Seroquel vs Zyprexa

Introduction

Seroquel (quetiapine) and Zyprexa (olanzapine) are both second-generation atypical antipsychotic medications and are one of the most common drugs prescribed for the treatment of psychiatric disorders such as schizophrenia, bipolar disorder, and other psychiatric conditions.

According to research, these psychiatric disorders are caused by a failure in the nervous system, causing a problem in communication between the nerves (neurotransmission) [¹]. This is primarily because of the secretions of neurotransmitters, "chemical messengers," that help pass information from one nerve to another.

For people suffering from such psychiatric conditions, these medicines can affect the hormone secretions in the brain to regulate mood, behavior, and cognitive abilities. The two antipsychotic medications work by inhibiting specific “chemical messengers” that may cause symptoms such as hallucinations, delusions, and disordered thinking. Seroquel blocks the action of histamine, which is responsible for sedation and drowsiness. Zyprexa binds to the dopamine receptor to reduce symptoms of schizophrenia.

While these drugs share many similarities, some important differences can affect which medication best suits a patient.

About Seroquel and Zyprexa

What is Seroquel?

Quetiapine (the generic name for Seroquel) is an antipsychotic medicine that alters chemical reactions in the brain, especially those that involve dopamine and serotonin. Seroquel is a prescription medication for mental health conditions like schizophrenia, bipolar disorder, and major depressive disorder. Seroquel received FDA approval for treating psychiatric disorders in 1997 [2].

The medication works by “tipping the balance scale” of chemicals (neurotransmitters) in the brain back to normal. This helps to restore normal brain function and improve concentration, sleep, appetite, and mood.

What Conditions are Seroquel Approved to Treat?

The FDA approves Seroquel for the treatment of several mental disorders [³], including:

Schizophrenia in patients over the age of 13
Bipolar disorders (depressive and manic episodes) in adults and children aged 10-17,
Depression

How Does Seroquel Work for Psychiatric Disorders?

Seroquel can improve the positive and negative symptoms of schizophrenia by acting on neurotransmitter receptors. In simple terms, Seroquel blocks signals of the “chemical messengers” from reaching the mobile phone of the nerve cells. It works to treat schizophrenia through an antagonistic action (blocking) of the dopamine type 2 (D2) and serotonin 2A (5HT2A) receptors [⁴]. The activation of the D2 receptor is primarily responsible for hallucinations and delusions in schizophrenia patients [⁵], and by blocking the receptor, Seroquel effectively prevents its activation. Similarly, serotonin is responsible for depressive and manic episodes in schizophrenia [⁶].

In bipolar patients, Seroquel improves symptoms by binding to the metabolite of the norepinephrine transporter (NET). Research suggests that high levels of NET can increase depressive and manic episodes in bipolar [⁷].

What is Zyprexa?

Olanzapine (the generic name for Zyprexa) is an antipsychotic medicine that works to alter chemical reactions in the brain to improve mood and other symptoms associated with psychiatric disorders. Zyprexa is also used in combination with Prozac to treat depression. Zyprexa is a prescription medication that first received FDA approval for treating psychiatric disorders in 2004 [⁸].

What Conditions is Zyprexa Approved to Treat?

The FDA approves Zyprexa for different mental disorders [⁹], including:

Schizophrenia in patients over the age of 13
Bipolar disorder (including depressive and manic episodes) in adults
Depression does not get better with two other medicines.

How Does Zyprexa Work for Psychiatric Disorders?

Like Seroquel, Zyprexa works through an antagonistic (blocking) effect on different hormone receptors in the brain. The receptors that Zyprexa works on include the dopamine receptors D1, D2, D2, and D4, as well as the serotonin receptors 5HT2A, 5HT2C, 5HT3, and 5HT6 [¹⁰].

The binding of Zyprexa on the D2 receptors helps reduce hallucination, delusions, and disordered thought in schizophrenic patients, and its affinity (ability to bind) towards the serotonin receptors helps prevent the onset of anhedonia (inability to feel pleasure), depression, and mood disorders [¹¹].

Unlike other antipsychotic drugs, Zyprexa binding to the dopamine receptors is easily dissociable (can unbind), allowing some dopamine reactivity with the receptor to ensure a balance of functions and reduce side effects [¹²].

Effectiveness

How Effective are Seroquel and Zyprexa for Treating Psychiatric Disorders?

Seroquel and Zyprexa have established a long history of effectiveness in treating psychiatric disorders, especially schizophrenia and bipolar disorder.

A 2004 study to determine the effectiveness of Seroquel against species of schizophrenic symptoms combined data from three randomized trials and concluded that Seroquel is effective in treating a wide range of schizophrenia symptoms, including positive, negative, and depressive symptoms. Furthermore, the medication reduces patient agitation, aggression, and hostility [¹³].

Another 2016 study found that Seroquel effectively treated Generalized Anxiety Disorder (GAD). The study evaluated 2,248 GAD patients and concluded that Seroquel effectively improved GAD symptoms in adult patients [¹⁴].

A 2014 study compared the efficacy of Zyprexa with Risperidone in over 60 female schizophrenic patients in a 12-week clinical trial. The study concluded that Zyprexa and risperidone were equally effective in improving schizophrenia symptoms. Zyprexa showed better efficacy in reducing the negative symptoms associated with schizophrenia and had reduced side effects [¹⁵].

Another 2019 study analyzed and reviewed previous studies on Zyprexa to conclude that previous literature showed that Zyprexa was highly effective in treating psychotic disorders compared to other first and second-generation antipsychotic medications and had lower side effects such as weight gain [¹⁶].

Dosage Information

How is Seroquel Administered for Psychiatric Disorders?

