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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). This medicine is sometimes used after at least 2 other medications have been tried without success.

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 this medicine if you also take pimozide or thioridazine, or if you take fluoxetine or olanzapine in a non-combination form (Prozac, Zyprexa, and others).

Serious drug interactions can occur when certain medicines are used with fluoxetine and olanzapine. Tell your doctor about all your current medicines and any you start or stop using.

Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

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

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

You should not use this medicine if you also take pimozide or thioridazine, or if you take other forms of fluoxetine or olanzapine (such as Prozac, Rapiflux, Sarafem, Selfemra, or Zyprexa).

Do not use this medicine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine. Do not take an MAO inhibitor within 5 weeks after you stop taking fluoxetine and olanzapine.

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.

To make sure this medicine 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, high or low blood pressure, history of heart attack or stroke;

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

  • personal or family history of long QT syndrome;

  • low levels of potassium or magnesium in your blood;

  • a bleeding or blood-clotting disorder;

  • an enlarged prostate, bowel obstruction, or severe constipation;

  • breast cancer; 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. If you become pregnant while taking fluoxetine and olanzapine, do not stop taking it 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. 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.

It may take up to 4 weeks before your symptoms improve. 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), including aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using this medicine with an NSAID may cause you to bruise or bleed easily.

Avoid driving or operating machinery until you know how this medicine will affect you. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Dizziness or severe drowsiness can cause falls, fractures, or other injuries.

Fluoxetine and olanzapine side effects

Get emergency medical help if you have signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

In rare cases, olanzapine may cause a severe drug reaction that can affect many parts of the body. Seek medical treatment if you have new or worsening symptoms of fever, facial swelling, a red or blistering skin rash, flu symptoms, swollen glands, feeling weak or tired, severe tingling or numbness, upper stomach pain, loss of appetite, jaundice (yellowing of the skin or eyes), weight loss, pain or burning when you urinate, lower back pain, swelling in your legs or feet, cough, chest pain, or trouble breathing.

High doses or long-term use of fluoxetine and olanzapine can cause a serious movement disorder that may not be reversible, especially in women and older adults. Tell your doctor right away if you have uncontrollable muscle movements of your lips, tongue, eyes, face, arms, or legs.

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.

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, fruity breath odor, confusion, upset stomach.

Common side effects may include:

  • increased appetite, weight gain;

  • trouble concentrating, feeling tired;

  • 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)

What other drugs will affect fluoxetine and olanzapine?

Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.

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

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

  • any other antidepressant;

  • St. John's Wort;

  • tryptophan (sometimes called L-tryptophan);

  • a blood thinner--warfarin, Coumadin, Jantoven;

  • medicine to treat anxiety, mood disorders, thought disorders, or mental illness--amitriptyline, buspirone, desipramine, lithium, nortriptyline, and many others;

  • medicine to treat ADHD or narcolepsy--Adderall, Concerta, Ritalin, Vyvanse, and others;

  • migraine headache medicine--rizatriptan, sumatriptan, zolmitriptan, and others; or

  • narcotic pain medicine--fentanyl, tramadol.

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: 15.02.

Date modified: May 03, 2017
Last reviewed: March 28, 2017

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