Olanzapine (Zyprexa®)
Information last updated: February 2020, with selected references up to September 2024 added
Most pregnancies result in healthy babies, but there are chances of complications and unexpected outcomes. These chances are called baseline risks. In Canada, the baseline risk of major birth defects is 3-5%. This means that 3-5 out of 100 babies born in the general population will be born with a major birth defect. There are also baseline risks for miscarriages (15-25 out of 100 pregnancies), premature birth and other outcomes. The information provided will summarize if taking this drug is likely to change these risks.
Summary:
Approximately 4400 pregnancies with exposure to olanzapine in the first trimester of pregnancy were included in published studies that examined the rates of birth defects. Based on this, taking olanzapine during pregnancy is not likely to lead to an increase in major birth defects above the baseline risk. Olanzapine belongs to a family of medications called second-generation antipsychotics (sometimes also referred to as atypical antipsychotics). Some studies reported higher rates of some adverse pregnancy or newborn outcomes when pregnancies exposed to a second-generation antipsychotic medication were compared to unexposed pregnancies. Even if there are increases in the risks, the actual risk to any pregnancy would be small. It is important to note, these adverse outcomes were not found in the better designed studies, where it appears that the increased risks may be explained by other factors, such as additional medications used in pregnancy, or the underlying mental health condition that the medication was given to treat.
If olanzapine is used in late pregnancy, it is suggested to monitor the newborn for withdrawal-like symptoms after birth. If symptoms occur, they are usually short-lived.
To see more details please click on the tabs below. Any decisions concerning olanzapine treatment during pregnancy and lactation should be discussed with a healthcare provider, weighing the benefits of treatment against any possible risks.
Please consult with your health care provider if you are considering stopping or making any changes to your regular medications.
This information about olanzapine is of a general nature and about medical use and does not replace the medical care and advice of your healthcare provider. For questions on dose, timing, side effects, interactions, etc. please consult your healthcare provider. Additionally, please read the patient insert provided with your medication. If you are using olanzapine or other drugs or medications for non-medical reasons or beyond what was recommended by a healthcare provider, please see Harm Reduction section. In case of emergency, please go to the emergency room or call 911.
Although participants in the studies referenced below may have used olanzapine in various combinations, the studies usually do not provide detailed information on drug combinations. This makes it challenging to comment on the safety of using this medication in combination with others during pregnancy or lactation.
Olanzapine (Zyprexa®) is a second-generation antipsychotic. Second-generation antipsychotics are sometimes referred to as atypical antipsychotics. It is used to treat bipolar disorder, depression, schizophrenia, and other mental health conditions.
If the product you are using contains other active ingredients, please check our Exposures A to Z for available information on the ingredient(s).
For more information on treating mental health conditions while pregnant or while providing your breastmilk to an infant, please see Mental Health in Pregnancy and Lactation.
Pronunciation
Please check back. We are in the process of reviewing if there is available information on the pre-pregnancy effects of olanzapine.
Approximately 4400 pregnancies with exposure to olanzapine in the first trimester of pregnancy were included in published studies that examined the rates of birth defects. Based on most available data, it is not likely that taking olanzapine in pregnancy will increase the risk of babies being born with major birth defects beyond the baseline risk. One study reported a link between olanzapine and oral clefts. However, due to the study design, these findings may have occurred by chance and are unlikely to represent a real risk. The baseline risk for oral clefts in Canada is approximately 1 in 700 liveborn infants. If the finding is real, the chance of oral clefts occurring remains low (2 in 700).More studies are needed to investigate this further.
Studies have reported increased risks of miscarriage, prematurity (delivery before 37 weeks), low birth weight, pregnancy related high blood pressure conditions, placenta abruption (when the placenta separates from the wall of the womb before birth) and caesarean section in pregnancies exposed to second-generation antipsychotic medications when compared to an unexposed group of pregnancies which included women both with and without mental health conditions. However, when women who were treated with a second-generation antipsychotic medication during pregnancy were compared only to those who have a mental health condition but were not treated with a second-generation antipsychotic in pregnancy, no increased risks for the adverse outcomes mentioned above were reported. This suggests that the higher risks mentioned above might be associated with the woman’s mental health condition and related factors and not the medication itself. Even if the increased risks are real, they are expected to be small.
Some studies have reported increased risks of gestational diabetes (diabetes that starts in pregnancy) in pregnancies exposed to olanzapine or second-generation antipsychotic medications as a group, while other studies have not. One of the better designed studies, from Ontario, compared over 1,000 pregnancies exposed to second-generation antipsychotic medications to pregnancies in women with a mental health condition who were not treated with a second-generation antipsychotic in pregnancy. They reported no increase in the risk of gestational diabetes in the exposed pregnancies. It is not clear if the increased risk of gestational diabetes reported in some studies is associated with the use of second-generation antipsychotic medications or can be explained by other risk factors such as obesity.
Please check back. We are in the process of reviewing if there is available information on the effects of paternal exposure to olanzapine.
There have been reports of newborns exposed to second-generation antipsychotic medications during the 3rd trimester having withdrawal-like symptoms after birth (e.g., unusual muscle movements, breathing and feeding issues, low blood sugar, agitation, etc.). In most cases, the infants were also exposed to other medications in pregnancy, some of which are known to be associated with such withdrawal-like symptoms after birth. No increased risk of these symptoms was reported in studies that compared infants of women who were treated with a second-generation antipsychotic medication for their condition during pregnancy to infants of women who have a mental health condition but were not treated with a second-generation antipsychotic in pregnancy. This suggests that not only the second-generation antipsychotics, but other factors, such as maternal mental health conditions, other related factors, and/or other medications used in pregnancy, may also play a roll in increasing the risk of such withdrawal symptoms.
