Olanzapine and Fluoxetine (Oral)

Olanzapine and Fluoxetine is a combination medication given to patients with bipolar disorder or treatment-resistant depression. Your doctor may give this to you to treat or manage episodes of serious depression. It treats mood problems and psychotic symptoms that may result as a symptom of bipolar disorder or depression.

Overview

Olanzapine is an antipsychotic drug, and Fluoxetine is an SSRI, an antidepressant medication known as a selective serotonin reuptake inhibitor. Olanzapine and Fluoxetine increase the activity of chemicals in the brain that contribute to happiness and functioning, such as serotonin, dopamine, and norepinephrine.

Olanzapine and Fluoxetine is used to treat depression. It may be prescribed to treat depression in patients who experience bipolar disorder. It also may be prescribed to patients whose depression has proved resistant to treatment with other antidepressants. Olanzapine and Fluoxetine is available in a capsule and is only available with the prescription of a doctor.

Conditions Treated

Type Of Medicine

  • Antidepressant
  • Selective serotonin reuptake inhibitor
  • Antipsychotic

Side Effects

Mild Side Effects

Some patients who take Olanzapine and Fluoxetine may experience some mild unwanted side effects in addition to the therapeutic effects for which the medication was prescribed. These side effects are a result of your body adjusting to the new medication and do not usually need medical intervention. These side effects may subside or go away entirely during the course of treatment as your body adjusts itself to the new medication. If these side effects become worse, do not go away, or become bothersome, contact your doctor. A health care professional may be able to suggest treatments or remedies that can help you reduce or prevent these side effects.

Some patients taking Olanzapine and Fluoxetine may experience gastrointestinal side effects such as:

  • Diarrhea
  • Increased appetite
  • Weight gain

Some patients taking Olanzapine and Fluoxetine may experience sexual side effects such as:

  • Decreased interest in sexual activity
  • Decreased sex drive or sexual desire, or a loss of sexual performance or ability
  • A change in the discharge or semen or problems with discharge or semen
  • Inability to have or maintain an erection
  • Inability to experience orgasm

Some patients taking Olanzapine and Fluoxetine may experience dental or oral side effects, such as:

  • Dry mouth
  • Tooth disorders

Some patients taking Olanzapine and Fluoxetine may experience other side effects, such as:

  • A loss of strength or lack of strength
  • Difficulty moving around normally
  • Pain or stiffness in the muscle
  • Swelling, redness, or pain in the joints
  • Unusual twitching

Serious Side Effects

Some patients who take Olanzapine and Fluoxetine may experience more serious or severe unwanted side effects in addition to the therapeutic effects for which the medication was prescribed. These side effects may not occur in all patients. If these side effects do occur, they will require medical attention. Patients who experience any of these side effects while taking Olanzapine and Fluoxetine should contact their doctor immediately. You may need to lower your dose, stop taking the medication, or seek medical attention for a health problem that may have been triggered by this medication.

Some patients who take Olanzapine and Fluoxetine may experience gastrointestinal side effects such as:

  • Rapid weight gain
  • Unusual weight gain or loss of weight
  • Constipation
  • Severe pain in the stomach
  • Bloody stools or stools that are black and tarry
  • Vomiting blood or vomiting of material that resembles coffee grounds

Some patients who take Olanzapine and Fluoxetine may experience respiratory side effects such as:

  • Congestion in the chest or throat
  • A cough
  • Soreness or dryness of the throat
  • Hoarseness when speaking
  • A runny nose
  • Difficulty when swallowing
  • Difficulty when speaking
  • Changes in the voice
  • Breathing that is labored or difficult
  • Tightness in the chest

Some patients who take Olanzapine and Fluoxetine may experience neurological side effects such as:

  • Insomnia or difficulty with sleeping
  • Dizziness
  • Confusion
  • Delusions
  • Dementia
  • A change in personality
  • Loss of memory or problems with memory
  • Nervousness

Some patients who take Olanzapine and Fluoxetine may experience muscular side effects such as:

  • Body aches or pain
  • Shakiness in the arms, legs, hands, or feet
  • Trembling or shaking in the hands or feet
  • Tingling in the hands or feet
  • An increase in body movements
  • Increased blinking or spasming of the eyelid
  • Inability to move the eyes
  • Unusual facial expressions
  • Compulsive sticking out of the tongue
  • Uncontrolled twisting movements of the torso, arms, legs, or neck

Some patients who take Olanzapine and Fluoxetine may experience ocular side effects such as:

  • Blurred vision
  • Impaired vision
  • A change in vision

Some patients who take Olanzapine and Fluoxetine may experience other side effects such as:

  • Swelling or bloating in the face or extremities such as hands, arms, feet, and lower legs
  • Tender or swollen glands in the neck
  • Ear pain
  • Fever
  • A headache
  • A slow, fast, irregular, or pounding pulse or heartbeat
  • Pounding in the ears

Dosage

The dosages and schedule given here for taking Olanzapine and Fluoxetine is standard information provided by the manufacturer. Your doctor may change your dose or schedule depending upon the strength of the medicine, your condition, and the medical problem for which you are taking Olanzapine and Fluoxetine. When taking this medication, always follow your doctor's directions. Do not change your dose unless your doctor tells you to.

Patients taking Olanzapine and Fluoxetine to treat bipolar I depression will start taking one capsule orally per day, usually in the evening. This capsule contains 6 mg of olanzapine and 25 mg of fluoxetine. This dose may be adjusted upwards as needed. Most adult patients will not take more than 3 of these capsules per day. Patients aged 10 to 17 years will not usually take more than 2 of these capsules per day. