Li HL. Olanzapine-induced restless legs syndrome: Two case reports. World J Psychiatry 2026; 16(8): 120880 [DOI: 10.5498/wjp.120880]
Corresponding Author of This Article
Hong-Liang Li, Academic Fellow, Lecturer, Department of Clinic, Jurong Mental Hospital, No. S243 Hongjing Road, Jurong City, Zhenjiang 212400, Jiangsu Province, China. 291413125@qq.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
case-report
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World J Psychiatry. Aug 19, 2026; 16(8): 120880 Published online Aug 19, 2026. doi: 10.5498/wjp.120880
Olanzapine-induced restless legs syndrome: Two case reports
Hong-Liang Li
Hong-Liang Li, Department of Clinic, Jurong Mental Hospital, Zhenjiang 212400, Jiangsu Province, China
Author contributions: Li HL contributed to the conceptualization, methodology, data curation, original draft writing, visualization, and formal analysis; the author consented to manuscript submission to the journal, and authorized the latest report.
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Informed consent statement: Written informed consent was obtained from the guardian for participation in this study.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Hong-Liang Li, Academic Fellow, Lecturer, Department of Clinic, Jurong Mental Hospital, No. S243 Hongjing Road, Jurong City, Zhenjiang 212400, Jiangsu Province, China. 291413125@qq.com
Received: March 11, 2026 Revised: June 10, 2026 Accepted: July 6, 2026 Published online: August 19, 2026 Processing time: 129 Days and 3.2 Hours
Abstract
BACKGROUND
Olanzapine, a second-generation antipsychotic acting as a serotonin-dopamine antagonist, is widely used in the treatment of schizophrenia, bipolar disorder and other psychiatric illnesses. Common adverse effects of olanzapine include somnolence, weight gain, metabolic syndrome, and extrapyramidal symptoms. However, olanzapine-induced restless legs syndrome (RLS) is a rare adverse reaction, with a reported incidence of only 0.5%-2.3% in clinical trials, which is easily overlooked in clinical practice. To date, few case reports have systematically described the clinical characteristics of olanzapine-induced RLS in schizophrenia patients with long-term disease course and multiple comorbidities. I here report two cases of olanzapine-induced RLS, summarize the diagnostic and therapeutic experience, and review relevant literature to improve clinicians’ awareness of this adverse reaction.
CASE SUMMARY
The clinical data of two chronic schizophrenia patients who developed RLS after olanzapine administration in December of the admission year were retrospectively collected and analyzed. Combined with a systematic review of relevant literature, the pathogenesis, differential diagnosis and management strategies of olanzapine-induced RLS were discussed.
CONCLUSION
Olanzapine may induce RLS by interfering with the dopaminergic system and iron metabolism. Clinicians should closely monitor sleep quality and lower extremity discomfort in schizophrenia patients treated with olanzapine, promptly identify RLS and implement individualized interventions to improve treatment adherence and quality of life.
Core Tip: Olanzapine-induced restless legs syndrome (RLS) is a rare adverse drug reaction with an incidence of only 0.5%-2.3%, easily ignored in psychiatric practice. This article reports two elderly female schizophrenia patients complicated with multiple physical illnesses who developed typical RLS after olanzapine administration. We analyze its possible mechanisms related to dopaminergic dysfunction and abnormal iron metabolism, summarize individualized dose adjustment and antipsychotic switching strategies, and remind clinicians to actively screen RLS symptoms during olanzapine treatment.
