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

Most common
akathisia (up to 20%)
dizziness (up to 15%)
headache (up to 27%)
insomnia (up to 20%)

Zyprexa

Most common
akathisia (up to 27%)
dizziness (up to 18%)
somnolence (up to 52%)
weight gain (up to 10%)

Abilify vs. Zyprexa Dosage

Abilify

Dosage
Dosage Table
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

Dosage
Dosage Table
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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