fluoxetine and olanzapine

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Symbyax, |fluoxetine and olanzapine
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fluoxetine and olanzapine

Generic Name: fluoxetine and olanzapine (flew OX eh teen and oh LAN za peen)
Brand Names: Symbyax

What is fluoxetine and olanzapine?

Fluoxetine is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Olanzapine is an antipsychotic medication. These drugs affect chemicals in the brain.

The combination of fluoxetine and olanzapine is used to treat depression caused by bipolar disorder (manic depression).

Fluoxetine and olanzapine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about fluoxetine and olanzapine?

You may have an increased risk of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are under 18 years old. Talk with your doctor about this risk. While you are taking fluoxetine and olanzapine you will need to be monitored for worsening symptoms of depression and/or suicidal thoughts during the first weeks of treatment, or whenever your dose is changed. In addition to you watching for changes in your own symptoms, your family or other caregivers should be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse: mood changes, anxiety, panic attacks, trouble sleeping, irritability, agitation, aggressiveness, severe restlessness, mania (mental and/or physical hyperactivity), thoughts of suicide or hurting yourself. Do not take fluoxetine and olanzapine together with pimozide (Orap), thioridazine (Mellaril), or a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), rasagiline (Azilect), phenelzine (Nardil), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate). SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking fluoxetine and olanzapine, do not stop taking the medication without first talking to your doctor.

What should I discuss with my healthcare provider before taking fluoxetine and olanzapine?

You may have an increased risk of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are under 18 years old. Talk with your doctor about this risk. While you are taking fluoxetine and olanzapine you will need to be monitored for worsening symptoms of depression and/or suicidal thoughts during the first weeks of treatment, or whenever your dose is changed. In addition to you watching for changes in your own symptoms, your family or other caregivers should be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks.

Do not use fluoxetine and olanzapine if you are using any of the following drugs:

  • pimozide (Orap);

  • thioridazine (Mellaril); or

  • an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam).

Serious and sometimes fatal reactions can occur when these medicines are taken with fluoxetine and olanzapine. You must wait at least 14 days after stopping an MAO inhibitor before you can take fluoxetine and olanzapine. You must wait 5 weeks after stopping fluoxetine and olanzapine before you can take thioridazine (Mellaril).

Before taking fluoxetine and olanzapine, tell your doctor if you are allergic to any drugs, if you smoke, or if you have:

  • liver disease;

  • heart disease, high or low blood pressure, or a history of heart attack or stroke;

  • diabetes;

  • seizures or epilepsy;

  • glaucoma;

  • paralytic ileus (a stomach disorder);

  • enlarged prostate; or

  • a history of drug abuse or suicidal thoughts.

If you have any of these conditions, you may not be able to use fluoxetine and olanzapine, or you may need a dosage adjustment or special tests.

FDA pregnancy category C. SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking fluoxetine and olanzapine, do not stop taking the medication without first talking to your doctor. Fluoxetine and olanzapine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. This medication is not for use in psychotic conditions that are related to dementia. Olanzapine has caused fatal heart attack and stroke in older adults with dementia-related conditions.

How should I take fluoxetine and olanzapine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.

Take each dose with a full glass of water. Fluoxetine and olanzapine can be taken with or without food.

Try to take the medicine at the same time each day. Follow the directions on your prescription label.

It may take 4 weeks or longer before you start feeling better. Do not stop using fluoxetine and olanzapine without first talking to your doctor. Store fluoxetine and olanzapine at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have taken too much of this medication. Symptoms of an overdose may include nausea, vomiting, tremor, problems with speech or vision, seizure (convulsions), and coma.

What should I avoid while taking fluoxetine and olanzapine?

Avoid becoming overheated or dehydrated. Drink plenty of fluids, especially in hot weather and during exercise. It is easier to become dangerously overheated and dehydrated while you are taking fluoxetine and olanzapine. Avoid drinking alcohol, which can increase some of the side effects of fluoxetine and olanzapine.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, other medication for depression or anxiety). They can add to sleepiness caused by fluoxetine and olanzapine.

Fluoxetine and olanzapine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Fluoxetine and olanzapine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse: mood changes, anxiety, panic attacks, trouble sleeping, irritability, agitation, aggressiveness, severe restlessness, mania (mental and/or physical hyperactivity), thoughts of suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:

  • sudden and severe headache, blurred vision, confusion, chest pain, numbness, and problems with vision, speech, or balance;

  • increased thirst, frequent urination, excessive hunger, or weakness;

  • fever, stiff muscles, confusion, sweating, fast or uneven heartbeats, trouble breathing;

  • jerky muscle movements you cannot control;

  • seizure (convulsions);

  • feeling light-headed, fainting;

  • easy bruising or bleeding; or

  • nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Other less serious side effects are more likely to occur, such as:

  • trouble swallowing;

  • weight gain, swelling in your hands of feet;

  • drowsiness, trouble concentrating;

  • sleep problems (insomnia);

  • runny nose, sore throat;

  • dry mouth, diarrhea, changes in appetite; or

  • decreased sex drive, impotence, or difficulty having an orgasm.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect fluoxetine and olanzapine?

Talk to your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), indomethacin, piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others. Taking any of these drugs with fluoxetine and olanzapine may cause you to bruise or bleed easily.

Before taking fluoxetine and olanzapine, tell your doctor if you are using any of the following medicines:

  • flecainide (Tambocor);

  • vinblastine (Velban);

  • blood pressure medication;

  • tryptophan (also called L-tryptophan);

  • lithium, clozapine (Clozaril, Fazaclo), haloperidol (Haldol);

  • valproate (Depacon, Depakene), phenytoin (Dilantin), carbamazepine (Carbatrol, Tegretol);

  • a blood thinner such as warfarin (Coumadin);

  • another form of fluoxetine or olanzapine such as Prozac, Prozac Weekly, Sarafem, or Zyprexa;

  • theophylline (Theo-Dur, TheoBid, Uniphyl, Slo-Bid, Elixophyllin, and others);

  • medicine to treat Parkinson"s disease, such as bromocriptine (Parlodel), pergolide (Permax), pramipexole (Mirapex), ropinorole (Requip), or cabergoline (Cabaser);

  • almotriptan (Axert), frovatriptan (Frova), sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt), or zolmitriptan (Zomig);

  • diazepam (Valium) or similar medicines such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), estazolam (ProSom), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril), triazolam (Halcion), and others; or

  • any other antidepressants such as amitriptyline (Elavil), citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), or sertraline (Zoloft).

If you are using any of these drugs, you may not be able to use fluoxetine and olanzapine, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect fluoxetine and olanzapine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist has additional information about fluoxetine and olanzapine written for health professionals that you may read.

What does my medication look like?

Fluoxetine and olanzapine is available with a prescription under the brand name Symbyax. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

  • Symbyax 6 mg/25 mg (olanzapine/fluoxetine and olanzapine)-mustard yellow and light yellow capsules

  • Symbyax 6 mg/50 mg (olanzapine/fluoxetine and olanzapine)-mustard yellow and light grey capsules

  • Symbyax 12 mg/25 mg (olanzapine/fluoxetine and olanzapine)-red and light yellow capsules

  • Symbyax 12 mg/50 mg (olanzapine/fluoxetine and olanzapine)-red and light grey capsules

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ("Multum") is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum"s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum"s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2006 Cerner Multum, Inc. Version: 5.01. Revision Date: 2/22/07 12:47:22 PM.



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