Skip to Content

Symbyax (fluoxetine / olanzapine) Disease Interactions

There are 31 disease interactions with Symbyax (fluoxetine / olanzapine):

Major

Atypical antipsychotic agents (applies to Symbyax) dementia

Major Potential Hazard, High plausibility.

Elderly patients with dementia- related psychosis treated with antipsychotic drugs are at an increased risk of death, mostly from cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) causes. A causal relationship with antipsychotic use has not been established. In controlled trials, treatment with some atypical antipsychotic drugs was also associated with an increased risk of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, in elderly patients with dementia- related psychosis. These agents are not approved for the treatment of patients with dementia- related psychosis.

Major

Neuroleptics (applies to Symbyax) acute alcohol intoxication

Major Potential Hazard, High plausibility. Applicable conditions: 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.

References

  1. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  2. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  3. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  4. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  5. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  6. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  7. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  8. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  9. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  10. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
View all 10 references
Major

Neuroleptics (applies to Symbyax) CNS depression

Major Potential Hazard, High plausibility. Applicable conditions: 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.

References

  1. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  2. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  3. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  4. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  5. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  6. Vetter PH, Proppe DG "Clozapine-induced coma." J Nerv Ment Dis 180 (1992): 58-9
  7. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
View all 7 references
Major

Neuroleptics (applies to Symbyax) NMS

Major Potential Hazard, High plausibility. Applicable conditions: 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.

References

  1. Anderson ES, Powers PS "Neuroleptic malignant syndrome associated with clozapine use." J Clin Psychiatry 52 (1991): 102-4
  2. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  3. Sharma R, Trappler B, Ng YK, Leeman CP "Risperidone-induced neutroleptic malignant syndrome." Ann Pharmacother 30 (1996): 775-8
  4. Hermesh H, Sirota P, Eviatar J "Recurrent neuroleptic malignant syndrome due to haloperidol and amantadine." Biol Psychiatry 25 (1989): 962-5
  5. Najara JE, Enikeev ID "Risperidone and neuroleptic malignant syndrome: a case report." J Clin Psychiatry 56 (1995): 534-5
  6. Tarsy D "Risperidone and neuroleptic malignant syndrome." JAMA 275 (1996): 446
  7. Levenson JL "Neuroleptic malignant syndrome after the initiation of olanzapine." J Clin Psychopharmacol 19 (1999): 477-8
  8. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  9. Dave M "Two cases of risperidone-induced neuroleptic malignant syndrome." Am J Psychiatry 152 (1995): 1233-4
  10. Nemecek D "Atropism may precipitate neuroleptic malignant syndrome during treatment with clozapine." Am J Psychiatry 150 (1993): 1561
  11. Chong LS, Abbott PM "Neuroleptic malignant syndrome secondary to loxapine." Br J Psychiatry 159 (1991): 572-3
  12. Aisen PS, Lawlor BA "Neuroleptic malignant syndrome induced by low-dose haloperidol." Am J Psychiatry 149 (1992): 844
  13. Burkhard PR, Vingerhoets FJG "Olanzapine induced neuroleptic malignant syndrome." Arch Gen Psychiat 56 (1999): 101-2
  14. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  15. Singer S, Richards C, Boland RJ "Two cases of risperidone-induced neuroleptic malignant syndrome." Am J Psychiatry 152 (1995): 1234
  16. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  17. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  18. Levitt AJ, Midha R, Craven JL "Neuroleptic malignant syndrome with intravenous haloperidol." Can J Psychiatry 35 (1990): 789
  19. Webster P, Wijeratne C "Risperidone-induced neuroleptic malignant syndrome." Lancet 344 (1994): 1228-9
  20. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  21. Ewert AL, Kloek J, Wells B, Phelps S "Neuroleptic malignant syndrome associated with loxapine" J Clin Psychiatry 44 (1983): 37-8
  22. Nyfort-Hansen K, Alderman CP "Possible neuroleptic malignant syndrome associated with olanzapine." Ann Pharmacother 34 (2000): 667
  23. Gleason PP, Conigliaro RL "Neuroleptic malignant syndrome with risperidone." Pharmacotherapy 17 (1997): 617-21
  24. "Product Information. Abilify (aripiprazole)." Bristol-Myers Squibb, Princeton, NJ.
  25. Caroff SN "The neuroleptic malignant syndrome." J Clin Psychiatry 41 (1980): 79-83
  26. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  27. Raitasuo V, Vataja R, Elomaa E "Risperidone-induced neuroleptic malignant syndrome in young patient." Lancet 344 (1994): 1705
  28. DasGupta K, Young A "Clozapine-induced neuroleptic malignant syndrome." J Clin Psychiatry 52 (1991): 105-7
  29. Campellone JV, Mccluskey LF, Greenspan D "Fatal outcome from neuroleptic malignant syndrome associated with clozapine." Neuropsychiatry Neuropsychol Behav Neurol 8 (1995): 70-3
  30. Johnson V, Bruxner G "Neuroleptic malignant syndrome associated with olanzapine." Aust N Z J Psychiat 32 (1998): 884-6
  31. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  32. Ryken TC, Merrell AN "Haloperidol-induced neuroleptic malignant syndrome in a 67-year-old woman with parkinsonism." West J Med 151 (1989): 326-8
  33. Kern JL, Cernek PK "Delayed risperidone-induced malignant syndrome." Ann Pharmacother 30 (1996): 300
  34. Moltz DA, Coeytaux RR "Case report: Possible neuroleptic malignant syndrome associated with olanzapine." J Clin Psychopharmacol 18 (1998): 485-6
  35. Margolese HC, Chouinard G "Olanzapine-induced neuroleptic malignant syndrome with mental retardation." Am J Psychiat 156 (1999): 1115-6
  36. SierraBiddle D, Herran A, DiezAja S, GonzalezMata JM, Vidal E, DiezManrique F, VazquezBarquero JL "Neuroleptic malignant syndrome and olanzapine." J Clin Psychopharmacol 20 (2000): 704-5
  37. Miller DD, Sharafuddin MJ, Kathol RG "A case of clozapine-induced neuroleptic malignant syndrome." J Clin Psychiatry 52 (1991): 99-101
  38. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  39. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  40. Padgett R, Lipman E "Use of neuroleptics after an episode of neuroleptic malignant syndrome" Can J Psychiatry 34 (1989): 323-5
View all 40 references
Major