Researchers conducted numerous clinical trials to assess the safety and effective dosage and administration of Seroquel and Zyprexa for psychiatric disorder patients. Seroquel is available in tablet form and administered orally. The different strengths of Seroquel include the following:

25 mg tablets that are peach and round
50 mg tablets that are white and round
100 mg tablets that are yellow and round
200 mg tablets that are white and round
300 mg tablets that are white and capsule-shaped
400 mg tablets that are yellow and capsule-shaped

How is Zyprexa Administered for Psychiatric Disorders?

Zyprexa tablets are available in different strengths as tablets for oral consumption. These strengths include the following:

2.5 mg tablets
5.0 mg tablets
7.5 mg tablets
10 mg tablets
15 mg tablets
20 mg tablets

Zyprexa tablets 2.5 mg to 10 mg are white and round, while 15 and 20 mg are blue and pink, respectively.

Side Effects

What are the Most Common Side Effects of Seroquel?

The most common side effects of Seroquel include the following:

Constipation
Fatigue
Weight gain
Blurred Vision
Dizziness
Nausea/vomiting
Dry mouth
Stomach pain
Increase in appetite
Irritability
Numbness of arms or legs
Irregular or missing menstrual periods in females
Breast enlargement in males
Decreased libido

Are There Any Potential Serious Side Effects of Seroquel?

If you experience any of these serious side effects, seek medical help immediately:

Fainting
Seizures
Fever
Muscle pain or weakness
Sweating
Irregular heartbeat and palpitations
Bleeding or bruising
Painful urination
Hives, rashes, or blisters
Difficulty breathing or swallowing
Painful erection of the penis

What are the Most Common Side Effects of Zyprexa?

The most common side effects of Zyprexa include:

Low blood pressure
Fatigue
Dry mouth
Increased appetite
Shakes
Constipation and digestive problems
Dizziness
Unexplained weight gain
Headache
Abdominal pain
Pain in muscles or joints

Are There Any Potential Serious Side Effects of Zyprexa?

If you experience any of these serious side effects, seek medical help immediately:

Stroke
Trouble speaking
Numbness
Fever
Rash
Swollen Throat
Painful urination
Blurry vision
Excessive sweating
Trouble breathing
Uncontrolled movement or twitching
fainting

Contraindications and Interactions

Warnings and General Precautions for Seroquel and Zyprexa

Some general warnings and precautions for Seroquel and Zyprexa include:

The increased mortality rate in elderly (above 65) with dementia-related disorders due to cerebrovascular adverse reactions such as stroke
May cause suicidal thoughts in adolescents and young adults
May cause Neuroleptic Malignant Syndrome (NMS)
It may cause metabolic changes such as Diabetes and weight gain.
It may cause irreversible dyskinetic movements (tardive dyskinesia), especially in the elderly.
May cause increased blood pressure in children
May cause agranulocytosis (low white blood cells)

Contraindications and Important interactions for Seroquel and Zyprexa

Contraindications

Seroquel

Could cause hypersensitivity (allergic reactions)

Could cause anaphylactic reactions in some patients

Patients with Diabetes, hyperglycemia, and low blood pressure must be extra careful when taking Seroquel

Zyprexa

Could cause hypersensitivity (allergic reactions)

Could cause anaphylactic reactions in some patients

Patients with Diabetes, hyperglycemia, and low blood pressure must be extra careful when taking Zyprexa

Drug/Medication Interactions

Seroquel

Anti-arrhythmic drugs amiodarone, moxifloxacin, sotalol, and others affect heart rhythm, primarily QT prolongation
Azole antifungals
Antipsychotic drugs such as ziprasidone and thioridazine
Gatifloxacin and Moxifloxacin
Pentamidine
Methadone

Zyprexa

Metoclopramide
Aripiprazole
Klonopin
lorazepam
Clonazepam
Fluoxetine

Food/Beverage/Supplement Interactions

Seroquel

Avoid mixing alcohol with Seroquel, as it can increase the risk of side effects.

Avoid grapefruit as it can increase side effects such as weight gain.

Avoid ST. John’s wort (an herbal supplement) as it could lower the efficacy of Seroquel

Zyprexa

Do not combine Zyprexa with alcohol, which could increase dizziness and other side effects.

Grapefruit could lower the efficacy of Zyprexa.

Avoid tobacco use when taking Zyprexa

Cost Comparison

How Much do Seroquel and Zyprexa Cost?

Both Seroquel and Zyprexa have low-cost generic options available. 100 tablets of 25 mg Seroquel can cost around $418.60 without insurance, which means $4.19 per tablet. According to the National Institute of Health Science, a schizophrenia patient might need to take the medication for several years, and a bipolar I patient might need it for several months [¹⁷]. That means that a once-a-day dosage, a patient will spend around $1500 a year.

30 tablets of 10 mg Zyprexa cost around $759.13, which means $25.30 per tablet. According to the National Insitute of Health Science, some patients may need to take the medication for several years [¹⁸]. On a once-a-day dosage, a patient will spend around $9236 a year.

Popularity of Seroquel and Zyprexa

Seroquel has become a popular choice for treatment among patients suffering from psychiatric disorders. The number of prescriptions for Seroquel exceed 10 million, while the estimated number of patients in the United States is around two million [¹⁹].

Similarly, Zyprexa is widely used by patients due to its effectiveness and lower side effects. There are more than three million prescriptions for Zyprexa in the United States, with more than 600,000 patients [²⁰].

Conclusion

Seroquel and Zyprexa are both effective antipsychotic medications that can treat various psychiatric conditions. While they share many similarities regarding the mechanism of action and indications, they also have important differences in side effect profiles and dosing.

Ultimately, the choice of which medication to use will depend on the specific needs of the patient and the judgment of their treating physician. It is important to carefully weigh the risks and benefits of each medication before deciding.