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Drug vs. Drug

Vraylar vs. Zyprexa: Differences, similarities & side effects

Compare Vraylar to Zyprexa for the treatment of schizophrenia, bipolar depression, and other mental health conditions
Karen Berger medical writer and reviewer headshot
By | Sep. 10, 2024
A capsule and a round tablet with "vs" between them: Vraylar vs. Zyprexa: Differences, similarities & side effects

Key takeaways

  • Vraylar and Zyprexa are second-generation antipsychotics used to treat schizophrenia, bipolar disorder, and other mental health conditions.

  • Vraylar costs approximately $1,996 per month out-of-pocket, while brand-name Zyprexa costs about $573. Generic olanzapine can be as low as $12 with a SingleCare coupon.

  • Common side effects of Vraylar include headache, insomnia, and extrapyramidal symptoms (EPS). Zyprexa commonly causes decreased energy, dry mouth, increased hunger, sleepiness, and dizziness. Both medications may lead to weight gain and metabolic changes.

  • Consult your healthcare provider for personalized medical advice and to determine the most suitable treatment.

In this article:

Antipsychotic medications treat conditions related to psychosis—a group of symptoms involving a disconnection from reality. Antipsychotic drugs can treat schizophrenia, bipolar disorder, and other mental health conditions. There are two main types of antipsychotics: typical (first generation) and atypical (second generation). Since atypical antipsychotics have fewer side effects than typical antipsychotics, they’re the preferred drugs for treating psychosis. 

Vraylar (cariprazine) and Zyprexa (olanzapine) are two brand-name atypical antipsychotics that are used in the treatment of schizophrenia and bipolar depression. As members of the same class of drugs, they both work by regulating levels of the neurotransmitters (chemical messengers), dopamine and serotonin, in the brain. Read on to learn more about the similarities and differences between Vraylar and Zyprexa.

Vraylar vs. Zyprexa: Key differences

Vraylar is a brand-name drug, while Zyprexa is available in both brand name and generic as olanzapine. Vraylar is FDA-approved for use in adults only. Zyprexa can be used in adults as well as adolescents, depending on the use. 

Compare Vraylar vs. Zyprexa key differences
Vraylar Zyprexa
Drug class Second-generation antipsychotic; atypical antipsychotic Second-generation antipsychotic; atypical antipsychotic
Brand/generic status Brand Brand and generic 
What is the generic name? The active ingredient is cariprazine, but there is no generic available Olanzapine 
What form(s) does the drug come in? Oral capsules: 1.5 mg, 3 mg, 4.5 mg, and 6 mg Oral tablets (Zyprexa): 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, and 20 mg

Orally disintegrating tablets (Zyprexa Zydis): 5 mg, 10 mg, 15 mg, and 20 mg

Injection (Zyprexa Relprevv)
What is the standard dosage? Varies by indication; Generally, the dose ranges from 1.5 to 3 mg or 6 mg by mouth once daily Varies by indication; A typical dose is 5 to 20 mg by mouth once daily
How long is the typical treatment? Long-term Long-term
Who typically uses the medication? Adults  Adults 

Adolescents (for some uses)

Vraylar vs. Zyprexa: Conditions treated

Vraylar and Zyprexa are approved by the Food and Drug Administration (FDA) to treat schizophrenia and as an acute treatment of manic or mixed episodes associated with bipolar I disorder. Vraylar can also be used as a standalone treatment for bipolar depression, while Zyprexa can be used for bipolar depression only when used with fluoxetine, in a combination medicine called Symbyax. The table below provides more information about the FDA-approved uses for each drug.

