fluoxetine and olanzapine

Generic Name: fluoxetine and olanzapine (floo OX eh teen and oh LAN za peen)
Brand Name: 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.

Fluoxetine and olanzapine is a combination medicine used to treat depression caused by bipolar disorder (manic depression). Fluoxetine and olanzapine is also used to treat depression after at least 2 other medications have been tried without successful treatment of symptoms.

Fluoxetine and olanzapine may also be used for other purposes not listed in this medication guide.

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

You should not use fluoxetine and olanzapine if you also take pimozide or thioridazine, or if you are being treated with methylene blue injection.

Do not use fluoxetine and olanzapine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine. 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 or an MAOI.

Slideshow: View Frightful (But Dead Serious) Drug Side Effects

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using fluoxetine and olanzapine. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Fluoxetine and olanzapine should not be given to a child younger than 10 years old.

This medicine is not approved for use in psychotic conditions related to dementia. Fluoxetine and olanzapine may increase the risk of death in older adults with dementia-related conditions.

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

You should not use fluoxetine and olanzapine if you are allergic to it, if you also take pimozide or thioridazine, or if you are being treated with methylene blue injection.

Do not use fluoxetine and olanzapine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine. 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 or an MAOI.

Do not take fluoxetine and olanzapine if you take either drug in a non-combination form (such as Prozac, Rapiflux, Sarafem, Selfemra, Zyprexa, or Zyprexa Zydis).

Tell your doctor about all other antidepressants you take, especially Celexa, Cymbalta, Desyrel, Effexor, Lexapro, Luvox, Oleptro, Paxil, Pexeva, Viibryd, or Zoloft.

Fluoxetine and olanzapine is not approved for use in psychotic conditions related to dementia. This medicine may increase the risk of death in older adults with dementia-related conditions.

To make sure fluoxetine and olanzapine is safe for you, tell your doctor if you have:

  • liver disease;

  • diabetes, high cholesterol or triglycerides;

  • seizures or epilepsy;

  • narrow-angle glaucoma;

  • heart disease, slow heartbeats, high or low blood pressure;

  • history of "mini-stroke" or "TIA" or if you have recently had a heart attack;

  • personal or family history of long QT syndrome;

  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  • a bleeding or blood-clotting disorder;

  • breast cancer;

  • bowel obstruction, severe constipation;

  • enlarged prostate; or

  • a history of drug abuse or suicidal thoughts.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using fluoxetine and olanzapine. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Taking this medication during pregnancy may cause problems in the newborn, such as withdrawal symptoms, breathing problems, feeding problems, fussiness, tremors, and limp or stiff muscles. However, you may have withdrawal symptoms or other problems if you stop taking your medicine during pregnancy.

Tell your doctor right away if you become pregnant while taking fluoxetine and olanzapine. Do not start or stop taking this medicine during pregnancy without your doctor's advice.

Fluoxetine and olanzapine can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are taking this medication.

This medicine should not be given to a child younger than 10 years old.

How should I take fluoxetine and olanzapine?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

You may take fluoxetine and olanzapine with or without food. Take the medicine at the same time each day.

Olanzapine can cause high blood sugar (hyperglycemia). If you are diabetic, check your blood sugar levels on a regular basis while you are taking olanzapine.

It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking fluoxetine and olanzapine?

Drinking alcohol can increase certain side effects of fluoxetine and olanzapine.

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with fluoxetine and olanzapine may cause you to bruise or bleed easily.

Fluoxetine and olanzapine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be 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.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

High doses or long-term use of fluoxetine and olanzapine can cause a serious movement disorder that may not be reversible. Symptoms of this disorder include uncontrollable muscle movements of your lips, tongue, eyes, face, arms, or legs. The longer you take fluoxetine and olanzapine, the more likely you are to develop a serious movement disorder. The risk of this side effect is higher in women and older adults.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;

  • chest pain and severe dizziness, fast or pounding heartbeats;

  • feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin;

  • high levels of serotonin in the body--agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination;

  • severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, confusion, uneven heartbeats, tremors;

  • low levels of sodium in the blood--headache, confusion, slurred speech, vomiting, severe weakness, feeling unsteady, shallow breathing; or

  • high blood sugar--increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, confusion, upset stomach.

Common side effects may include:

  • increased appetite, weight gain;

  • tired feeling;

  • trouble concentrating;

  • vision changes; or

  • swelling in your hands or feet.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Fluoxetine and olanzapine dosing information

Usual Adult Dose for Depression:

Initial Dose: Fluoxetine 25 mg-olanzapine 6 mg orally once a day
Maintenance dose: Adjust as clinically necessary to within a range of:
-Fluoxetine: 25 to 50 mg orally once a day
-Olanzapine: 3 to 12 mg orally once a day
Maximum dose: Fluoxetine 50 mg-olanzapine 12 mg orally once a day
Duration: It is generally accepted that treatment-resistant depression and Bipolar I disorder, including the depressive episodes associated with Bipolar I disorder, are chronic illnesses requiring chronic treatment.

