Fluoxetine / olanzapine Disease Interactions
There are 21 disease interactions with fluoxetine / olanzapine:
Acute Alcohol Intoxication- Cardiovascular Disease
- Cns Depression
- Nms
- Tardive Dyskinesia
Diabetes- Anticholinergic Effects
- Breast Cancer
- Dehydration
- Liver Disease
- Parkinsonism
- Seizure Disorders
- Alt Elevations
- Pku
- Liver Disease
- Mania
- Platelet Function
- Seizure Disorders
- Siadh
- Renal Dysfunction
- Weight Loss
Neuroleptics (Includes Fluoxetine/olanzapine) ↔ Acute Alcohol Intoxication
Severe Potential Hazard, High plausibility
Applies to: Alcoholism
The use of neuroleptic agents is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of neuroleptic agents may be additive with those of alcohol. Severe respiratory depression and respiratory arrest may occur. Therapy with neuroleptic agents should be administered cautiously in patients who might be prone to acute alcohol intake.
Neuroleptics (Includes Fluoxetine/olanzapine) ↔ Cardiovascular Disease
Severe Potential Hazard, Moderate plausibility
Applies to: Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction, Hypotension, Heart Disease
Neuroleptic agents may cause hypotension (including orthostatic hypotension), reflex tachycardia, increased pulse rate, syncope and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, fatal cardiac arrest has occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include hypertension, edema, arrhythmias, thrombophlebitis, myocarditis, angina, myocardial infarction, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation, diffuse T-wave flattening, and ST segment depression. Therapy with neuroleptic agents should be administered cautiously in patients with severe cardiovascular disease, pheochromocytoma, a predisposition to hypotension, or conditions that could be exacerbated by hypotension such as a history of myocardial infarction, angina, or ischemic stroke. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. If parenteral therapy is given, patients should be in a supine position during administration and for at least 30 to 60 minutes afterwards. Patients who experience orthostatic hypotension should be cautioned not to rise too abruptly. Occasionally, when severe, hypotension may require treatment with vasoconstrictive agents such as norepinephrine or phenylephrine. Epinephrine should not be used, however, since neuroleptic agents can reverse its vasopressor effects and cause a further lowering of blood pressure.
Neuroleptics (Includes Fluoxetine/olanzapine) ↔ Cns Depression
Severe Potential Hazard, High plausibility
Applies to: Altered Consciousness, Respiratory Arrest
The use of neuroleptic agents is contraindicated in comatose patients and patients with severe central nervous system depression. Neuroleptic agents may potentiate the CNS and respiratory depression in these patients.
Neuroleptics (Includes Fluoxetine/olanzapine) ↔ Nms
Severe Potential Hazard, High plausibility
Applies to: Neuroleptic Malignant Syndrome
The central dopaminergic blocking effects of neuroleptic agents may precipitate or aggravate a potentially fatal symptom complex known as neuroleptic malignant syndrome (NMS). NMS is observed most frequently when high-potency agents like haloperidol are administered intramuscularly, but may occur with any neuroleptic agent given for any length of time. Clinical manifestations of NMS include hyperpyrexia, muscle rigidity, altered mental status and autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac arrhythmias). Additional signs may include elevated creatine phosphokinase, myoglobinuria, and acute renal failure. Neuroleptic agents should not be given to patients with active NMS and should be immediately discontinued if currently being administered in such patients. In patients with a history of NMS, introduction or reintroduction of neuroleptic agents should be carefully considered, since NMS may recur.
Neuroleptics (Includes Fluoxetine/olanzapine) ↔ Tardive Dyskinesia
Severe Potential Hazard, Moderate plausibility
Applies to: Tardive Dyskinesia
Neuroleptic agents may precipitate symptoms of tardive dyskinesia (TD), a syndrome consisting of rhythmic involuntary movements variously involving the tongue, face, mouth, lips, jaw, and/or trunk and extremities, following chronic use of at least several months but often years. Elderly patients, particularly women, are most susceptible. Both the risk of developing the syndrome and the likelihood that it will become irreversible increase with the duration and total cumulative dose of neuroleptic therapy administered. However, patients may infrequently develop symptoms after relatively brief treatment periods at low dosages. If TD occurs during neuroleptic therapy, prompt withdrawal of the offending agent or at least a lowering of the dosage should be considered. TD symptoms may become more severe after drug discontinuation or a dosage reduction, but may gradually improve over months to years. In patients with preexisting drug-induced TD, initiating or increasing the dosage of neuroleptic therapy may temporarily mask the symptoms of TD but could eventually worsen the condition. The newer, atypical neuroleptic agents (e.g., risperidone, quetiapine, olanzapine) tend to be associated with a substantially reduced risk of inducing TD and are considered the drugs of choice in patients being treated for psychosis.
