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Fluoxetine / olanzapine Disease Interactions

There are 32 disease interactions with fluoxetine / olanzapine:

Major

Atypical Antipsychotic Agents (Includes Fluoxetine/olanzapine) ↔ Dementia

Severe Potential Hazard, High plausibility

Applies to: Dementia

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 had 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 (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.

References

  1. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  2. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  3. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
View all 10 references
Major

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.

References

  1. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  2. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  3. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
View all 7 references
Major

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.

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
View all 40 references
Major

Neuroleptics (Includes Fluoxetine/olanzapine) ↔ Tardive Dyskinesia

Severe Potential Hazard, High 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.

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. Ghelber D, Belmaker RH "Tardive dyskinesia with quetiapine." Am J Psychiat 156 (1999): 796-7
  3. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
View all 42 references
Major

Ssri Antidepressants (Includes Fluoxetine/olanzapine) ↔ Depression

Severe Potential Hazard, Moderate plausibility

Applies to: Bipolar Disorder, Depression, 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 (Includes Fluoxetine/olanzapine) ↔ Depression

Moderate Potential Hazard, Moderate plausibility

Applies to: Depression, 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 (Includes Fluoxetine/olanzapine) ↔ Aspiration

Moderate Potential Hazard, Moderate plausibility

Applies to: 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 Agents (Includes Fluoxetine/olanzapine) ↔ Seizure

Moderate Potential Hazard, Moderate plausibility

Applies to: Alcoholism, Seizures, Head Injury

Antipsychotic 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 Antipsychotic 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 (Includes Fluoxetine/olanzapine) ↔ Hematologic Abnormalities

Moderate Potential Hazard, High plausibility

Applies to: 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 (Includes Fluoxetine/olanzapine) ↔ Hyperglycemia/Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: 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 (Includes Fluoxetine/olanzapine) ↔ Hypotension

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypotension, 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 (Includes Fluoxetine/olanzapine) ↔ Lipid Alterations

Moderate Potential Hazard, Moderate plausibility

Applies to: 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 (Includes Fluoxetine/olanzapine) ↔ Weight Gain

Moderate Potential Hazard, Moderate plausibility

Applies to: 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 (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.

References

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

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.

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. Grohmann R, Ruther E, Sassim N, Schmidt LG "Adverse effects of clozapine." Psychopharmacology (Berl) 99 (1989): s101-4
View all 14 references
Moderate

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.

References

  1. Dickson RA, Dalby JT, Williams R, Edwards AL "Risperidone-induced prolactin elevations in premenopausal women with schizophrenia." Am J Psychiatry 152 (1995): 1102-3
  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
View all 16 references
Moderate

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.

References

  1. Hobbs DC "Metabolism of thiothixene." J Pharm Sci 57 (1968): 105-11
  2. Jann MW, Grimsley SR, Gray EC, Chang WH "Pharmacokinetics and pharmacodynamics of clozapine." Clin Pharmacokinet 24 (1993): 161-76
  3. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
View all 11 references
Moderate

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.

References

  1. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  2. 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
  3. 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
View all 14 references
Moderate

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.

References

  1. Mahr GC, Berchou R, Balon R "A grand mal seizure associated with desipramine and haloperidol." Can J Psychiatry 32 (1987): 463-4
  2. Welch J, Manschreck T, Redmond D "Clozapine-induced seizures and EEG changes." J Neuropsychiatry Clin Neurosci 6 (1994): 250-6
  3. 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
View all 29 references
Moderate

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.

References

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

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).

References

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

Ssri (Includes Fluoxetine/olanzapine) ↔ Hyponatremia

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyponatremia

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 (Includes Fluoxetine/olanzapine) ↔ Glaucoma

Moderate Potential Hazard, Moderate plausibility

Applies to: Glaucoma/Intraocular Hypertension, 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 (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.

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. Finley PR "Selective serotonin reuptake inhibitors: pharmacologic profiles and potential therapeutic distinctions." Ann Pharmacother 28 (1994): 1359-69
View all 17 references
Moderate

Ssris (Includes Fluoxetine/olanzapine) ↔ Mania

Moderate Potential Hazard, Moderate plausibility

Applies to: Mania, 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. Peet M "Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants." Br J Psychiatry 164 (1994): 549-50
  2. "Product Information. Zoloft (sertraline)." Roerig Division, New York, NY.
  3. Guthrie SK "Sertraline: a new specific serotonin reuptake blocker." DICP 25 (1991): 952-61
View all 27 references
Moderate

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.

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. Messiha FS "Fluoxetine - adverse effects and drug-drug interactions." J Toxicol Clin Toxicol 31 (1993): 603-30
View all 18 references
Moderate

Ssris (Includes Fluoxetine/olanzapine) ↔ Qt Prolongation

Moderate Potential Hazard, Moderate plausibility

Applies to: 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 (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, 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.
View all 21 references
Moderate

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.

References

  1. Kessler J, Samuels SC "Sertraline and hyponatremia." N Engl J Med 335 (1996): 524
  2. Schattner A, Skurnik Y "Fluoxetine-induced SIADH." J Am Geriatr Soc 44 (1996): 1413
  3. 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
View all 30 references
Moderate

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.

References

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

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.

References

  1. "Product Information. Celexa (citalopram)." Forest Pharmaceuticals, St. Louis, MO.
  2. 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
  3. Fernstrom MH, Massoudi M, Kupfer DJ "Fluvoxamine and weight loss." Biol Psychiatry 24 (1988): 948-9
View all 11 references

You should also know about...

fluoxetine / olanzapine drug Interactions

There are 1242 drug interactions with fluoxetine / olanzapine

fluoxetine / olanzapine alcohol/food Interactions

There are 5 alcohol/food interactions with fluoxetine / olanzapine

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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