Compare Vraylar vs. Zyprexa conditions treated
Condition Vraylar Zyprexa
Schizophrenia Yes (adults) Yes (adults and adolescents)
Acute treatment of manic episodes or mixed episodes associated with bipolar I disorder Yes (adults) Yes (adults and adolescents), can be used alone or in combination with a mood stabilizer such as valproate or lithium
Maintenance treatment of bipolar I disorder No  Yes (adults and adolescents)
Depressive episodes associated with bipolar I disorder (bipolar depression) Yes (adults) Yes (when used as a combination medicine called Symbyax that contains both olanzapine and fluoxetine)
Add-on medication to antidepressants such as Prozac (fluoxetine) to treat depression Yes (adults) Yes (Symbyax)
Acute agitation associated with schizophrenia or bipolar I mania No  Yes (injection only)

 

Is Zyprexa better than Vraylar?

There are no clinical trials directly comparing Vraylar and Zyprexa. A meta-analysis (review of many studies) published in The Lancet examined 32 antipsychotic medications for the treatment of schizophrenia, although not all medications studied are available in the United States. Key findings related to Zyprexa (olanzapine) include how effective it is in reducing overall symptoms compared to many other drugs, particularly in improving depressive symptoms and social functioning. However, olanzapine was also noted for causing significantly more weight gain and elevated prolactin levels compared to most other medications, and it carried a higher risk of extrapyramidal symptoms (EPS) compared to placebo (inactive medicine). 

The study did not report specific findings for Vraylar compared to other antipsychotic medications.

Only your healthcare provider can determine the best treatment based on multiple individual factors such as your medical conditions, medical and family history, and other considerations.

Vraylar vs. Zyprexa: Insurance coverage and cost comparison

Most commercial health insurance plans and Medicare prescription plans cover Vraylar. Since Zyprexa is available as generic olanzapine, insurance plans generally cover the generic version instead of brand-name Zyprexa or charge a higher copay. Contact your insurance plan for information on the most recent pricing estimates for both medicines.

For individuals who pay out of pocket, without insurance, a one-month supply of Vraylar costs about $1,996. However, you can use a free SingleCare coupon to pay $1,298 per month. 

The out-of-pocket cost of a one-month supply of brand-name Zyprexa is about $573. However, using a free SingleCare coupon and choosing generic olanzapine can decrease the price to as low as $12.

Compare Vraylar vs. Zyprexa cost & coverage
Vraylar Zyprexa
Typically covered by insurance? Yes  Yes (generic)
Typically covered by Medicare Part D? Yes  Yes (generic)
Quantity 30, 1.5 mg capsules 30, 5 mg tablets
SingleCare cost $1,298 $12

 

Vraylar vs. Zyprexa side effects

Common side effects of Vraylar include headache, insomnia (trouble sleeping), and movement problems called extrapyramidal symptoms (EPS).

Common Zyprexa side effects in adults include decreased energy, dry mouth, increased hunger, sleepiness, shaking, constipation, dizziness, restlessness, and changes in behavior. Additional common side effects in pediatric patients 13-17 years old include headache, stomach pain, arm and leg pain, and tiredness. Pediatric patients experience more sleepiness than adults and greater increases in prolactin levels and liver enzymes.

In rare cases, an allergic reaction may occur. People with symptoms of hives, difficulty breathing, or swelling of the face, lips, tongue, or throat should get emergency medical help. 

Zyprexa is also associated with a condition called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), which can cause death. If you have symptoms of rash, fever, or swollen glands, get emergency medical help.

The table below provides more information about side effects. Note that the frequency is a range, which can vary by factors such as dose and indication for use. This is not a full list of adverse effects, and others may occur. Consult your healthcare provider or pharmacist for more information and a full list of side effects.