Neuroleptics (applies to Symbyax) tardive dyskinesia

Major Potential Hazard, High plausibility.

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.

References

  1. Yesavage JA, Tanke ED, Sheikh JI "Tardive dyskinesia and steady-state serum levels of thiothixene." Arch Gen Psychiatry 44 (1987): 913-5
  2. Ghelber D, Belmaker RH "Tardive dyskinesia with quetiapine." Am J Psychiat 156 (1999): 796-7
  3. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  4. Pinder RM, Brogden RN, Swayer R, Speight TM, Spencer R, Avery GS "Pimozide: a review of its pharmacological properties and therapeutic uses in psychiatry." Drugs 12 (1976): 1-40
  5. "Product Information. Abilify (aripiprazole)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  7. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  8. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  9. Little JT, Jankovic J "Tardive myoclonus." Mov Disord 2 (1987): 307-11
  10. Tamminga CA, Thaker GK, Moran M, Kakigi T, Gao XM "Clozapine in tardive dyskinesia - observations from human and animal model studies." J Clin Psychiatry 55 (1994): 102-6
  11. Branchey MH, Branchey LB, Richardson MA "Effects of neuroleptic adjustment on clinical condition and tardive dyskinesia in schizophrenic patients." Am J Psychiatry 138 (1981): 608-12
  12. Yassa R, Mohelsky HE "Tardive dyskinesia in thiothixene treatment ." J Clin Psychiatry 46 (1985): 151
  13. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  14. Meltzer HY, Luchins DJ "Effect of clozapine in severe tardive dyskinesia: a case report." J Clin Psychopharmacol 4 (1984): 286-7
  15. de Leon J, Moral L, Camunas C "Clozapine and jaw dyskinesia: a case report." J Clin Psychiatry 52 (1991): 494-5
  16. Pakkenberg H, Fog R "Spontaneous oral dyskinesia. Results of treatment with tetrabenazine, pimozide, or both." Arch Neurol 31 (1974): 352-3
  17. Gwinn KA, Caviness JN "Risperidone-induced tardive dyskinesia and parkinsonism." Mov Disord 12 (1997): 119-21
  18. Bransgrove LL, Kelly MW "Movement disorders in patients treated with long-acting injectable antipsychotic drugs." Am J Hosp Pharm 51 (1994): 895-9
  19. Elliott ES, Marken PA, Ruehter VL "Clozapine-associated extrapyramidal reaction." Ann Pharmacother 34 (2000): 615-8
  20. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  21. Friedman JH "Clozapine treatment of psychosis in patients with tardive dystonia: report of three cases." Mov Disord 9 (1994): 321-4
  22. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  23. Peabody CA, Brody D, Warner MD "Tardive dyskinesia after low-dose haloperidol." Biol Psychiatry 22 (1987): 111-2
  24. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  25. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  26. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  27. Dave M "Tardive oculogyric crises with clozapine." J Clin Psychiatry 55 (1994): 264-5
  28. Kopala LC, Honer WG "Schizophrenia and severe tardive dyskinesia responsive to risperidone." J Clin Psychopharmacol 14 (1994): 430-1
  29. Riddle MA, Hardin MT, Towbin KE, et al "Tardive dyskinesia following haloperidol treatment in Tourette's syndrome." Arch Gen Psychiatry 44 (1987): 98-9
  30. Narendran R, Young CM, Pato MT "Possible risperidone-induced tardive dystonia." Ann Pharmacother 34 (2000): 1487-8
  31. Heel RC, Brogden RN, Speight TM, Avery GS "Loxapine: a review of its pharmacological properties and therapeutic efficacy as an antipsychotic agent." Drugs 15 (1978): 198-217
  32. Lamberti JS, Bellnier T "Clozapine and tardive dystonia." J Nerv Ment Dis 181 (1993): 137-8
  33. Buzan RD "Risperidone-induced tardive dyskinesia." Am J Psychiatry 153 (1996): 734-5
  34. Dave M "Clozapine-related tardive dyskinesia." Biol Psychiatry 35 (1994): 886-7
  35. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  36. Bruun RD "Subtle and underrecognized side effects of neuroleptic treatment in children with Tourette's disorder." Am J Psychiatry 145 (1988): 621-4
  37. Portnoy RA "Hyperkinetic dysarthria as an early indicator of impending tardive dyskinesia." J Speech Hear Disord 44 (1979): 214-9
  38. Mahmood T, Clothier EB, Bridgman R "Risperidone-induced extrapyramidal reactions." Lancet 346 (1995): 1226
  39. Herran A, Vazquez-Barquero JL "Tardive dyskinesia associated with olanzapine." Ann Intern Med 131 (1999): 72
  40. Woerner MG, Sheitman BB, Lieberman JA, Kane JM "Tardive dyskinesia induced by risperidone?" Am J Psychiatry 153 (1996): 843
  41. Owens DGC "Extrapyramidal side effects and tolerability of risperidone - a review." J Clin Psychiatry 55 Suppl (1994): 29-35
  42. Small JG, Milstein V, Marhenke JD, Hall DD, Kellams JJ "Treatment outcome with clozapine in tardive dyskinesia, neuroleptic sensitivity, and treatment-resistant psychosis." J Clin Psychiatry 48 (1987): 263-7
View all 42 references
Major