Fluoxetine (Includes Fluoxetine/olanzapine) ↔ Diabetes
Moderate Potential Hazard, Moderate plausibility
Applies to: Diabetes Mellitus
Fluoxetine may alter blood glucose control in patients with diabetes. Hypoglycemia may occur during therapy with fluoxetine, and hyperglycemia may occur following discontinuation of the drug. Dosage adjustments in insulin and/or oral hypoglycemic medications may be necessary in patients with diabetes whenever fluoxetine therapy is initiated or discontinued.
Neuroleptics (Includes Fluoxetine/olanzapine) ↔ Anticholinergic Effects
Moderate Potential Hazard, High plausibility
Applies to: Gastrointestinal Obstruction, Glaucoma/Intraocular Hypertension, Urinary Retention
Most neuroleptic agents have anticholinergic activity, to which elderly patients are particularly sensitive. Clozapine and low-potency agents such as chlorpromazine and thioridazine tend to exhibit the greatest degree of anticholinergic effects in the class, while haloperidol as well as the newer, atypical agents like quetiapine, risperidone and ziprasidone have generally been associated with very low frequencies of anticholinergic adverse effects. Therapy with neuroleptic agents should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders.
Neuroleptics (Includes Fluoxetine/olanzapine) ↔ Breast Cancer
Moderate Potential Hazard, Moderate plausibility
Applies to: Breast Cancer
The chronic use of neuroleptic agents can cause persistent elevations in prolactin levels. Based on in vitro data, approximately one-third of human breast cancers are thought to be prolactin-dependent. The clinical significance of this observation with respect to long-term neuroleptic therapy is unknown. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in rodent studies but not in human clinical or epidemiologic studies. Until further data are available, therapy with neuroleptic agents should be administered cautiously in patients with a previously detected breast cancer.
Neuroleptics (Includes Fluoxetine/olanzapine) ↔ Dehydration
Moderate Potential Hazard, Moderate plausibility
Applies to: Dehydration, Diarrhea, Vomiting
Neuroleptic agents may cause hypotension (including orthostatic hypotension) and associated reflex tachycardia, syncope or dizziness, particularly during initiation of therapy or rapid escalation of dosage. Tolerance to the hypotensive effects often develops after a few doses to a few months. Rarely, fatal cardiac arrest has occurred secondary to severe hypotension. Therapy with neuroleptic agents should be administered cautiously in patients with conditions that would predispose them to hypotension, such as hypovolemia or dehydration (e.g., due to severe diarrhea or vomiting). In addition, neuroleptic agents can interfere with the body's ability to regulate core body temperature, occasionally producing hyperthermia during strenuous exercise, exposure to hot weather, and concomitant treatment with anticholinergic medications. Patients who are dehydrated may be particularly susceptible.
Neuroleptics (Includes Fluoxetine/olanzapine) ↔ Liver Disease
Moderate Potential Hazard, Moderate plausibility
Applies to: Liver Disease
Most neuroleptic agents are extensively metabolized by the liver. The plasma concentrations of these agents may be increased and the half-lives prolonged in patients with impaired hepatic function. Therapy with neuroleptic agents should be administered cautiously in patients with significant liver disease. Lower initial dosages and slower titration may be appropriate.
Neuroleptics (Includes Fluoxetine/olanzapine) ↔ Parkinsonism
Moderate Potential Hazard, Moderate plausibility
Applies to: Parkinsonism
The use of neuroleptic agents is associated with pseudo-parkinsonian symptoms such as akinesia, bradykinesia, tremors, pill-rolling motion, cogwheel rigidity, and postural abnormalities including stooped posture and shuffling gait. The onset is usually 1 to 2 weeks following initiation of therapy or an increase in dosage. Older neuroleptic agents such as haloperidol are more likely to induce these effects, and their use may be contraindicated in patients with Parkinson's disease or parkinsonian symptoms.
Neuroleptics (Includes Fluoxetine/olanzapine) ↔ Seizure Disorders
Moderate Potential Hazard, Moderate plausibility
Applies to: CNS Disorder, Alcoholism
Neuroleptic agents can lower the seizure threshold and induce seizures, particularly when dosages are high or increased rapidly and during the initiation of therapy. Clozapine appears to have the greatest epileptogenic potential, while most of the other newer, atypical neuroleptic agents (e.g., risperidone, quetiapine, olanzapine), as well as haloperidol and molindone, have the least. Therapy with neuroleptic agents should be administered cautiously in patients with a history of seizures or other factors predisposing to seizures such as abnormal EEG, preexisting CNS pathology, or head trauma. Adequate anticonvulsant therapy should be maintained during administration of neuroleptic agents. Clozapine should not be used in patients with uncontrolled epilepsy.