Compare Vraylar vs. Zyprexa side effects
Vraylar Zyprexa
Side effect Applicable? Frequency Applicable? Frequency
Headache  Yes  9–18% Yes  17%
Insomnia Yes  11–13% Yes  12%
EPS Yes  15–20% Yes  10–32%
Dry mouth  Yes  1–3% Yes  6%
Increased appetite  Yes  3–5% Yes  3–24%
Nausea  Yes  5–8% Yes  2-9%
Vomiting  Yes  4–5% Yes  4%
Drowsiness  Yes  5–10% Yes  Varies; Up to 52% in people who also took lithium or valproate
Dizziness  Yes  3–5% Yes  7–18%
Constipation  Yes  6–10% Yes  4–11%
Source: Vraylar (DailyMed), Zyprexa (DailyMed)

Vraylar and Zyprexa drug interactions

Before taking Vraylar or Zyprexa, tell your healthcare provider about all the medications you take, including prescription drugs, over-the-counter medications, vitamins, and supplements. Some drug combinations should be avoided, while others may require a dosage change. You should avoid alcohol while taking Vraylar or Zyprexa. Consult your healthcare provider about drug interactions and how they affect you. 

 

Compare Vraylar vs. Zyprexa drug interactions
Drug Drug class Interacts with Vraylar? Interacts with Zyprexa?
Clarithromycin 

Ketoconazole

Ritonavir

Voriconazole 

 Strong CYP3A4 inhibitors Yes  No 
Diltiazem 

Erythromycin 

Verapamil 

 Moderate CYP3A4 inhibitors  Yes  Yes 
Carbamazepine

Phenytoin 

Rifampin 

St. John’s wort

 Strong CYP3A4 inducers  Yes  Yes 
Bosentan 

Modafinil 

Nafcillin 

 Moderate CYP3A4 inducers Yes  No 
Fluvoxamine SSRI antidepressant Yes  Yes 
Benztropine

Diphenhydramine

 Anticholinergic drugs  Yes  Yes 
Atenolol 

Lisinopril 

Valsartan 

 Medications that lower blood pressure  Yes  Yes 
Alcohol

Anxiety medicines

Muscle relaxants

Opioid pain medicines 

Seizure medicines

Sleeping medicines

 Drugs that cause central nervous system depression Yes  Yes 

Vraylar and Zyprexa drug warnings

Before taking Vraylar or Zyprexa, tell your healthcare provider about any medical conditions you have, including if you are pregnant, planning to become pregnant, or breastfeeding.

Both Vraylar and Zyprexa have a black box warning listed in the prescribing information. A black box warning is the most serious warning required by the FDA. This warning states that:

  • Older adults with dementia-related psychosis who take an antipsychotic medicine have a higher risk of death and should not take Vraylar or Zyprexa.
  • Antidepressants can increase the risk of suicidal thoughts and behaviors, especially in children and young adults. Patients of any age who take Vraylar (or olanzapine in combination with fluoxetine or another antidepressant) should be closely monitored for changes in mood and behavior or suicidal thoughts and behaviors.

Other warnings for both drugs include:

  • Neuroleptic malignant syndrome (NMS) is a rare and serious condition that has been reported with antipsychotic medications and can cause death. Symptoms may include stiff muscles, very high fever, delirium, and kidney failure. Get emergency medical help if you have any of these symptoms.
  • Vraylar and Zyprexa can cause tardive dyskinesia, a type of EPS that causes repetitive, involuntary movements like grimacing, blinking, and lip-smacking.  
  • Vraylar and Zyprexa can cause metabolic changes, such as weight gain, high blood sugar (diabetes), and high cholesterol. 
  • Patients who take Vraylar or Zyprexa will have blood cell counts monitored. 
  • Vraylar and Zyprexa can cause orthostatic hypotension (a drop in blood pressure when standing up) and fainting. Because Vraylar or Zyprexa can cause these effects, as well as extreme drowsiness, sedation, and incoordination, individuals who take these medicines may be at higher risk for falls and fractures. People who take Vraylar or Zyprexa should avoid consuming alcohol and should not drive or operate machinery until they know how the medication affects them, as these drugs can cause cognitive and motor impairment.  
  • Vraylar and Zyprexa should be used cautiously in people with a history of seizures.
  • Vraylar and Zyprexa may cause you to be more sensitive to very hot temperatures. To avoid becoming too hot or dehydrated, drink plenty of fluids, especially when exercising and in the heat.