Symbyax contains a combination of fluoxetine and olanzapine. Fluoxetine is an antidepressant belonging to a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Olanzapine is an antipsychotic medication. These drugs affect chemicals in the brain.
Symbyax is used to treat depression caused by bipolar disorder (manic depression).
Symbyax is also used to treat depression after at least 2 other medications have been tried without successful treatment of symptoms.
Important information
You should not use Symbyax if you also take pimozide or thioridazine, or if you are being treated with methylene blue injection.
Do not use Symbyax if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine. You must wait at least 14 days after stopping an MAO inhibitor before you can take Symbyax. You must wait 5 weeks after stopping this medicine before you can take thioridazine or an MAOI.
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 Symbyax. Your family or other caregivers should also be alert to changes in your mood or symptoms.
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.
Symbyax should not be given to a child younger than 10 years old.
Symbyax is not approved for use in psychotic conditions related to dementia. Symbyax may increase the risk of death in older adults with dementia-related conditions.
Before taking this medicine
You should not use Symbyax if you are allergic to fluoxetine or olanzapine, if you also take pimozide or thioridazine, or if you are being treated with methylene blue injection.
Do not use Symbyax if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine. You must wait at least 14 days after stopping an MAO inhibitor before you can take this medicine. You must wait 5 weeks after stopping Symbyax before you can take thioridazine or an MAOI.
Do not take Symbyax if you take either drug in a non-combination form, (such as Prozac, Rapiflux, Sarafem, Selfemra, Zyprexa, or Zyprexa Zydis)
Tell your doctor about all other antidepressants you take, especially Celexa, Cymbalta, Desyrel, Effexor, Lexapro, Luvox, Oleptro, Paxil, Pexeva, Viibryd, or Zoloft.
Symbyax is not approved for use in psychotic conditions related to dementia. This medicine may increase the risk of death in older adults with dementia-related conditions.
To make sure Symbyax is safe for you, tell your doctor if you have:
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liver disease;
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diabetes, high cholesterol or triglycerides;
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seizures or epilepsy;
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narrow-angle glaucoma;
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heart disease, slow heartbeats, high or low blood pressure;
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history of "mini-stroke" or "TIA" or if you have recently had a heart attack;
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personal or family history of long QT syndrome;
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an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);
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a bleeding or blood-clotting disorder;
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breast cancer;
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bowel obstruction, severe constipation;
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enlarged prostate; or
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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 Symbyax. 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.
Tell your doctor right away if you become pregnant while taking Symbyax. Do not start or stop taking this medicine during pregnancy 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 Symbyax?
Take Symbyax exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.
You may take Symbyax with or without food. Take the medicine at the same time each day.
Olanzapine can cause high blood sugar (hyperglycemia). If you are diabetic, check your blood sugar levels on a regular basis while you are taking olanzapine.
It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and 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?
Drinking alcohol can increase certain side effects of Symbyax.
Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with Symbyax may cause you to bruise or bleed easily.
This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Symbyax side effects
Get emergency medical help if you have any of these signs of an allergic reaction to Symbyax: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
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.
High doses or long-term use of olanzapine can cause a serious movement disorder that may not be reversible. Symptoms of this disorder include uncontrollable muscle movements of your lips, tongue, eyes, face, arms, or legs. The longer you take Symbyax, the more likely you are to develop a serious movement disorder. The risk of this side effect is higher in women and older adults.
Call your doctor at once if you have:
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a light-headed feeling, like you might pass out;
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blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
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chest pain and severe dizziness, fast or pounding heartbeats;
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feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin;
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high levels of serotonin in the body--agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination;
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severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, confusion, uneven heartbeats, tremors;
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low levels of sodium in the blood--headache, confusion, slurred speech, vomiting, severe weakness, feeling unsteady, shallow breathing; or
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high blood sugar--increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, confusion, upset stomach.
Common Symbyax side effects may include:
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 Symbyax?
Taking Symbyax with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking Symbyax with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.
Many drugs can interact with fluoxetine and olanzapine. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with Symbyax, especially:
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any other antidepressant or medication to treat mental illness;
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buspirone;
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fentanyl, tramadol;
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lithium;
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St. John"s Wort;
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tryptophan (sometimes called L-tryptophan); or
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migraine headache medicine--almotriptan, frovatriptan, sumatriptan, naratriptan, rizatriptan, zolmitriptan.
This list is not complete and many other drugs can interact with Symbyax. 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.