Comments:
-Dose adjustments may be made according to efficacy and tolerability
-The safety of doses above fluoxetine 75 mg and olanzapine 18 mg per day has not been evaluated in clinical studies

Use: Acute treatment of treatment-resistant depression and depressive episodes associated with Bipolar I Disorder

Usual Adult Dose for Bipolar Disorder:

Initial Dose: Fluoxetine 25 mg-olanzapine 6 mg orally once a day
Maintenance dose: Adjust as clinically necessary to within a range of:
-Fluoxetine: 25 to 50 mg orally once a day
-Olanzapine: 3 to 12 mg orally once a day
Maximum dose: Fluoxetine 50 mg-olanzapine 12 mg orally once a day
Duration: It is generally accepted that treatment-resistant depression and Bipolar I disorder, including the depressive episodes associated with Bipolar I disorder, are chronic illnesses requiring chronic treatment.

Comments:
-Dose adjustments may be made according to efficacy and tolerability
-The safety of doses above fluoxetine 75 mg and olanzapine 18 mg per day has not been evaluated in clinical studies

Use: Acute treatment of treatment-resistant depression and depressive episodes associated with Bipolar I Disorder

Usual Geriatric Dose for Depression:

Initial Dose: Fluoxetine 25 mg-olanzapine 3 mg to fluoxetine 25 mg-olanzapine 6 mg orally once a day
Maintenance dose: Adjust with caution as clinically necessary to within a range of:
-Fluoxetine: 25 to 50 mg orally once a day
-Olanzapine: 6 to 12 mg orally once a day
Maximum dose: Fluoxetine 50 mg-olanzapine 12 mg orally once a day
Duration: It is generally accepted that treatment-resistant depression and Bipolar I disorder, including the depressive episodes associated with Bipolar I disorder, are chronic illnesses requiring chronic treatment.

Comments:
-Dose adjustments may be made according to efficacy and tolerability
-This drug combination has not been systematically studied in patients over 65 years of age

Use: Acute treatment of treatment-resistant depression and depressive episodes associated with Bipolar I Disorder

Usual Geriatric Dose for Bipolar Disorder:

Initial Dose: Fluoxetine 25 mg-olanzapine 3 mg to fluoxetine 25 mg-olanzapine 6 mg orally once a day
Maintenance dose: Adjust with caution as clinically necessary to within a range of:
-Fluoxetine: 25 to 50 mg orally once a day
-Olanzapine: 6 to 12 mg orally once a day
Maximum dose: Fluoxetine 50 mg-olanzapine 12 mg orally once a day
Duration: It is generally accepted that treatment-resistant depression and Bipolar I disorder, including the depressive episodes associated with Bipolar I disorder, are chronic illnesses requiring chronic treatment.

Comments:
-Dose adjustments may be made according to efficacy and tolerability
-This drug combination has not been systematically studied in patients over 65 years of age

Use: Acute treatment of treatment-resistant depression and depressive episodes associated with Bipolar I Disorder

Usual Pediatric Dose for Bipolar Disorder:

10 to 17 years of age:
Initial Dose: Fluoxetine 25 mg-olanzapine 3 mg orally once a day
Maintenance dose: Adjust as clinically necessary to within a range of:
-Fluoxetine: 25 to 50 mg orally per day
-Olanzapine: 6 to 12 mg orally per day
Maximum dose: Fluoxetine 50 mg-olanzapine 12 mg orally per day
Duration: It is generally accepted that Bipolar I disorder, including the depressive episodes associated with Bipolar I disorder, is a chronic illness requiring chronic treatment.

Comments:
-The safety of doses above fluoxetine 50 mg and olanzapine 12 mg per day has not been evaluated in pediatric clinical studies

Use: Acute treatment of depressive episodes associated with Bipolar I Disorder

What other drugs will affect fluoxetine and olanzapine?

Taking this medicine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking fluoxetine and olanzapine with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Many drugs can interact with fluoxetine and olanzapine. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with fluoxetine and olanzapine, especially:

  • any other antidepressant or medication to treat mental illness;

  • buspirone;

  • fentanyl, tramadol;

  • lithium;

  • St. John's Wort;

  • tryptophan (sometimes called L-tryptophan); or

  • migraine headache medicine--almotriptan, frovatriptan, sumatriptan, naratriptan, rizatriptan, zolmitriptan.

This list is not complete and many other drugs can interact with fluoxetine and olanzapine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about fluoxetine and olanzapine.
  • 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.
  • Disclaimer: 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 1996-2012 Cerner Multum, Inc. Version: 13.05. Revision Date: 2014-11-05, 11:08:08 AM.

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