Zyprexa (olanzapine) vs Risperdal (risperidone)
Zyprexa and Risperdal, compared on what the public record actually supports: side effects by rate from each FDA label, what the largest trial comparison found, who takes each one, who pays, what the labels warn, and what the litigation record holds. Sources on every number.
the short answer
- is Zyprexa or Risperdal more effective? there is no head-to-head trial record in our library that settles this pair, and we do not fill the gap with a guess. what can be compared is below: each label's own side-effect table, who takes each drug, who pays, and the legal record.
- which has fewer side effects? the labels say their trials “cannot be directly compared”, because each drug was tested in different people under different rules. what each label prints: Zyprexa (olanzapine): 5% stopped for an adverse reaction vs 6% on placebo (Zyprexa label, SPL version 68, effective 2026-02-11). Risperdal (risperidone): 7% (39/564) stopped for an adverse reaction vs 4% (10/225) on placebo (Risperdal label, SPL version 45, effective 2026-05-28). the reactions both labels list, side by side, are in the table below.
- which should i take? not a question this page answers. the odds ratios are averages across thousands of strangers; your history, other medications and what you can live with are not in them. the questions for your prescriber below are built from what is on this page.
What this page will not do is rank them. For most same-class pairs, head-to-head efficacy differences are smaller than the rankings look — the largest network meta-analysis ever run (21 antidepressants, 522 trials) found every drug beat placebo and the gaps between drugs mostly modest and uncertain. Which one fits you turns on your history, your other medications, and side-effect trade-offs — a prescriber conversation. This page arms that conversation; here are the questions worth taking into it →
side effects by rate: what each label prints, not a head-to-head trial
the labels' own warning, first: “Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect or predict the rates observed in practice.” the two columns below come from different trials, in different people, under different inclusion rules. read each against its own placebo column, not against the other drug.
| reaction | Olanzapine (N=532) vs Placebo (N=294) | RISPERDAL 2–8 mg per day (N=366) / RISPERDAL >8–16 mg per day (N=198) vs Placebo (N=225) |
|---|---|---|
| dry mouth | 9% vs 5% | 4% / 0% vs 1% |
| constipation | 9% vs 4% | 8% / 9% vs 6% |
| insomnia | 12% vs 11% | 32% / 25% vs 27% |
| somnolence | 29% vs 13% | 10% / 5% vs 2% |
| dizziness | 11% vs 4% | 7% / 4% vs 2% |
| tremor | 4% vs 3% | 2% / 3% vs 1% |
| akathisia | 3% vs 2% | 10% / 10% vs 3% |
| dyspepsia | 7% vs 5% | 8% / 6% vs 5% |
- Zyprexa (olanzapine): 5% stopped for an adverse reaction vs 6% on placebo (Zyprexa label, SPL version 68, effective 2026-02-11).
- Risperdal (risperidone): 7% (39/564) stopped for an adverse reaction vs 4% (10/225) on placebo (Risperdal label, SPL version 45, effective 2026-05-28).
