Olanzapine/Fluoxetine, Oral

What are other names for this medicine?

Type of medicine: antipsychotic/antidepressant for bipolar depression

Generic and brand names: olanzapine/fluoxetine, oral; Symbyax

What is this medicine used for?

This medicine is taken by mouth to treat depression in people with bipolar disorder. It may be used for other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• Alzheimer's disease or dementia
• diabetes
• an enlarged prostate or trouble urinating
• glaucoma
• heart disease, a heart attack, stroke, or heart failure
• high cholesterol
• low blood pressure
• liver or kidney disease
• Parkinson's disease
• problems with low levels of sodium in the blood
• seizures
• thoughts of suicide
• trouble swallowing

Tell your healthcare provider if you are taking or planning to take any other prescription or nonprescription medicines during treatment with this medicine.

Do not take this medicine if you have taken an MAO inhibitor antidepressant or thioridazine in the last 5 weeks. Serious side effects can occur. Talk with your healthcare provider about this.

Do not take pimozide (Orap) while taking this medicine.

Females of childbearing age: Talk with your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

Check the label on the medicine for directions about your specific dose. Take it at night unless specifically instructed otherwise by your healthcare provider. Take this medicine exactly as directed by your healthcare provider. Do not increase the dosage on your own. Do not stop taking this medicine without your healthcare provider's approval. Your dosage needs to be reduced gradually.

If you miss a dose, do not take a double dose the next day. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: irregular heartbeat, trouble walking, coma, confusion, seizures, drowsiness.

What should I watch out for?

Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment. Talk with your provider about this.

Behavior changes may be caused by the medicine or by depression or another mental illness. Contact your provider right away if you or your family notice any disturbing changes in your thoughts or behavior, such as:

• more outgoing or aggressive behavior than normal
• confusion
• hallucinations
• worsening of depression
• suicidal thoughts

This medicine can cause low blood pressure, especially at the beginning of treatment or when taken with alcohol or diazepam (Valium). Low blood pressure may make you feel lightheaded or dizzy. Take care to avoid falling.

Older adults with dementia are at greater risk for side effects. Talk with your provider about this.

This medicine can cause drowsiness, dizziness, and problems with judgment. Do not drive or operate machinery until you are fully alert.

While taking this medicine, be careful when you exercise, especially when it is hot. This medicine affects your body's ability to cool down, and you may get too hot. If you get too hot, you might vomit, feel dizzy, have a fast heartbeat, get very stiff muscles, or be confused. Contact your provider right away if you have these symptoms.

This medicine may increase the risk of developing diabetes, especially if you are overweight or have a family history of diabetes. If you have diabetes, this medicine may affect your blood sugar level and change the amount of insulin or other diabetes medicines you may need. Talk to your healthcare provider about this.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you are unable to reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat)

Serious (report these to your healthcare provider right away): Thoughts of suicide; seizures; increased thirst; increased urination; extreme hunger; uncontrolled muscle movements; stiff neck; slurred speech; fever; sweating; confusion; weakness or numbness on one side of your body; unusual bruising or bleeding.

Other: Drowsiness; trouble sleeping; agitation; headache; dizziness; nervousness; runny nose; anxiety; constipation; dry mouth; stomach upset; tremors or shaking; weight gain; change in sexual ability or desire.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• ACE inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril), and ramipril (Altace)
• alpha blockers such as prazosin (Minipress) and doxazosin (Cardura)
• antidepressants such as bupropion (Wellbutrin), nefazodone, amitriptyline, nortriptyline (Aventyl, Pamelor), imipramine (Tofranil), doxepin (Sinequan), sertraline (Zoloft), fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), venlafaxine (Effexor), fluvoxamine (Luvox), bupropion (Wellbutrin), and trazodone (Desyrel)
• antipsychotics such as thioridazine, olanzapine (Zyprexa), aripiprazole (Abilify), clozapine (Clozaril), haloperidol (Haldol), and risperidone (Risperdal)
• antiseizure medicines such as carbamazepine (Tegretol) and phenytoin (Dilantin)
• beta blockers such as atenolol (Tenormin), acebutolol (Sectral), pindolol, metoprolol (Lopressor, Toprol XL), sotalol (Betapace), nadolol (Corgard), propranolol (Inderal), labetalol (Normodyne, Trandate), and carvedilol (Coreg)
• calcium channel blockers such as nifedipine (Adalat, Procardia), isradipine (DynaCirc), felodipine (Plendil), verapamil (Calan, Isoptin), diltiazem (Cardizem), and nicardipine (Cardene)
• cold and flu medicines, especially antihistamines such as diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton)
• diabetes medicines such as insulin, glyburide (DiaBeta, Micronase), glipizide (Glucotrol), repaglinide (Prandin), metformin (Glucophage), rosiglitazone (Avandia), tolbutamide, and pioglitazone (Actos)
• levodopa/carbidopa (Sinemet)
• MAO inhibitor antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl), or tranylcypromine (Parnate) (Do not take an MAO inhibitor and this medicine within 14 days of each other.)
• migraine medicines such as almotriptan (Axert), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)
• natural remedies such as St. John's wort, tryptophan, garlic, and Co-Q10
• pain medicines such as codeine, morphine, meperidine (Demerol), hydromorphone (Dilaudid), hydrocodone (Vicodin, Lortab), oxycodone (Percocet, OxyContin, Tylox), and tramadol (Ultram)
• pimozide (Orap)
• proton pump inhibitors such as omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), and lansoprazole (Prevacid)
• rifampin (Rifadin, Rifamate)
• sedatives such as phenobarbital (Solfoton), amobarbital (Amytal), zolpidem (Ambien), triazolam (Halcion), butabarbital (Butisol), and zaleplon (Sonata)
• sleeping pills such as zolpidem (Ambien), zaleplon (Sonata), and chloral hydrate (Aquachlor)
• tranquilizers such as diazepam (Valium), meprobamate (Equanil), chlordiazepoxide (Librium), alprazolam (Xanax), and lorazepam (Ativan)
• warfarin (Coumadin)

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.