From the Guidelines
Taking Abilify 30 mg and Zyprexa 5 mg together is not recommended due to the increased risk of side effects, including sedation, metabolic effects, movement disorders, and cardiovascular effects, and should only be considered under direct medical supervision. These medications are both antipsychotics that work in similar ways, and combining them may not provide additional therapeutic benefit. According to a recent study 1, antipsychotic monotherapy is generally preferred, as it incurs less health service costs and gives a lower overall risk for adverse effects. The study also suggests that medication adherence may be better with monotherapies, as the patient needs to remember to take only one antipsychotic.
Some key considerations when taking these medications together include:
- Increased sedation and risk of oversedation, particularly when combined with benzodiazepines 1
- Metabolic effects, such as weight gain and blood sugar changes, which can be exacerbated by the combination of these medications
- Movement disorders, such as extrapyramidal symptoms (EPS), which can be increased with the use of multiple antipsychotics
- Cardiovascular effects, including changes in blood pressure and heart rate, which can be affected by the combination of these medications
If you're currently taking both medications or considering this combination, it's essential to consult with your psychiatrist immediately. In some specific clinical situations, psychiatrists may temporarily prescribe both medications during a transition period when switching from one to the other, or in treatment-resistant cases, but this requires careful monitoring of side effects, regular blood work, and close follow-up. Never adjust these medications on your own, as proper dosing and monitoring are critical for both safety and effectiveness. Additionally, pharmacogenetic testing may be considered to determine the best treatment approach and minimize the risk of adverse effects 1.
From the Research
Safety of Combining Abilify and Zyprexa
- The safety of taking Abilify 30 mg and Zyprexa 5 mg together has been evaluated in several studies 2, 3, 4, 5, 6.
- A study published in 2021 found that aripiprazole (Abilify) and olanzapine (Zyprexa) can induce metabolic changes, but the metabolic side effects produced by aripiprazole are more benign 2.
- Another study published in 2009 found that olanzapine-treated patients had significantly greater improvement in symptom efficacy at 28 weeks, as well as significantly greater mean increases in weight and glucose, and significantly greater worsening on lipids parameters compared to aripiprazole-treated patients 3.
- A 2023 study found that olanzapine treatment showed better continuation rates at 26 and 52 weeks after hospital discharge than aripiprazole, whereas maintenance with the two antipsychotics did not differ significantly at 104 weeks, due to reduced tolerability of long-term olanzapine treatment 4.
- A 2021 study found that aripiprazole decreased diastolic blood pressure and QTc, while olanzapine had a systolic and diastolic blood pressure, heart rate, and QTc lowering effect, and that polymorphisms in certain genes were significantly associated with these changes 5.
- A 2019 study found that all three antipsychotics (aripiprazole, olanzapine, and risperidone) significantly improved symptoms in first-episode schizophrenia, but olanzapine was associated with the largest weight gain and more side effects 6.
Metabolic Effects
- Aripiprazole and olanzapine can induce metabolic changes, including changes in prolactin levels, lipid and glucose metabolism, and hepatic, haematological, thyroid, and renal function 2.
- Olanzapine was found to induce hyperprolactinaemia, while aripiprazole did not 2.
- C-peptide concentrations were higher after aripiprazole administration and were influenced by certain polymorphisms 2.
- Olanzapine and certain polymorphisms were associated with elevated glucose levels 2.
Cardiovascular Effects
- Aripiprazole decreased diastolic blood pressure and QTc, while olanzapine had a systolic and diastolic blood pressure, heart rate, and QTc lowering effect 5.
- Polymorphisms in certain genes were significantly associated with these changes 5.
Adverse Events
- The most frequent adverse drug reactions to aripiprazole were somnolence, headache, insomnia, dizziness, restlessness, palpitations, akathisia, and nausea, while those to olanzapine were somnolence, dizziness, asthenia, constipation, dry mouth, headache, and nausea 5.
- Certain polymorphisms had a role in the development of adverse drug reactions 5.