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Olanzapine/fluoxetine
Combination of
Olanzapine	Atypical antipsychotic
Fluoxetine	Selective serotonin reuptake inhibitor
Clinical data
Trade names	Symbyax, Cinol Forte, Olapin Forte, others
AHFS/Drugs.com	Professional Drug Facts
License data	US DailyMed: Olanzapine_and_fluoxetine;
Pregnancy; category	AU: C; ;
Routes of; administration	By mouth
ATC code	N06CA03 (WHO) ;
Legal status
Legal status	US: ℞-only;
Identifiers
CAS Number	250603-12-4;
KEGG	D10206 ;
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Olanzapine/fluoxetine (trade name Symbyax, created by Eli Lilly and Company) is a fixed-dose combination medication containing olanzapine (Zyprexa), an atypical antipsychotic, and fluoxetine (Prozac), a selective serotonin reuptake inhibitor (SSRI). Olanzapine/fluoxetine is primarily used to treat the depressive episodes of bipolar I disorder^[2] as well as treatment-resistant depression.^[1]^[3]

Medical uses

Olanzapine/fluoxetine was approved by the U.S. Food and Drug Administration (FDA) to treat the depressive episodes of bipolar I disorder in 2003.^[1] In 2009, it was granted approval for the treatment of treatment-resistant depression.^[4]

Olanzapine/fluoxetine, or other antidepressant/antipsychotic combinations, are sometimes prescribed off-label for anxiety disorders,^[5] eating disorders,^[6] obsessive–compulsive disorder (OCD),^[7] and posttraumatic stress disorder (PTSD).^[8]

Side effects

Possible side effects of olanzapine/fluoxetine include all those of the two component drugs: olanzapine (side effects) and fluoxetine (side effects). Common side effects include suicidal thoughts, increased appetite, weight gain, drowsiness, fatigue, dry mouth, swelling, tremor, blurred vision, and difficulty concentrating.^[1]

Olanzapine/fluoxetine could produce a severe allergic reaction and should not be used if the patient has previously experienced an allergic reaction to either fluoxetine or olanzapine.^[9]

Olanzapine is correlated with an increase in blood sugar. Patients with diabetes, or those at risk for developing it, require careful monitoring.^[9]

In rare cases, olanzapine/fluoxetine may cause neuroleptic malignant syndrome.^[1]

Like other SSRIs, olanzapine/fluoxetine carries a boxed warning stating that it could increase the risk of suicidal thoughts and behaviors in patients aged 24 and under. The warning also states that olanzapine/fluoxetine may increase the risk of death in elderly patients with dementia-related psychosis.^[1]

References

^ ^a ^b ^c ^d ^e ^f "Symbyax- olanzapine and fluoxetine hydrochloride capsule". DailyMed. 21 April 2020. Retrieved 30 September 2020.
^ "Tratamento medicamentoso dos transtornos bipolares - Transtornos psiquiátricos". Manuais MSD edição para profissionais (in Brazilian Portuguese). Retrieved 2022-10-02.
^ Benazzi F, Berk M, Frye MA, Wang W, Barraco A, Tohen M (October 2009). "Olanzapine/fluoxetine combination for the treatment of mixed depression in bipolar I disorder: a post hoc analysis". The Journal of Clinical Psychiatry. 70 (10): 1424–1431. doi:10.4088/JCP.08m04772gre. PMID 19906346.
^ Grohol, J. "FDA Approves Symbyax for Treatment Resistant Depression". Psych Central Blog. Archived from the original on 2017-12-26. Retrieved 2010-07-17.
^ McIntyre R, Katzman M (2003). "The role of atypical antipsychotics in bipolar depression and anxiety disorders". Bipolar Disorders. 5 (Suppl 2): 20–35. doi:10.1111/j.1399-2406.2003.00061.x. PMID 14700010.
^ Pederson KJ, Roerig JL, Mitchell JE (October 2003). "Towards the pharmacotherapy of eating disorders". Expert Opinion on Pharmacotherapy. 4 (10): 1659–1678. doi:10.1517/14656566.4.10.1659. PMID 14521477. S2CID 38506292.
^ Koran LM, Ringold AL, Elliott MA (July 2000). "Olanzapine augmentation for treatment-resistant obsessive-compulsive disorder". The Journal of Clinical Psychiatry. 61 (7): 514–517. doi:10.4088/JCP.v61n0709. PMID 10937610.
^ Stein MB, Kline NA, Matloff JL (October 2002). "Adjunctive olanzapine for SSRI-resistant combat-related PTSD: a double-blind, placebo-controlled study". The American Journal of Psychiatry. 159 (10): 1777–1779. doi:10.1176/appi.ajp.159.10.1777. PMID 12359687.
^ ^a ^b "Symbyax". Drugs.com.