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
Zyprexa
Risperdal vs. Zyprexa Dosage
Risperdal
Zyprexa
| 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 |
| 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
| 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
| 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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