what makes each table, in the labels' words
- Zyprexa (olanzapine), SPL version 68, effective 2026-02-11, 6 ADVERSE REACTIONS / 6.1 Clinical Trials Experience, tablets (label also covers Zydis orally disintegrating tablets and IntraMuscular injection; adult oral data used here). inclusion rule: “Table 11 enumerates the incidence, rounded to the nearest percent, of treatment-emergent adverse reactions that occurred in 2% or more of patients treated with oral olanzapine (doses ≥2.5 mg/day) and with incidence greater than placebo who participated in the acute phase of placebo-controlled trials.” trials: “The information below for olanzapine is derived from a clinical trial database for olanzapine consisting of 10,504 adult patients with approximately 4765 patient-years of exposure to olanzapine plus 722 patients with exposure to intramuscular olanzapine for injection. The short-term findings are based on premarketing trials of (1) oral olanzapine for schizophrenia, bipolar I disorder (manic or mixed episodes), a subsequent trial of patients having various psychiatric symptoms in association with Alzheimer's disease, and premarketing combination trials, and (2) intramuscular olanzapine for injection in agitated patients with schizophrenia or bipolar I mania. Table 11 is not restricted by the label to one indication; it is the pooled short-term placebo-controlled oral-olanzapine dataset.” DailyMed
- Risperdal (risperidone), SPL version 45, effective 2026-05-28, 6 ADVERSE REACTIONS / 6.1 Clinical Trials Experience, tablets, oral solution, and M-TAB orally disintegrating tablets. inclusion rule: “Table 8 lists the adverse reactions reported in 2% or more of RISPERDAL-treated adult patients with schizophrenia in three 4- to 8-week, double-blind, placebo-controlled trials (the table caption adds "and greater than placebo").” trials: “The data described in this section are derived from a clinical trial database consisting of 9803 adult and pediatric patients exposed to one or more doses of RISPERDAL for the treatment of schizophrenia, bipolar mania, autistic disorder, and other psychiatric disorders in pediatrics and elderly patients with dementia. Of these 9803 patients, 2687 were patients who received RISPERDAL while participating in double-blind, placebo-controlled trials. The conditions and duration of treatment with RISPERDAL varied greatly and included (in overlapping categories) double-blind, fixed- and flexible-dose, placebo- or active-controlled studies and open-label phases of studies, inpatients and outpatients, and short-term (up to 12 weeks) and longer-term (up to 3 years) exposures.” DailyMed
every row above was transcribed from the current FDA label on 2026-09-08; the full tables, including the reactions only one label lists, are on side-effect rates, drug vs placebo. the sexual side-effect rows carry each label's own underreporting caveat on the SSRI sexual side effects page.
olanzapine (Zyprexa)
atypical antipsychotic
- FDA approval
- 1996 · full approval journey →
- Who takes it (US, —)
- No year from 2014 to 2024 meets AHRQ’s reliability rule for this drug, so we print no count. Years not shown, under AHRQ’s reliability rule: 2014, 2015, 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024 (fewer than 60 survey respondents).Correction (29 September 2026): An earlier version of this section took its numbers from ClinCalc DrugStats, a third-party site that republishes this survey; we now compute them from AHRQ’s public-use files ourselves. It showed 668,979 people and 3,642,411 prescriptions for 2024. No year meets AHRQ’s reliability rule for this drug, so that count is removed. It said prescriptions were up 51% since 2014; too few years meet the rule to show a trend, so that line is removed.
- Who pays (2024)
- Medicare: 3,986,220 claims · 606,074 beneficiariesMedicaid: ≥2,622,442 prescriptionsCommercial claims: not published in any public dataset — a real absence, not a zero.
- Boxed warning
- Yes — on the current FDA label. read it in context →
- Adverse-event reports (FAERS)
- Caveat first: FAERS counts unverified REPORTS, not patients or rates — no denominator, and attention inflates reporting. Never compare these counts head-to-head; a longer-marketed, more-prescribed drug accumulates more reports by exposure alone. how to read FAERS →109,181 all-time reports; most-reported terms: drug ineffective, weight increased, off label use
- Legal & safety record
- the full litigation & recall record →
risperidone (Risperdal)
atypical antipsychotic
- FDA approval
- 1993 · full approval journey →
- Who takes it (US, 2021)
- 584,234 patients · 4,225,630 prescriptions (AHRQ MEPS)2014 → 2021: 5,798,069 → 4,225,630 prescriptions; later years fall under AHRQ’s reliability rule, so no direction is statedThe latest year shown is 2021: only 34 survey respondents reported it in 2024, under the 60 AHRQ requires.Correction (29 September 2026): An earlier version of this section took its numbers from ClinCalc DrugStats, a third-party site that republishes this survey; we now compute them from AHRQ’s public-use files ourselves. It showed 546,604 people and 2,272,519 prescriptions for 2024, a year that does not meet AHRQ’s reliability rule; the latest year that does is 2021. It said prescriptions were down 61% since 2014; the series stops in 2021 because later years fail the rule, so we state no direction.
- Who pays (2024)
- Medicare: 3,809,739 claims · 495,588 beneficiariesMedicaid: ≥3,417,961 prescriptionsCommercial claims: not published in any public dataset — a real absence, not a zero.