SSRI antidepressants (applies to Symbyax) depression

Major Potential Hazard, Moderate plausibility. Applicable conditions: Psychosis

Adult and pediatric patients with depression and other psychiatric disorders may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Families and caregivers should be advised of the need for close observation and communication with the treating physician. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset. It may be prudent to refrain from dispensing large quantities of medication to these patients.

Moderate

Antidepressant/antipsychotic agents (applies to Symbyax) depression

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Bipolar Disorder

Adult and pediatric patients with depression and other psychiatric disorders may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset.

Moderate

Antipsychotic agents (applies to Symbyax) aspiration

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Dysphagia

Esophageal dysmotility and aspiration have been associated with the use of antipsychotic drugs. These drugs should be administered cautiously in patients at risk for aspiration pneumonia.

Moderate

Antipsychotic/neuroleptic agents (applies to Symbyax) seizure

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Alcoholism, Seizures, Head Injury

Antipsychotic and neuroleptic drugs can lower the seizure threshold and trigger seizures in a dose-dependent manner. This risk is greatest in patients with a history of seizures or with conditions that lower the seizure threshold. Therapy with these drugs should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism.

Moderate

Atypical antipsychotic agents (applies to Symbyax) hematologic abnormalities

Moderate Potential Hazard, High plausibility. Applicable conditions: Neutropenia

Cases of leukopenia, neutropenia, and agranulocytosis have been reported with the use of atypical antipsychotic agents. Patients with preexisting low white blood cell count may be at increased risk. Therapy with these agents should be administered cautiously in patients with a history of, or predisposition to, decreased white blood cell or neutrophil counts. Clinical monitoring of hematopoietic function is recommended. At the first sign of a clinically significant decline in white blood cells, discontinuation of atypical antipsychotic therapy should be considered in the absence of other causative factors, and the patient closely monitored for fever or other signs and symptoms of infection.

Moderate

Atypical antipsychotic agents (applies to Symbyax) hyperglycemia/diabetes

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus, Obesity

Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported with the use of atypical antipsychotic agents. Patients with diabetes should be monitored for worsening control of blood glucose when treated with these agents. It is recommended that patients with risk factors for diabetes mellitus starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment, and periodically thereafter. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when treatment with these agents was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the atypical antipsychotic drug.

Moderate

Atypical antipsychotic agents (applies to Symbyax) hypotension

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Dehydration, Diarrhea, Vomiting, Syncope, Ischemic Heart Disease, Congestive Heart Failure, History - Myocardial Infarction, Arrhythmias, Cerebrovascular Insufficiency

The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.

Moderate

Atypical antipsychotic agents (applies to Symbyax) lipid alterations

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Hyperlipidemia

Atypical antipsychotic drugs have been associated with undesirable alterations in lipid levels. While all agents in the class have been shown to produce some changes, each drug has its own specific risk profile. Before or soon after initiation of antipsychotic medication, obtain a fasting lipid profile at baseline and monitor periodically during treatment.

Moderate

Atypical antipsychotic agents (applies to Symbyax) weight gain

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Obesity

Weight gain has been observed with atypical antipsychotic use. While all agents in the class have been shown to produce some changes, each drug has its own specific risk profile. When treating pediatric patients with atypical antipsychotic agents, weight gain should be monitored and assessed against that expected for normal growth. Monitor weight at baseline and frequently thereafter.

Moderate

Fluoxetine (applies to Symbyax) diabetes

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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.

References

  1. "Product Information. Prozac (fluoxetine)." Dista Products Company, Indianapolis, IN.
Moderate

Neuroleptics (applies to Symbyax) anticholinergic effects

Moderate Potential Hazard, High plausibility. Applicable conditions: 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.

References

  1. Frankenburg FR, Kando JC, Centorrino F, Gilbert JM "Bladder dysfunction associated with clozapine therapy." J Clin Psychiatry 57 (1996): 39-40
  2. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  3. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  4. Cohen MAA, Alfonso CA, Mosquera M "Development of urinary retention during treatment with clozapine and meclizine." Am J Psychiatry 151 (1994): 619-20
  5. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  6. Heel RC, Brogden RN, Speight TM, Avery GS "Loxapine: a review of its pharmacological properties and therapeutic efficacy as an antipsychotic agent." Drugs 15 (1978): 198-217
  7. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  8. Marinkovic D, Timotijevic I, Babinski T, Totic S, Paunovic VR "The side-effects of clozapine: a four year follow-up study." Prog Neuropsychopharmacol Biol Psychiatry 18 (1994): 537-44
  9. Grohmann R, Ruther E, Sassim N, Schmidt LG "Adverse effects of clozapine." Psychopharmacology (Berl) 99 (1989): s101-4
  10. Pinder RM, Brogden RN, Swayer R, Speight TM, Spencer R, Avery GS "Pimozide: a review of its pharmacological properties and therapeutic uses in psychiatry." Drugs 12 (1976): 1-40
  11. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  12. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  13. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  14. Tueth M "Side effects of clozipine (Clozaril) requiring emergency treatment." Am J Emerg Med 11 (1993): 312-3
View all 14 references
Moderate

