Fluoxetine/Olanzapine

DEA Class;  Rx

Common Brand Names; Symbyax

Hypersensitivity to any component

Concomitant thioridazine, pimozide

Rhabdomyolysis and venous thromboembolic events (including pulmonary embolism and deep venous thrombosis)

Fluoxetine

• Aplastic anemia, cholestatic jaundice, eosinophilic pneumonia, erythema multiforme, violent behavior, atrial fibrillation, cataract, cerebrovascular accident, epidermal necrolysis, erythema nodosum, heart arrest, hepatic failure/necrosis, hypoglycemia, kidney failure, memory impairment, optic neuritis, pulmonary hypertension, Stevens-Johnson syndrome.

Olanzapine

• Diabetic coma, jaundice, random triglyceride levels of greater than or equal to 1000 mg/dL, restless legs syndrome, stuttering, salivary hypersecretion, allergic reaction (eg, anaphylactoid reaction, angioedema, pruritus or urticaria), diabetic ketoacidosis, discontinuation reaction (diaphoresis, nausea or vomiting), drug reaction with eosinophilia and systemic symptoms (DRESS)

This drug combination has potential to impair judgment, thinking, or motor skills; patients should be cautioned about operating hazardous machinery, including automobiles until they are reasonably certain that therapy does not affect them adversely

Pupillary dilation occurs following use of many antidepressant drugs may trigger an angle-closure attack in a patient with anatomically narrow angles who does not have a patent iridectomy

Cerebrovascular adverse events (eg, stroke,transient ischemic attack), including fatalities, reported in patients in trials of olanzapine in elderly patients with dementia-related psychosis; this drug combination is not approved for treatment of patients with dementia-related psychosis

Olanzapine exhibits in vitro muscarinic receptor affinity; in premarketing clinical studies, this drug combination was associated with constipation, dry mouth, and tachycardia, all adverse reactions possibly related to cholinergic antagonism; such adverse reactions were not often the basis for study discontinuations; this drug combination should be used with caution in patients with a current diagnosis or prior history of urinary retention, clinically significant prostatic hypertrophy, constipation, a history of paralytic ileus, or related condition

Potential for abnormal bleeding with concomitant ASA, NSAIDs, or other antiplatelet drugs; case reports and epidemiological studies (case-control and cohort design) have demonstrated an association between use of drugs that interfere with serotonin reuptake and occurrence of gastrointestinal bleeding; bleeding reactions related to SNRIs and SSRIs use have ranged from ecchymoses, hematomas, epistaxis, and petechiae to life-threatening hemorrhages; patients should be cautioned about risk of bleeding associated with concomitant use of this combination drug and NSAIDs, aspirin, or other drugs that affect coagulation

There is pregnancy exposure registry that monitors pregnancy outcomes in women exposed to psychiatric medications, during pregnancy

Consider developmental and health benefits of breastfeeding along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from therapy or underlying maternal condition

Infants exposed to drug combination should be monitored for agitation, irritability, poor feeding, poor weight gain, excess sedation, and extrapyramidal symptoms (tremors and abnormal muscle movements)