- Boxed warning
- Yes — on the current FDA label. read it in context →
- Adverse-event reports (FAERS)
- Caveat first: FAERS counts unverified REPORTS, not patients or rates — no denominator, and attention inflates reporting. Never compare these counts head-to-head; a longer-marketed, more-prescribed drug accumulates more reports by exposure alone. how to read FAERS →75,463 all-time reports; most-reported terms: gynaecomastia, off label use, drug ineffective
- Legal & safety record
- the full litigation & recall record →
questions for your prescriber, built from this page
this page does not tell you to start, stop or switch anything. it arms the conversation where that decision belongs. take these in:
- which of Zyprexa and Risperdal did you have in mind first, and what in my history points that way?
- the trials put these two close together on average. what, for me specifically, breaks the tie: another medication i take, a side effect i can't live with, sleep, weight, sexual function?
- the label lists these reactions above placebo for the one you're suggesting. which of them should i expect in the first weeks, and which would make you want to hear from me the same day?
- how long were the approval trials, and what do we know past that point?
- how will we judge whether it is working, by when, and what is the plan if it isn't?
- if i ever want to come off it, how is that done, and over how long?
- is there a cheaper generic or a formulation that changes the dosing, and does my insurance prefer one of these two?
the longer checklist, for any antidepressant, is questions to ask before starting antidepressants. if you are already on one and it feels like it stopped working, that has its own page.
What the warnings mean, drug by drug
Each explainer reads one drug's current FDA label and the studies in our library, in both directions: the boxed warnings with the label's own numbers, the trials behind the approval and how long they ran, side effects by rate, and the research since.
Questions people search
Is Zyprexa or Risperdal better?
No honest page can answer that in one line. Head-to-head differences between comparable psychiatric medications are usually smaller than rankings suggest, and which fits you depends on your history, other medications, and side-effect trade-offs, a prescriber conversation. What can be compared is the public record (usage, payers, label warnings, approval history, litigation), which is what this page does, with sources.
Is Zyprexa the same as olanzapine, and Risperdal the same as risperidone?
Zyprexa is a brand name for olanzapine. Risperdal is a brand name for risperidone. olanzapine is an atypical antipsychotic; risperidone is an atypical antipsychotic. This page uses the generic names because the federal datasets do.
Which has fewer side effects, Zyprexa or Risperdal?
The two FDA labels cannot be compared head to head, in their own words, because each drug's trials ran in different people under different rules. What each label prints: Zyprexa (olanzapine): 5% stopped for an adverse reaction vs 6% on placebo (Zyprexa label, SPL version 68, effective 2026-02-11). Risperdal (risperidone): 7% (39/564) stopped for an adverse reaction vs 4% (10/225) on placebo (Risperdal label, SPL version 45, effective 2026-05-28). The page shows the reactions both labels list, each against its own placebo column.
Which is prescribed more, Zyprexa or Risperdal?
The page shows federal survey estimates we compute from AHRQ’s Medical Expenditure Panel Survey public-use files for both olanzapine and risperidone: patients and prescriptions in the latest reliable year, and the yearly series from 2014 where AHRQ’s reliability rule allows it, with a direction stated only when the change is larger than the survey’s margin of error. Prescription volume reflects habits, prices, and marketing as much as evidence, so it is context, not a verdict.
Where these numbers come from
- Patients and prescriptions: computed by us from AHRQ's public-use Medical Expenditure Panel Survey Prescribed Medicines files, 2014 (HC-168A) to 2024 (HC-254A), with AHRQ's reliability rule (a year with fewer than 60 respondents or a relative standard error over 50% is not shown) — counts of people filling prescriptions, not outcomes. A direction is stated only when the change is larger than the survey's margin of error. Until 29 September 2026 these came from ClinCalc DrugStats, a third-party site; see the correction under each drug where a figure changed.
- Medicare/Medicaid: CMS public datasets; commercial insurance publishes no per-drug series, so it renders as an absence, never a synthesized number.
- Label facts: the drugs' current FDA labels via DailyMed — quoted in context on each drug's approval-journey page.
- FAERS: openFDA — reports, never rates; the caveat travels above every count.
- Litigation: court records and regulator documents only, on the linked record pages; settled is never adjudicated.
Explore both drugs in depth: /m/olanzapine · /m/risperidone · or the whole library →