Neuroleptics (applies to Symbyax) hyperprolactinemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Breast Cancer

The chronic use of neuroleptic agents can cause persistent elevations in prolactin levels due to antagonism of dopamine D2 receptors. 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. Caution is also advised in patients with preexisting hyperprolactinemia. Hyperprolactinemia may suppress hypothalamic gonadotrophin releasing hormone (GnRH), resulting in reduced pituitary gonadotropin secretion. This, in turn, may inhibit reproductive function by impairing gonadal steroidogenesis in both female and male patients. Galactorrhea, amenorrhea, gynecomastia, and impotence have been reported in patients receiving prolactin-elevating compounds; however, the clinical significance of elevated serum prolactin levels is unknown for most patients. Long-standing hyperprolactinemia when associated with hypogonadism may lead to decreased bone density in both female and male patients.

References

  1. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  2. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  3. Meco G, Falaschi P, Casacchia M, et al "Neuroendocrine effects of haloperidol decanoate in patients with chronic schizophrenia." Adv Biochem Psychopharmacol 40 (1985): 89-93
  4. Ash PR, Bouma D "Exaggerated hyperprolactinemia in response to thiothixene ." Arch Neurol 38 (1981): 534-5
  5. Bai YM, Ciu HJ, Guo ZZ "Risperidone-induced hyperprolactinemia in an elderly woman." Am J Psychiatry 159 (2002): 2112
  6. Dickson RA, Dalby JT, Williams R, Edwards AL "Risperidone-induced prolactin elevations in premenopausal women with schizophrenia." Am J Psychiatry 152 (1995): 1102-3
  7. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  8. Huang ML, Van Peer A, Woestenborghs R, De Coster R, Heykants J, Jansen AA, Zylicz Z, Visscher HW, Jonkman JH "Pharmacokinetics of the novel antipsychotic agent risperidone and the prolactin response in healthy subjects." Clin Pharmacol Ther 54 (1993): 257-68
  9. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  10. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  11. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  12. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  13. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  14. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  15. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  16. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
View all 16 references
Moderate

Neuroleptics (applies to Symbyax) liver disease

Moderate Potential Hazard, Moderate plausibility.

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.

References

  1. Hobbs DC "Metabolism of thiothixene." J Pharm Sci 57 (1968): 105-11
  2. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  3. Jann MW, Grimsley SR, Gray EC, Chang WH "Pharmacokinetics and pharmacodynamics of clozapine." Clin Pharmacokinet 24 (1993): 161-76
  4. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  5. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  6. Hobbs DC, Welch WM, Short MJ, Moody WA, Van der Velde CD "Pharmacokinetics of thiothixene in man." Clin Pharmacol Ther 16 (1974): 473-8
  7. Heel RC, Brogden RN, Speight TM, Avery GS "Loxapine: a review of its pharmacological properties and therapeutic efficacy as an antipsychotic agent." Drugs 15 (1978): 198-217
  8. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  9. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  10. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  11. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
View all 11 references
Moderate

Neuroleptics (applies to Symbyax) parkinsonism

Moderate Potential Hazard, Moderate plausibility.

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.

References

  1. Pinder RM, Brogden RN, Swayer R, Speight TM, Spencer R, Avery GS "Pimozide: a review of its pharmacological properties and therapeutic uses in psychiatry." Drugs 12 (1976): 1-40
  2. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  3. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  4. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  5. Moleman P, Janzen G, von Bargen BA, et al "Relationship between age and incidence of parkinsonism in psychiatric patients treated with haloperidol." Am J Psychiatry 143 (1986): 232-4
  6. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  7. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  8. Mahmood T, Clothier EB, Bridgman R "Risperidone-induced extrapyramidal reactions." Lancet 346 (1995): 1226
  9. Heel RC, Brogden RN, Speight TM, Avery GS "Loxapine: a review of its pharmacological properties and therapeutic efficacy as an antipsychotic agent." Drugs 15 (1978): 198-217
  10. Owens DGC "Extrapyramidal side effects and tolerability of risperidone - a review." J Clin Psychiatry 55 Suppl (1994): 29-35
  11. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  12. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  13. Bransgrove LL, Kelly MW "Movement disorders in patients treated with long-acting injectable antipsychotic drugs." Am J Hosp Pharm 51 (1994): 895-9
  14. Gwinn KA, Caviness JN "Risperidone-induced tardive dyskinesia and parkinsonism." Mov Disord 12 (1997): 119-21
View all 14 references
Moderate

Olanzapine (applies to Symbyax) ALT elevations

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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.

References

  1. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
Moderate

Olanzapine (applies to Symbyax) PKU

Moderate Potential Hazard, High plausibility. Applicable conditions: 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).

References

  1. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
Moderate

SSRI (applies to Symbyax) hyponatremia

Moderate Potential Hazard, Moderate plausibility.

