Olanzapine/fluoxetine: Difference between revisions
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{{Short description|Antidepressant medication}} |
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{{Drugbox |
{{Drugbox |
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| width = 150px |
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| image2 = Fluoxetine-2D-skeletal.svg |
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| width2 = 200px |
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<!--Combo data--> |
<!--Combo data--> |
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| component1 = Olanzapine |
| component1 = Olanzapine |
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| class1 = [[Atypical antipsychotic]] |
| class1 = [[Atypical antipsychotic]] |
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| component2 = Fluoxetine |
| component2 = Fluoxetine |
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| class2 = [[ |
| class2 = [[Selective serotonin reuptake inhibitor]] |
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<!--Clinical data--> |
<!--Clinical data--> |
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| tradename = |
| tradename = Symbyax, Cinol Forte, Olapin Forte, others |
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| Drugs.com = {{Drugs.com|ppa|olanzapine-and-fluoxetine}} |
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| pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X --> |
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| DailyMedID = Olanzapine_and_fluoxetine |
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| pregnancy_US = <!-- A / B / C / D / X --> |
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| pregnancy_AU = C |
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| pregnancy_US = C |
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| pregnancy_category = |
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| legal_AU = <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled--> |
| legal_AU = <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled--> |
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| legal_CA = <!-- OTC, Rx-only, Schedule I, II, III, IV, V, VI, VII, VIII --> |
| legal_CA = <!-- OTC, Rx-only, Schedule I, II, III, IV, V, VI, VII, VIII --> |
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| legal_UK = <!-- GSL, P, POM, CD, CD Lic, CD POM, CD No Reg POM, CD (Benz) POM, CD (Anab) POM or CD Inv POM --> |
| legal_UK = <!-- GSL, P, POM, CD, CD Lic, CD POM, CD No Reg POM, CD (Benz) POM, CD (Anab) POM or CD Inv POM --> |
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| legal_US = |
| legal_US = Rx-only |
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| legal_US_comment = <ref name="Symbyax FDA label" /> |
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| legal_status = |
| legal_status = |
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| routes_of_administration = |
| routes_of_administration = [[Oral administration|By mouth]] |
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| ATC_prefix = N06 |
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| ATC_supplemental = |
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<!--Identifiers--> |
<!--Identifiers--> |
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| KEGG_Ref = {{keggcite|changed|kegg}} |
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| KEGG = D10206 |
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| ATC_prefix = <!-- 'none' if uncategorised --> |
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| CAS_number = 250603-12-4 |
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<!--Chemical data--> |
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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]]<ref>{{Cite web |title=Tratamento medicamentoso dos transtornos bipolares - Transtornos psiquiátricos |url=https://www.msdmanuals.com/pt-br/profissional/transtornos-psiqui%C3%A1tricos/transtornos-do-humor/tratamento-medicamentoso-dos-transtornos-bipolares |access-date=2022-10-02 |website=Manuais MSD edição para profissionais |language=pt-BR}}</ref> as well as [[treatment-resistant depression]].<ref name="Symbyax FDA label">{{cite web | title=Symbyax- olanzapine and fluoxetine hydrochloride capsule | website=DailyMed | date=21 April 2020 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6b28c424-0b7e-4b75-b090-f116b113554e | access-date=30 September 2020}}</ref><ref>{{cite journal | vauthors = Benazzi F, Berk M, Frye MA, Wang W, Barraco A, Tohen M | title = Olanzapine/fluoxetine combination for the treatment of mixed depression in bipolar I disorder: a post hoc analysis | journal = The Journal of Clinical Psychiatry | volume = 70 | issue = 10 | pages = 1424–1431 | date = October 2009 | pmid = 19906346 | doi = 10.4088/JCP.08m04772gre }}</ref> |
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==Medical uses== |
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⚫ | Olanzapine/fluoxetine was approved by the U.S. [[Food and Drug Administration]] (FDA) to treat the depressive episodes of [[bipolar I disorder]] in 2003.<ref name="Symbyax FDA label" /> In 2009, it was granted approval for the treatment of [[treatment-resistant depression]].<ref>{{cite web | author = Grohol, J. | title = FDA Approves Symbyax for Treatment Resistant Depression | work = Psych Central Blog | url = http://psychcentral.com/blog/archives/2009/03/23/fda-approves-symbyax-for-treatment-resistant-depression/ | access-date = 2010-07-17 | archive-date = 2017-12-26 | archive-url = https://web.archive.org/web/20171226073909/https://psychcentral.com/blog/archives/2009/03/23/fda-approves-symbyax-for-treatment-resistant-depression/ | url-status = dead }}</ref> |
