zyprexa compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Abilify and Zyprexa are both atypical antipsychotics approved for schizophrenia and bipolar I mania, but they differ sharply in weight gain risk and sedation.
Abilify tends to cause less weight gain and sedation, while Zyprexa is more sedating and carries a higher risk of significant weight and metabolic changes.
Both carry the same class boxed warning for increased risk of death in elderly patients with dementia-related psychosis, a use neither drug is approved for.
Abilify vs. Zyprexa Drug Summary
Abilify
Abilify (aripiprazole) is an atypical antipsychotic FDA-approved for schizophrenia, bipolar I disorder, and as an add-on for major depressive disorder. It also has approvals for irritability linked to autism and for Tourette's disorder in children. It's usually taken as a once-daily oral tablet, though monthly injectable forms exist.
Zyprexa
Zyprexa (olanzapine) is an atypical antipsychotic FDA-approved for schizophrenia and bipolar I disorder, including acute mania and long-term maintenance. Combined with fluoxetine, it's also approved for bipolar depression and treatment-resistant depression. It's taken as a once-daily oral tablet, a dissolving tablet, or given by injection for agitation or long-acting maintenance.
Abilify vs. Zyprexa Side Effects
Abilify
Zyprexa
Abilify vs. Zyprexa Dosage
Abilify
Zyprexa
| STAGE | DOSE | WHEN |
| Starting dose | 10-15 mg once daily | At the start |
| Maximum dose | 5.25-15 mg per IM dose | If needed |
| Dose changes | 4 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 5-10 mg once daily | At the start |
| Maximum dose | 2.5-10 mg per IM dose | If needed |
| Dose changes | 4 increases | As tolerated |
Abilify
| STAGE | DOSE | WHEN |
| Starting dose | 10-15 mg once daily | At the start |
| Maximum dose | 5.25-15 mg per IM dose | If needed |
| Dose changes | 4 increases | As tolerated |
Zyprexa
| STAGE | DOSE | WHEN |
| Starting dose | 5-10 mg once daily | At the start |
| Maximum dose | 2.5-10 mg per IM dose | If needed |
| Dose changes | 4 increases | As tolerated |
Abilify vs. Zyprexa Indications
Abilify
Abilify is FDA-approved for schizophrenia, bipolar I disorder, and as an add-on treatment for major depressive disorder. It also carries approvals for irritability in autism spectrum disorder and for Tourette's disorder in children. Off-label, it is sometimes used at low doses for anxiety, though this is not an FDA-approved use.
Schizophrenia in adults and adolescents (13-17)
Bipolar I disorder, manic or mixed episodes
Add-on treatment for major depressive disorder
Irritability linked to autism spectrum disorder (6-17)
Tourette's disorder (6-18)
Zyprexa
Zyprexa is FDA-approved for schizophrenia and bipolar I disorder, including acute mania and long-term maintenance. Combined with fluoxetine, it is also approved for bipolar depression and treatment-resistant depression. Off-label, it is sometimes used to prevent nausea from chemotherapy.
Schizophrenia in adults and adolescents (13-17)
Bipolar I mania, alone or with lithium/valproate
Maintenance treatment of bipolar I disorder
Bipolar depression and treatment-resistant depression (with fluoxetine)
Acute agitation in schizophrenia or bipolar mania
Abilify vs. Zyprexa Pros and Cons
Abilify
Abilify's partial-agonist mechanism generally causes less weight gain and sedation than older-style atypical antipsychotics. It has broader approvals across depression augmentation, autism-related irritability, and tics, but lacks Zyprexa's combination option for treatment-resistant depression.
Pros
Lower risk of significant weight gain than Zyprexa
Less sedating, easier for daytime alertness
FDA-approved for autism-related irritability and Tourette's disorder
Long-acting injectable doesn't require in-office monitoring period
Cons
Akathisia (restlessness) is a common early side effect
Not approved for bipolar depression or treatment-resistant depression
May cause nausea or insomnia during the first weeks
Less useful than Zyprexa for immediate sedation in severe agitation
Zyprexa
Zyprexa is one of the most established atypical antipsychotics, with a long track record and a uniquely broad set of mood-disorder approvals through its fluoxetine combination. Its sedating effect can help with acute agitation, but it comes with a substantially higher risk of weight gain and metabolic problems.
Pros
FDA-approved for bipolar depression and treatment-resistant depression with fluoxetine
More sedating, which can help with acute agitation or insomnia
Long track record with extensive real-world safety data
Available as a tablet, dissolving tablet, and injection for agitation
Cons
Higher risk of significant weight gain and metabolic changes than Abilify
More sedating, which can impair daytime alertness
Long-acting injection requires a monitored 3-hour observation period
Not approved for autism-related irritability or Tourette's disorder
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