Treatment with SSRI antidepressants can cause hyponatremia. Caution should be used when treating patients with hyponatremia or at greater risk of hyponatremia such as the elderly, patients taking diuretics or who are volume depleted.

Moderate

SSRIs (applies to Symbyax) glaucoma

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma (Narrow Angle)

Some SSRI antidepressants such as fluoxetine, paroxetine and sertraline may have an effect on pupil size causing dilation. This effect can potentially narrow the eye angle resulting in increased intraocular pressure and angle closure glaucoma, especially in predisposed patients. These drugs should be used with caution in patients with angle-closure glaucoma or history of glaucoma.

Moderate

SSRIs (applies to Symbyax) liver disease

Moderate Potential Hazard, High plausibility.

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.

References

  1. Guthrie SK "Sertraline: a new specific serotonin reuptake blocker." DICP 25 (1991): 952-61
  2. "Product Information. Celexa (citalopram)." Forest Pharmaceuticals, St. Louis, MO.
  3. "Product Information. Zoloft (sertraline)." Roerig Division, New York, NY.
  4. "Product Information. Luvox (fluvoxamine)." Solvay Pharmaceuticals Inc, Marietta, GA.
  5. "Product Information. Paxil (paroxetine)." GlaxoSmithKline, Research Triangle Park, NC.
  6. Wilde MI, Plosker GL, Benfield P "Fluvoxamine. An updated review of its pharmacology, and therapeutic use in depressive illness." Drugs 46 (1993): 895-924
  7. "Product Information. Prozac (fluoxetine)." Dista Products Company, Indianapolis, IN.
  8. Doogan DP, Caillard V "Sertraline: a new antidepressant." J Clin Psychiatry 49 (1988): 46-51
  9. Krastev Z, Terziivanov D, Vlahov V, Maleev A, Greb WH, Eckl KM, Dierdorf HD, Wolf D "The pharmacokinetics of paroxetine in patients with liver cirrhosis." Acta Psychiatr Scand Suppl 350 (1989): 91-2
  10. Kaye CM, Haddock RE, Langley PF, Mellows G, Tasker TC, Zussman BD, Greb WH "A review of the metabolism and pharmacokinetics of paroxetine in man." Acta Psychiatr Scand Suppl 350 (1989): 60-75
  11. van Harten J "Clinical pharmacokinetics of selective serotonin reuptake inhibitors." Clin Pharmacokinet 24 (1993): 203-20
  12. Finley PR "Selective serotonin reuptake inhibitors: pharmacologic profiles and potential therapeutic distinctions." Ann Pharmacother 28 (1994): 1359-69
  13. "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals, St. Louis, MO.
  14. Lund J, Thayssen P, Mengel H, Pedersen OL, Kristensen CB, Gram LF "Paroxetine: pharmacokinetics and cardiovascular effects after oral and intravenous single doses in man." Acta Pharmacol Toxicol (Copenh) 51 (1982): 351-7
  15. Benfield P, Ward A "Fluvoxamine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness." Drugs 32 (1986): 313-34
  16. Murdoch D, McTavish D "Sertraline. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depression and obsessive- compulsive disorder." Drugs 44 (1992): 604-24
  17. Schenker S, Bergstrom RF, Wolen RL, Lemberger L "Fluoxetine disposition and elimination in cirrhosis." Clin Pharmacol Ther 44 (1988): 353-9
View all 17 references
Moderate

SSRIs (applies to Symbyax) mania

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Bipolar Disorder, Depression

Selective serotonin reuptake inhibitors (SSRIs), like other antidepressants, may occasionally cause or activate 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. Prior to initiating treatment, it is recommended to adequately screen patients for bipolar disorder, including a family history of suicide, bipolar disorder, and depression.

