Seroquel vs. Zyprexa
See how Seroquel and Zyprexa compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Both Seroquel and Zyprexa are atypical antipsychotics approved for schizophrenia and bipolar I mania, and both carry a boxed warning against use in older adults with dementia-related psychosis.
Seroquel is taken once or twice daily and is FDA-approved by itself for bipolar depression, while Zyprexa is usually once daily and needs added fluoxetine to treat depression.
In trials, Zyprexa caused more sedation, weight gain, and akathisia, while Seroquel required a slower dose increase to avoid dizziness and low blood pressure.
Seroquel vs. Zyprexa Drug Summary
Seroquel
Seroquel (quetiapine) is an atypical antipsychotic used to treat schizophrenia, bipolar I mania, and bipolar depression, and it is used as an add-on for treatment-resistant depression. It comes as an oral tablet, usually started twice a day and raised gradually over the first several days to a target dose.
Zyprexa
Zyprexa (olanzapine) is an atypical antipsychotic used to treat schizophrenia and bipolar I disorder, including acute mania and maintenance treatment. It is taken as a tablet once daily, and a short-acting injection is available in the hospital for acute agitation.
Seroquel vs. Zyprexa Side Effects
Seroquel
Zyprexa
Seroquel vs. Zyprexa Dosage
Seroquel
Zyprexa
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg twice daily | Day 1 |
| Maximum dose | 300 mg once daily | If needed |
| Dose changes | 5 increases | Every 3 days |
| 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 |
Seroquel
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg twice daily | Day 1 |
| Maximum dose | 300 mg once daily | If needed |
| Dose changes | 5 increases | Every 3 days |
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 |
Seroquel vs. Zyprexa Indications
Seroquel
Seroquel is FDA-approved for schizophrenia in adults and adolescents 13 and older, and for bipolar I mania, either alone or combined with lithium or valproate. It is also approved by itself for depressive episodes of bipolar disorder, and it is used off-label as an add-on for hard-to-treat major depression.
Schizophrenia (adults and adolescents 13-17)
Bipolar I mania, alone or with lithium/valproate
Bipolar depression, as a standalone treatment
Maintenance treatment of bipolar I disorder
Off-label: adjunct for treatment-resistant depression
Zyprexa
Zyprexa is FDA-approved for schizophrenia in adults and adolescents 13 to 17, and for bipolar I mania, either alone or combined with lithium or valproate. It also treats acute agitation tied to those conditions, and when paired with fluoxetine, it treats bipolar depression and treatment-resistant depression.
Schizophrenia (adults and adolescents 13-17)
Bipolar I mania, alone or with lithium/valproate
Maintenance treatment of bipolar I disorder
Acute agitation, short-acting injection
With fluoxetine: bipolar and resistant depression
Seroquel vs. Zyprexa Pros and Cons
Seroquel
Quetiapine's sedating effect can help patients whose insomnia or anxiety complicates their psychiatric symptoms, and it is FDA-approved on its own for bipolar depression, unlike olanzapine. As a decades-old generic, it is usually inexpensive, though it still carries the same class-wide metabolic warnings as other atypical antipsychotics.
Pros
FDA-approved alone for bipolar depression, no second drug needed
Roughly $10 to $150 a month for generic quetiapine, before insurance
Sedating effect can help co-occurring insomnia or anxiety
Lower reported rate of akathisia than olanzapine
Cons
Multi-day dose titration needed to limit dizziness and low blood pressure
Often dosed twice a day during initial treatment
Sedation and dry mouth are among its most common side effects
Zyprexa
Olanzapine has one of the longest track records among atypical antipsychotics and offers a rapid-acting injection for acute agitation in the hospital. Its once-daily maintenance dosing is simple, but it carries a stronger metabolic burden and a higher brand list price than generic quetiapine.
Pros
Simple once-daily dosing once a maintenance dose is set
Short-acting IM injection available for acute agitation
Long-acting injectable option (Relprevv) exists for extended dosing intervals
Decades of real-world use since its 1996 approval
Cons
Higher rates of weight gain and sedation than many atypical antipsychotics
Akathisia reported more often than with quetiapine
Roughly $440 to $900 a month without insurance, well above generic quetiapine
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