Risperdal vs. Zyprexa

See how Risperdal and Zyprexa compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Risperdal and Zyprexa are both atypical antipsychotics used for schizophrenia and bipolar mania, but they differ in side effect profiles, dosing forms, and typical cost.

  • Zyprexa has broader FDA approval, including bipolar depression and treatment-resistant depression when combined with fluoxetine, plus an injectable option for acute agitation.

  • Risperdal is generally less expensive and causes fewer metabolic effects, while Zyprexa causes more sedation and a higher risk of weight gain.

Risperdal vs. Zyprexa Drug Summary

Risperdal

Risperdal (risperidone) is an atypical antipsychotic used to treat schizophrenia, bipolar mania, and irritability linked to autistic disorder in children. It comes as a tablet, orally disintegrating tablet, or oral solution, usually taken once or twice daily starting at a low dose.

Zyprexa

Zyprexa (olanzapine) is an atypical antipsychotic used for schizophrenia, bipolar mania, and long-term maintenance of bipolar disorder, and it can be paired with fluoxetine for depression. It comes as a tablet, orally disintegrating tablet, or injection, including a long-acting monthly shot called Relprevv.

Risperdal vs. Zyprexa Side Effects

Risperdal

Most common
somnolence (up to 25%)
dizziness (up to 14%)
insomnia (up to 32%)
parkinsonism (up to 17%)

Zyprexa

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

Risperdal vs. Zyprexa Dosage

Risperdal

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2 mg once daily Day 1
Maximum dose 4 mg to 8 mg daily If needed
Dose changes 1 increase 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

Risperdal vs. Zyprexa Indications

Risperdal

Risperdal is FDA-approved for schizophrenia in adults and teens, acute manic or mixed episodes of bipolar I disorder, and irritability tied to autistic disorder in children. It is sometimes used off-label for tic disorders or as an add-on for treatment-resistant OCD.

  • Schizophrenia (adults and adolescents 13-17)

  • Bipolar I mania, alone or with lithium/valproate

  • Irritability in autistic disorder (children/adolescents)

  • Off-label: tic disorders, OCD augmentation

Zyprexa

Zyprexa is FDA-approved for schizophrenia, bipolar I mania, and long-term maintenance of bipolar disorder, plus acute agitation in either condition. Combined with fluoxetine, it also treats bipolar depression and treatment-resistant depression.

  • Schizophrenia (adults and adolescents 13-17)

  • Bipolar I mania, alone or with lithium/valproate

  • Acute agitation (oral or IM)

  • With fluoxetine: bipolar depression, treatment-resistant depression

Risperdal vs. Zyprexa Pros and Cons

Risperdal

Risperdal has a long track record dating back to 1993 and comes in a liquid form for flexible dosing. It is generally less expensive than Zyprexa but carries a higher risk of movement-related side effects like parkinsonism and akathisia.

Pros

  • Oral solution option for flexible dosing

  • FDA-approved specifically for pediatric autism irritability

  • Long safety track record since 1993

  • Roughly $185 to $625 per month without insurance, less than Zyprexa

Cons

  • Higher rates of parkinsonism and akathisia than Zyprexa

  • No FDA-approved injectable option for acute agitation

  • Not approved for bipolar depression or treatment-resistant depression

Zyprexa

Zyprexa has broader FDA approval, including bipolar depression and treatment-resistant depression when paired with fluoxetine, and it offers both short-acting and long-acting injectable forms. It costs more than Risperdal and carries a higher risk of weight gain and sedation.

Pros

  • Broader FDA-approved indication list, including bipolar depression

  • Available as short-acting and long-acting (Relprevv) injections

  • IM option specifically for acute agitation

  • Off-label option for chemotherapy-induced nausea and vomiting

Cons

  • Higher risk of significant weight gain

  • More sedation, affecting up to 52% of patients

  • Relprevv requires 3-hour monitored observation after each dose

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