References

  1. Piredda SG, Rubinstein SL "Hypomania induced by fluoxetine?" Biol Psychiatry 32 (1992): 107
  2. Peet M "Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants." Br J Psychiatry 164 (1994): 549-50
  3. "Product Information. Zoloft (sertraline)." Roerig Division, New York, NY.
  4. Guthrie SK "Sertraline: a new specific serotonin reuptake blocker." DICP 25 (1991): 952-61
  5. Wagner W, Plekkenpol B, Gray TE, Vlaskamp H, Essers H "Review of fluvoxamine safety database." Drugs 43 Suppl 2 (1992): 48-53;disc. 53-4
  6. Burrai C, Bocchetta A, del Zompo M "Mania and fluvoxamine." Am J Psychiatry 148 (1991): 1263-4
  7. Lensgraf SJ, Favazza AR "Antidepressant-induced mania." Am J Psychiatry 147 (1990): 1569
  8. Vieta E, Bernardo M "Antidepressant-induced mania in obsessive-compulsive disorder." Am J Psychiatry 149 (1992): 1282-3
  9. "Product Information. Celexa (citalopram)." Forest Pharmaceuticals, St. Louis, MO.
  10. Beal DM, Harris D, Bartos M, Korsak C, Splane G, Quant R, Starke J "Safety and efficacy of fluoxetine." Am J Psychiatry 148 (1991): 1751
  11. Howland RH "Induction of mania with serotonin reuptake inhibitors." J Clin Psychopharmacol 16 (1996): 425-7
  12. "Product Information. Luvox (fluvoxamine)." Solvay Pharmaceuticals Inc, Marietta, GA.
  13. Diaferia G, Mundo E, Bianchi Y, Ronchi P "Behavioral side effects in obsessive-compulsive patients treated with fluvoxamine: a clinical description." J Clin Psychopharmacol 14 (1994): 78-9
  14. Boyer WF, Blumhardt CL "The safety profile of paroxetine." J Clin Psychiatry 53 Suppl (1992): 61-6
  15. "Product Information. Prozac (fluoxetine)." Dista Products Company, Indianapolis, IN.
  16. "Product Information. Paxil (paroxetine)." GlaxoSmithKline, Research Triangle Park, NC.
  17. Messiha FS "Fluoxetine - adverse effects and drug-drug interactions." J Toxicol Clin Toxicol 31 (1993): 603-30
  18. Marshall RD, Printz D, Cardenas D, Abbate L, Liebowitz MR "Adverse events in PTSD patients taking fluoxetine." Am J Psychiatry 152 (1995): 1238-9
  19. Dorevitch A, Frankel Y, Bar-Halperin A, Aronzon R, Zilberman L "Fluvoxamine-associated manic behavior: a case series." Ann Pharmacother 27 (1993): 1455-7
  20. Jefferson JW, Greist JH, Perse TL, Rosenfeld R "Fluvoxamine-associated mania/hypomania in patients with obsessive- compulsive disorder." J Clin Psychopharmacol 11 (1991): 391-2
  21. Achamallah NS, Decker DH "Mania induced by fluoxetine in an adolescent patient." Am J Psychiatry 148 (1991): 1404
  22. Murdoch D, McTavish D "Sertraline. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depression and obsessive- compulsive disorder." Drugs 44 (1992): 604-24
  23. Laporta M, Chouinard G, Goldbloom D, Beauclair L "Hypomania induced by sertraline, a new serotonin reuptake inhibitor." Am J Psychiatry 144 (1987): 1513-4
  24. Edwards JG, Inman WH, Wilton L, Pearce GL "Prescription-event monitoring of 10,401 patients treated with fluvoxamine." Br J Psychiatry 164 (1994): 387-95
  25. Mundo E, Ronchi P, Bellodi L "Drug-induced mania." Hosp Community Psychiatry 44 (1993): 689-90
  26. Berthier ML, Kulisevsky J "Fluoxetine - induced mania in a patient with poststroke depression." Br J Psychiatry 163 (1993): 698-9
  27. "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals, St. Louis, MO.
View all 27 references
Moderate

SSRIs (applies to Symbyax) platelet function

Moderate Potential Hazard, High plausibility. Applicable conditions: 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.

References

  1. Hergovich N, Aigner M, Eichler HG, Entlicher J, Drucker C, Jilma B "Paroxetine decreases platelet serotonin storage and platelet function in human beings." Clin Pharmacol Ther 68 (2000): 435-42
  2. "Product Information. Zoloft (sertraline)." Roerig Division, New York, NY.
  3. Skop BP, Brown TM "Potential vascular and bleeding complications of treatment with selective serotonin reuptake inhibitors." Psychosomatics 37 (1996): 12-6
  4. Alderman CP, Moritz CK, Ben-Tovim DI "Abnormal platelet aggregation associated with fluoxetine therapy." Ann Pharmacother 26 (1992): 1517-9
  5. "Product Information. Luvox (fluvoxamine)." Solvay Pharmaceuticals Inc, Marietta, GA.
  6. "Product Information. Paxil (paroxetine)." GlaxoSmithKline, Research Triangle Park, NC.
  7. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
  8. Leung M, Shore R "Fluvoxamine-associated bleeding." Can J Psychiatry 41 (1996): 604-5
  9. Pai VB, Kelly MW "Bruising associated with the use of fluoxetine." Ann Pharmacother 30 (1996): 786-8
  10. "Product Information. Prozac (fluoxetine)." Dista Products Company, Indianapolis, IN.
  11. Ottervanger JP, Stricker BH, Huls J, Weeda JN "Bleeding attributed to the intake of paroxetine." Am J Psychiatry 151 (1994): 781-2
  12. Aranth J, Lindberg C "Bleeding, a side effect of fluoxetine." Am J Psychiatry 149 (1992): 412
  13. "Product Information. Celexa (citalopram)." Forest Pharmaceuticals, St. Louis, MO.
  14. Yaryura-Tobias JA, Kirschen H, Ninan P, Mosberg HJ "Fluoxetine and bleeding in obsessive-compulsive disorder." Am J Psychiatry 148 (1991): 949
  15. Messiha FS "Fluoxetine - adverse effects and drug-drug interactions." J Toxicol Clin Toxicol 31 (1993): 603-30
  16. Humphries JE, Wheby MS, VandenBerg SR "Fluoxetine and the bleeding time." Arch Pathol Lab Med 114 (1990): 727-8
  17. Krivy J, Wiener J "Sertraline and platelet counts in idiopathic thrombocytopenia purpura." Lancet 345 (1995): 132
  18. Alderman CP, Seshadri P, Ben-Tovim DI "Effects of serotonin reuptake inhibitors on hemostasis." Ann Pharmacother 30 (1996): 1232-4
View all 18 references
Moderate

SSRIs (applies to Symbyax) QT prolongation

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Long QT Syndrome, Ventricular Arrhythmia

Some SSRI antidepressants such as fluoxetine and citalopram have shown to cause QT interval prolongation and ventricular arrhythmias including Torsade de Pointes. These drugs should be used with caution in patients with congenital QT syndrome, a previous personal or family history of QT prolongation, and ventricular arrhythmia. Consider periodic EKG assessment on these patients. Treatment should be discontinued and a cardiac evaluation should be considered if a patient develops signs or symptoms of ventricular arrhythmia.