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⚫ | Olanzapine/fluoxetine, or other [[antidepressant]]/[[antipsychotic]] combinations, are sometimes prescribed [[off-label use|off-label]] for [[anxiety disorders]],<ref name="pmid14700010">{{cite journal | vauthors = McIntyre R, Katzman M | title = The role of atypical antipsychotics in bipolar depression and anxiety disorders | journal = Bipolar Disorders | volume = 5 | issue = Suppl 2 | pages = 20–35 | year = 2003 | pmid = 14700010 | doi = 10.1111/j.1399-2406.2003.00061.x }}</ref> [[eating disorders]],<ref name="pmid14521477">{{cite journal | vauthors = Pederson KJ, Roerig JL, Mitchell JE | title = Towards the pharmacotherapy of eating disorders | journal = Expert Opinion on Pharmacotherapy | volume = 4 | issue = 10 | pages = 1659–1678 | date = October 2003 | pmid = 14521477 | doi = 10.1517/14656566.4.10.1659 | s2cid = 38506292 }}</ref> [[obsessive–compulsive disorder]] (OCD),<ref name="pmid10937610">{{cite journal | vauthors = Koran LM, Ringold AL, Elliott MA | title = Olanzapine augmentation for treatment-resistant obsessive-compulsive disorder | journal = The Journal of Clinical Psychiatry | volume = 61 | issue = 7 | pages = 514–517 | date = July 2000 | pmid = 10937610 | doi = 10.4088/JCP.v61n0709 }}</ref> and [[posttraumatic stress disorder]] (PTSD).<ref name="pmid12359687">{{cite journal | vauthors = Stein MB, Kline NA, Matloff JL | title = Adjunctive olanzapine for SSRI-resistant combat-related PTSD: a double-blind, placebo-controlled study | journal = The American Journal of Psychiatry | volume = 159 | issue = 10 | pages = 1777–1779 | date = October 2002 | pmid = 12359687 | doi = 10.1176/appi.ajp.159.10.1777 }}</ref> |
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⚫ | Possible side effects of olanzapine/fluoxetine include all those of the two component drugs: [[Olanzapine#Side effects.2C adverse reactions|olanzapine (side effects)]] and [[Fluoxetine#Adverse effects|fluoxetine (side effects)]]. Common side effects include suicidal thoughts, increased appetite, weight gain, [[somnolence|drowsiness]], [[Fatigue (medical)|fatigue]], [[Xerostomia|dry mouth]], [[Peripheral edema|swelling]], [[tremor]], blurred vision, and difficulty concentrating.<ref name="Symbyax FDA label" /> |
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⚫ | 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.<ref name="drugscom">{{cite web | title = Symbyax | work = Drugs.com | url = https://www.drugs.com/pdr/symbyax.html }}</ref> |
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==Available dosages== |
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Symbyax is available as a capsule. Currently, five dosage combinations are produced (measured in mg olanzapine/mg fluoxetine): 3mg/25mg, 6mg/25mg, 6mg/50mg, 12mg/25mg, 12mg/50mg.<ref name="symbyax_pi" /> |
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==Synergistic effects== |
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Symbyax increases [[extracellular]] [[serotonin]] due to its fluoxetine component. However, Symbyax also causes an increase in [[dopamine]] and [[norepinephrine]]; this increase is believed to be the result of a synergistic effect between fluoxetine and olanzapine. Preclinical trials reported a 232% increase in dopamine (compared to a 66% increase with just olanzapine or a 55% increase with just fluoxetine) and a 160% increase in norepinephrine (compared to an 89% increase with just fluoxetine or a 33% increase with just olanzapine).<ref name="mechanism_symbyax_web">"Symbyax Mechinism of Action. Lilly USA. 2010. http://www.insidesymbyax.com/Pages/symbyaxmechanismofaction.aspx</ref> |
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⚫ | 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]].<ref name="Symbyax FDA label" /> |
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⚫ | Possible side effects of |
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== See also == |
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* [[Amitriptyline/perphenazine]] |
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* [[Aripiprazole/sertraline]] |
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* "[[California rocket fuel]]" |
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* [[Flupentixol/melitracen]] |
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* [[Tranylcypromine/trifluoperazine]] |
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== References == |
== References == |
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== External links == |
== External links == |
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* {{cite web | url = https://druginfo.nlm.nih.gov/drugportal/name/fluoxetine%20hydrochloride%20mixture%20with%20olanzapine | publisher = U.S. National Library of Medicine | work = Drug Information Portal | title = Fluoxetine hydrochloride mixture with Olanzapine }} |
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* [http://www.symbyax.com/index.jsp Symbyax.com] |
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{{Mood stabilizers}} |
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{{Antidepressants}} |
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{{Anxiolytics}} |
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{{Navboxes |
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| title = [[Pharmacodynamics]] |
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| list1 = |
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{{Adrenergic receptor modulators}} |
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{{Dopamine receptor modulators}} |
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{{Histamine receptor modulators}} |
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{{Monoamine reuptake inhibitors}} |
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{{Muscarinic acetylcholine receptor modulators}} |
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{{Serotonin receptor modulators}} |
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{{OCD pharmacotherapies}} |
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{{Portal bar | Medicine}} |
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{{DEFAULTSORT:Olanzapine Fluoxetine}} |
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[[Category:Dopamine antagonists]] |
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[[Category:Muscarinic antagonists]] |
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[[Category:Selective serotonin reuptake inhibitors]] |
[[Category:Selective serotonin reuptake inhibitors]] |
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[[Category:Serotonin receptor antagonists]] |
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[[Category:Atypical antipsychotics]] |
[[Category:Atypical antipsychotics]] |
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[[Category: |
[[Category:Antidepressants]] |
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[[Category:Drugs developed by Eli Lilly and Company]] |
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[[Category: |
[[Category:Mood stabilizers]] |
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[[Category:Combination psychiatric drugs]] |