Jeffrey Panko NP Psychiatry · Patient education
Olanzapine–fluoxetine
Symbyax / Generic combination capsules
A guide for adults taking olanzapine–fluoxetine.
Follow the directions on your prescription and your provider's recommendations.
Formulations: Each capsule contains two medicines. The strength lists olanzapine first and fluoxetine second. Separate prescriptions for the components are sometimes used, but the doses must be specifically matched by your provider.
What it is used for
This combination treats depressive episodes in bipolar I disorder and treatment-resistant depression. Treatment-resistant depression means depression that has not improved adequately with appropriate antidepressant trials. This sheet is for adults.
How it works
Fluoxetine increases serotonin signaling by blocking reuptake. Olanzapine affects dopamine and serotonin receptors. Using them together has a different role from taking either medicine alone.
What to expect over time
Sleep or appetite may change before mood improves. Antidepressant benefit generally develops over several weeks. Track interest, energy, concentration, and daily functioning.
Schedule an earlier appointment if your mood gets worse. Report unusually high energy, little need for sleep, or impulsive behavior promptly.
Taking your medication
- Take once daily, usually in the evening, with or without food. Follow your prescription.
- If you miss a dose, take it when you remember unless it is almost time for the next dose. Then skip it. Do not double a dose.
- Do not add other olanzapine- or fluoxetine-containing medicines unless your provider has explicitly included them in your regimen.
- Consult with your provider before stopping or switching. Fluoxetine remains in the body for weeks after the last dose.
When to get help
Emergency symptoms. Get emergency care for fever with severe stiffness or confusion, fainting with an irregular heartbeat, a seizure, or trouble breathing. Fever, agitation, diarrhea, and twitching can signal serotonin syndrome.
Prompt medical advice. Report marked thirst and urination, new involuntary movements, unusual bleeding, severe restlessness, or a major change in mood promptly. Severe headache with confusion or weakness needs urgent assessment.
If you feel unsafe or have thoughts of self-harm, call 911 or go to an emergency department.
Possible side effects
- Sleepiness or fatigue
- Increased appetite and weight gain
- Dry mouth or constipation
- Dizziness, tremor, or sexual side effects
Keeping track of treatment
Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.
Antidepressants can increase suicidal thoughts in people under 25. Watch for changes in mood or behavior at any age, especially when starting treatment or changing a dose.
Keep checks of weight, blood pressure, blood sugar, and cholesterol. Olanzapine can cause substantial metabolic changes. Report increased thirst or urination, and new involuntary mouth, tongue, or limb movements.
If you take too much
For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.
Before you start
Discuss diabetes, heart-rhythm problems, fainting, seizures, glaucoma, low sodium, liver disease, severe constipation, and all previous antidepressant reactions.
Antipsychotics increase the risk of death in older adults with dementia-related psychosis. This combination is not approved for that use.
Discuss pregnancy, pregnancy plans, and breastfeeding with your provider. Treatment decisions should consider both the medication and the condition being treated.
Medicines and interactions
Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.
Do not combine with an MAOI. Allow at least 14 days after stopping an MAOI before starting this combination, and at least five weeks after stopping this combination before starting an MAOI.
Other serotonergic medicines, including tramadol and some cough medicines, can increase serotonin-syndrome risk. Pimozide and thioridazine must not be combined with fluoxetine.
Alcohol and sedatives increase impairment. NSAIDs, aspirin, and blood thinners add bleeding risk. Changes in cigarette smoking can affect olanzapine levels; tell your provider if you start or stop.
Everyday tips
Stand up slowly. Avoid driving until you know how the medication affects alertness and coordination.
Stay hydrated and take breaks in hot weather. Some antipsychotics interfere with temperature regulation.
Discuss appetite or weight changes early, and keep scheduled monitoring visits.
Your questions answered
Why use two medicines for depression?
The combination is supported for specific depressive conditions. Your provider should explain why it fits your diagnosis and prior treatment response.
What if appetite or weight increases?
Discuss the change early. Weight, glucose, and cholesterol monitoring help identify effects that may require a treatment adjustment.
Does the long half-life make switching easier?
It also means interactions can persist. A new medicine may require a waiting period even after you have stopped taking the capsules.
Storage and safety
Keep medication in its labeled container, away from excess heat and moisture and out of reach of children and pets. Do not share it. Ask a pharmacy about disposal of unused medication.
Sources
About this information
Educational handout; does not replace your prescription or provider's recommendations.
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.