It is suggested to let the pregnancy health care provider know if olanzapine is used in late pregnancy so that the baby can be watched for withdrawal-like symptoms after birth. Not every exposed baby will have these symptoms. For those who will, the symptoms usually go away within hours or days and do not require specific treatment. In some cases,longer hospital stays may be needed.
Please check back. We are in the process of reviewing if there is available information on the effects of taking olanzapine while providing your breastmilk to an infant/lactating.
Studies examining neurodevelopment included over 15,000 children exposed to second generation antipsychotics in pregnancy, with over 2500 of them exposed to olanzapine. These studies found no link between exposure to olanzapine, or to second generation antipsychotics as a group, and an increased risk of adverse neurodevelopmental outcomes in the children (e.g., autism spectrum disorders (ASD), attention deficit hyperactivity disorders (ADHD), learning difficulties, and behavioral disorders).
Costs of some medications are covered for eligible people under provincial or national Indigenous drug benefit plans. Please visit the Ontario Drug Benefit (ODB) program Check medication coverage or the Non-Insured Health Benefits (NIHB) program Drug Benefit List to check if olanzapine is covered for you.
Olanzapine, when used not as prescribed, has potential for problematic use.
Medications, if not taken as prescribed, if taken beyond the prescribed amount, or if taken in combination with certain other drugs, may cause harm to you and/or your pregnancy or your nursing child.
If you are using olanzapine or other drugs or medications for non-medical reasons or beyond what was recommended by a healthcare practitioner and you are pregnant, providing your breastmilk to an infant, or parenting please click Harm Reduction for additional information. In case of emergency, please go to the emergency room or call 911.
Using drugs beyond what your clinician prescribes during pregnancy or parenting in a way that harms you or your baby may result in a community member or care provider contacting child protective services.
Pregnancy:
Most of the data on approximately 4400 pregnancies with exposure to olanzapine in the first trimester, does not suggest an increased risk of major birth defects above the baseline risk. One study reported an association between olanzapine and oral clefts. However, this association was not statistically significant in the sensitivity analyses. As well, many comparisons (multiple hypothesis testing) were performed (nearly 400) in this study and therefore this finding may be by chance alone. Based on these limitations this finding is unlikely to represent a real risk. The baseline risk for oral clefts in Canada is approximately 1 in 700 liveborn infants. Even assuming the finding is real, the chance of oral clefts occurring remains low (2 in 700). More studies are needed to investigate this further.
Studies have reported increased risks of miscarriage, prematurity, low birth weight, small for gestational age, pregnancy related hypertensive conditions, placenta abruption and caesarean section in pregnancies exposed to second-generation antipsychotic medications compared to unexposed group of pregnancies which included people both with and without mental health conditions. However, studies reported no increased risk for these outcomes when women exposed to second-generation antipsychotic medication(s) in pregnancy were compared to unexposed women with mental health conditions. This suggests that the reported increased risks may be confounded by the underlying mental health conditions and may not be related to the medication itself.
The data are conflicting on whether exposure to olanzapine or second-generation antipsychotic medications in pregnancy is associated with an increased risk of gestational diabetes. It has been suggested that other risk factors, such as obesity, may be confounding the association.
There have been reports of newborns exposed to second-generation antipsychotic medications during the 3rd trimester having withdrawal-like symptoms after birth (e.g., unusual muscle movements, respiratory and feeding issues, low blood sugar, agitation, etc.). In most cases, the infants were exposed to other medications during pregnancy, some of which are known to be associated with withdrawal symptoms after birth. No increased risk for these outcomes was reported in studies that examined individuals with mental health conditions (in both the exposed and comparison groups) in those exposed compared to those unexposed to second-generation antipsychotic(s) in pregnancy. This suggests that the reported increased risks may be associated with the mental health condition, and/or concomitant medications used during pregnancy and not just with the second-generation antipsychotic use. It is suggested to monitor the newborn for withdrawal-like symptoms if olanzapine is used in late pregnancy. If symptoms occur, they are usually self-limited, resolve within hours or days, and typically do not require specific treatment. In some cases, however, longer hospital stays may be required.
Over 2500 children with prenatal exposure to olanzapine were included in studies on neurodevelopmental outcomes. There were no associations identified between exposure to olanzapine, or to second generation antipsychotics as a group (over 15,000 exposed children), and adverse neurodevelopmental outcomes such as: autism spectrum disorders (ASD), attention deficit hyperactivity disorders (ADHD), learning difficulties, and behavioral disorders.
Lactation:
Please check back. We are in the process of reviewing if there is available information on the effects of taking olanzapine during lactation.
Harm Reduction:
Olanzapine, when used not as prescribed, has potential for problematic use.
If your patient may be using olanzapine or other drugs or medications not as indicated during pregnancy, while providing breastmilk to an infant, or parenting please click Harm Reduction for additional information. In case of emergency, please advise them to go to the emergency room or call 911.
For additional resources see Health Canada Drug and Natural Health Product Monographs, Making Sense of Risk and Statistics.
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Disclaimer
First Exposure does not offer health care treatment. If you have an urgent question about your pregnancy or your baby’s health, you should contact your health care provider directly. If you don’t have a health care provider and you live in Ontario, you have a variety of health care options. In the case of an emergency, visit a hospital emergency room or call 911.