Olanzapine (Includes Fluoxetine/olanzapine) ↔ Alt Elevations
Moderate Potential Hazard, Moderate plausibility
Applies to: Liver Disease
The use of olanzapine may be associated with elevations in serum transaminase. During clinical trials, 2% of patients exposed to olanzapine experienced clinically significant ALT (SGPT) elevations (>= 3 times the upper limit of normal), compared to none in the placebo group. Jaundice did not occur in any of the affected patients, however, and liver enzymes tended to return toward baseline during treatment or following its discontinuation. The manufacturer recommends that therapy with olanzapine be administered cautiously in patients with signs and symptoms of hepatic impairment and in patients with preexisting conditions associated with limited hepatic functional reserve. Periodic assessment of serum transaminases should be performed in patients with significant hepatic disease.
Olanzapine (Includes Fluoxetine/olanzapine) ↔ Pku
Moderate Potential Hazard, High plausibility
Applies to: Phenylketonuria
Zyprexa Zydis (brand of olanzapine orally distintegrating tablets) contains 0.34 mg and 0.45 mg of phenylalanine per each 5 mg and 10 mg tablet, respectively. The phenylalanine content should be considered when this and similar products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).
Ssris (Includes Fluoxetine/olanzapine) ↔ Liver Disease
Moderate Potential Hazard, High plausibility
Applies to: Liver Disease
Selective serotonin reuptake inhibitors (SSRIs) are primarily metabolized by the liver. The plasma concentrations of SSRIs and their metabolites may be increased and the half-lives prolonged in patients with impaired hepatic function. Dosage adjustments may be necessary in accordance with the individual product package labeling.
Ssris (Includes Fluoxetine/olanzapine) ↔ Mania
Moderate Potential Hazard, Moderate plausibility
Applies to: Mania, Bipolar Disorder
Selective serotonin reuptake inhibitors (SSRIs), like other antidepressants, may occasionally cause mania or hypomania. The reported incidence ranged from 0.1% to 2% in premarketing testing of several SSRIs. Patients with bipolar disorder are generally more likely to experience mania from antidepressants. Therapy with SSRIs should be administered cautiously in patients with a history of mania or bipolar disorder.
Ssris (Includes Fluoxetine/olanzapine) ↔ Platelet Function
Moderate Potential Hazard, High plausibility
Applies to: Bleeding, Coagulation Defect, Thrombocytopathy, Thrombocytopenia, Vitamin K Deficiency
The use of selective serotonin reuptake inhibitors (SSRIs) has been associated with altered platelet function. Petechiae, purpura, ecchymosis, increased bleeding times, epistaxis and gastrointestinal hemorrhage have been reported. Therapy with SSRIs should be administered cautiously in patients with severe active bleeding or a hemorrhagic diathesis.
Ssris (Includes Fluoxetine/olanzapine) ↔ Seizure Disorders
Moderate Potential Hazard, Moderate plausibility
Applies to: Seizures
Selective serotonin reuptake inhibitors (SSRIs) may trigger seizures in approximately 0.2% of patients. Therapy with SSRIs should be administered cautiously in patients with seizure disorders.
Ssris (Includes Fluoxetine/olanzapine) ↔ Siadh
Moderate Potential Hazard, Moderate plausibility
Applies to: Dehydration, Hyponatremia, SIADH
The use of selective serotonin reuptake inhibitors (SSRIs) has rarely been associated with hyponatremia, sometimes secondary to development of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). These events have generally been reversible following discontinuation of SSRI therapy and/or medical intervention. SSRI-related hyponatremia may be more common in elderly female patients and those who are volume-depleted or receiving concomitant diuretic therapy. Caution may be warranted when SSRI therapy is administered in these patients and patients with preexisting hyponatremia or SIADH. Serum electrolytes, especially sodium as well as BUN and plasma creatinine, should be monitored regularly.
Fluoxetine (Includes Fluoxetine/olanzapine) ↔ Renal Dysfunction
Minor Potential Hazard, Low plausibility
Applies to: Renal Dysfunction
Fluoxetine is primarily metabolized by the liver. All but one metabolites are inactive, and they are excreted by the kidney. The clearance of norfluoxetine, the active metabolite, is not dependent on renal function. Dosage adjustments are generally not deemed necessary in patients with impaired renal function, although the clinical significance of possible metabolite accumulation is unknown. Caution may be warranted when fluoxetine therapy is administered in patients with severe renal dysfunction.
Ssris (Includes Fluoxetine/olanzapine) ↔ Weight Loss
Minor Potential Hazard, Moderate plausibility
Applies to: Weight Loss/Failure to Thrive, Malnourished, Anorexia/Feeding Problems
The use of selective serotonin reuptake inhibitors (SSRIs) may occasionally cause significant weight loss, which may be undesirable in patients suffering from anorexia, malnutrition or excessive weight loss. Anorexia may occur in approximately 5% to 10% of patients. Weight change should be monitored during therapy if an SSRI is used in these patients.
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Drug Interaction Classification
The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
| Major | Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. |
| Moderate | Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. |
| Minor | Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. |
Do not stop taking any medications without consulting your healthcare provider.
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