Moderate

SSRIs (applies to Symbyax) seizure disorders

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Seizures

Selective serotonin reuptake inhibitors (SSRIs) may trigger seizures in approximately 0.2% of patients, and some of them are not recommended in patients with unstable epilepsy. Therapy with SSRIs should be administered cautiously in patients with seizure disorders.

References

  1. Marshall RD, Printz D, Cardenas D, Abbate L, Liebowitz MR "Adverse events in PTSD patients taking fluoxetine." Am J Psychiatry 152 (1995): 1238-9
  2. Hargrave R, Martinez D, Bernstein AJ "Fluoxetine-induced seizures." Psychosomatics 33 (1992): 236-9
  3. "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals, St. Louis, MO.
  4. Messiha FS "Fluoxetine - adverse effects and drug-drug interactions." J Toxicol Clin Toxicol 31 (1993): 603-30
  5. Nemeroff CB "The clinical pharmacology and use of paroxetine, a new selective serotonin reuptake inhibitor." Pharmacotherapy 14 (1994): 127-38
  6. Edwards JG, Inman WH, Wilton L, Pearce GL "Prescription-event monitoring of 10,401 patients treated with fluvoxamine." Br J Psychiatry 164 (1994): 387-95
  7. Kim KY, Craig JM, Hawley JM "Seizure possibly associated with fluvoxamine." Ann Pharmacother 34 (2000): 1276-8
  8. "Product Information. Luvox (fluvoxamine)." Solvay Pharmaceuticals Inc, Marietta, GA.
  9. Boyer WF, Blumhardt CL "The safety profile of paroxetine." J Clin Psychiatry 53 Suppl (1992): 61-6
  10. Madi L, Obrien AAJ, Fennell J "Status epilepticus secondary to fluoxetine." Postgrad Med J 70 (1994): 383-4
  11. Murdoch D, McTavish D "Sertraline. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depression and obsessive- compulsive disorder." Drugs 44 (1992): 604-24
  12. Doogan DP, Caillard V "Sertraline: a new antidepressant." J Clin Psychiatry 49 (1988): 46-51
  13. Wagner W, Plekkenpol B, Gray TE, Vlaskamp H, Essers H "Review of fluvoxamine safety database." Drugs 43 Suppl 2 (1992): 48-53;disc. 53-4
  14. Spivey KM, Wait CM "Perioperative seizures and fluvoxamine." Br J Anaesth 71 (1993): 321
  15. "Product Information. Celexa (citalopram)." Forest Pharmaceuticals, St. Louis, MO.
  16. "Product Information. Zoloft (sertraline)." Roerig Division, New York, NY.
  17. Deahl M, Trimble M "Serotonin reuptake inhibitors, epilepsy and myoclonus." Br J Psychiatry 159 (1991): 433-5
  18. "Product Information. Paxil (paroxetine)." GlaxoSmithKline, Research Triangle Park, NC.
  19. Levine R, Kenin M, Hoffman JS, Dayknepple E "Grand mal seizures associated with the use of fluoxetine." J Clin Psychopharmacol 14 (1994): 145-6
  20. "Product Information. Prozac (fluoxetine)." Dista Products Company, Indianapolis, IN.
  21. Guthrie SK "Sertraline: a new specific serotonin reuptake blocker." DICP 25 (1991): 952-61
View all 21 references
Moderate

SSRIs (applies to Symbyax) SIADH

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Dehydration, Hyponatremia

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.

References

  1. Kessler J, Samuels SC "Sertraline and hyponatremia." N Engl J Med 335 (1996): 524
  2. Baliga RR, McHardy KC "Syndrome of inappropriate antidiuretic hormone secretion due to fluvoxamine therapy [published erratum appears in Br J Clin Pract 1993 May-Jun;47(3):119]." Br J Clin Pract 47 (1993): 62-3
  3. Schattner A, Skurnik Y "Fluoxetine-induced SIADH." J Am Geriatr Soc 44 (1996): 1413
  4. Robinson D, Brooks J, Mahler E, Sheikh JI "SIADH--compulsive drinking or SSRI influence?" Ann Pharmacother 30 (1996): 885
  5. Chua TP, Vong SK "Hyponatraemia associated with paroxetine." BMJ 306 (1993): 143
  6. Woo MH, Smythe MA "Association of SIADH with selective serotonin reuptake inhibitors." Ann Pharmacother 31 (1997): 108-10
  7. "Product Information. Luvox (fluvoxamine)." Solvay Pharmaceuticals Inc, Marietta, GA.
  8. Llorente MD, Gorelick M, Silverman MA "Sertraline as the cause of inappropriate antidiuretic hormone secretion." J Clin Psychiatry 55 (1994): 543-4
  9. Staab JP, Yerkes SA, Cheney EM, Clayton AH "Transient SIADH associated with fluoxetine." Am J Psychiatry 147 (1990): 1569-70
  10. Doshi D, Borison R "Association of transient SIADH with sertraline." Am J Psychiatry 151 (1994): 779-80
  11. "Product Information. Prozac (fluoxetine)." Dista Products Company, Indianapolis, IN.
  12. Bouman WP, Johnson H, TrescoliSerrano C, Jones RG "Recurrent hyponatremia associated with sertraline and lofepramine." Am J Psychiatry 154 (1997): 580
  13. Girault C, Richard JC, Chevron V, Goulle JP, Droy JM, Bonmarchand G, Leroy J "Syndrome of inappropriate secretion of antidiuretic hormone in two elderly women with elevated serum fluoxetine." J Toxicol Clin Toxicol 35 (1997): 93-5
  14. Blacksten JV, Birt JA "Syndrome of inappropriate secretion of antidiuretic hormone secondary to fluoxetine." Ann Pharmacother 27 (1993): 723-4
  15. Bradley ME, Foote EF, Lee EN, Merkle L "Sertraline-associated syndrome of inappropriate antidiuretic hormone: case report and review of the literature." Pharmacotherapy 16 (1996): 680-3
  16. "Selective serotonin reuptake inhibitors and SIADH." Med J Aust 164 (1996): 562
  17. "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals, St. Louis, MO.
  18. Ayonrinde OT, Sanfilippo FM "SSRI antidepressants and SIADH." Aust N Z J Psychiatry 31 (1997): 306-7
  19. Vishwanath BM, Navalgund AA, Cusano W, Navalgund KA "Fluoxetine as a cause of SIADH." Am J Psychiatry 148 (1991): 542-3
  20. Goddard C, Paton C "Hyponatraemia associated with paroxetine." BMJ 305 (1992): 1332
  21. "Product Information. Zoloft (sertraline)." Roerig Division, New York, NY.
  22. Kazal LA, Jr Hall DL, Miller LG, Noel ML "Fluoxetine-induced SIADH: a geriatric occurrence?" J Fam Pract 36 (1993): 341-3
  23. Thornton SL, Resch DS "SIADH associated with sertraline therapy." Am J Psychiatry 152 (1995): 809
  24. "Product Information. Celexa (citalopram)." Forest Pharmaceuticals, St. Louis, MO.
  25. "Product Information. Paxil (paroxetine)." GlaxoSmithKline, Research Triangle Park, NC.
  26. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
  27. Crews JR, Potts NL, Schreiber J, Lipper S "Hyponatremia in a patient treated with sertraline." Am J Psychiatry 150 (1993): 1564
  28. Cohen BJ, Mahelsky M, Adler L "More cases of SIADH with fluoxetine." Am J Psychiatry 147 (1990): 948-9
  29. Ayonrinde OT, Reutens SG, Sanfilippo FM "Paroxetine-induced SIADH." Med J Aust 163 (1995): 390
  30. Jackson C, Carson W, Markowitz J, Mintzer J "SIADH associated with fluoxetine and sertraline therapy." Am J Psychiatry 152 (1995): 809-10
View all 30 references
Minor

Fluoxetine (applies to Symbyax) renal dysfunction

Minor Potential Hazard, Low plausibility.

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.

References

  1. "Product Information. Prozac (fluoxetine)." Dista Products Company, Indianapolis, IN.
  2. Aronoff GR, Bergstrom RF, Pottratz ST, Sloan RS, Wolen RL, Lemberger L "Fluoxetine kinetics and protein binding in normal and impaired renal function." Clin Pharmacol Ther 36 (1984): 138-44
Minor

SSRIs (applies to Symbyax) weight loss

Minor Potential Hazard, Moderate plausibility. Applicable conditions: 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.

References

  1. "Product Information. Celexa (citalopram)." Forest Pharmaceuticals, St. Louis, MO.
  2. Fernstrom MH, Massoudi M, Kupfer DJ "Fluvoxamine and weight loss." Biol Psychiatry 24 (1988): 948-9
  3. "Product Information. Prozac (fluoxetine)." Dista Products Company, Indianapolis, IN.
  4. Oliveros SC, Iruela LM, Caballero L, Baca E "Fluoxetine-induced anorexia in a bulimic patient." Am J Psychiatry 149 (1992): 1113-4
  5. Fichtner CG, Braum BG "Hyperphagia and weight loss during fluoxetine treatment." Ann Pharmacother 28 (1994): 1350-2
  6. Vaz FJ, Salcedo MS "Fluoxetine-induced anorexia in a bulimic patient with antecedents of anorexia nervosa." J Clin Psychiatry 55 (1994): 118-9
  7. "Product Information. Paxil (paroxetine)." GlaxoSmithKline, Research Triangle Park, NC.
  8. Wagner W, Plekkenpol B, Gray TE, Vlaskamp H, Essers H "Review of fluvoxamine safety database." Drugs 43 Suppl 2 (1992): 48-53;disc. 53-4
  9. "Product Information. Zoloft (sertraline)." Roerig Division, New York, NY.
  10. Meyerowitz W, Jaramillo JDC "Sertraline treatment and weight loss." Curr Ther Res Clin Exp 55 (1994): 1176-81
  11. "Product Information. Luvox (fluvoxamine)." Solvay Pharmaceuticals Inc, Marietta, GA.
View all 11 references

Symbyax (fluoxetine / olanzapine) drug interactions

There are 794 drug interactions with Symbyax (fluoxetine / olanzapine)

Symbyax (fluoxetine / olanzapine) alcohol/food interactions

There are 5 alcohol/food interactions with Symbyax (fluoxetine / olanzapine)

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.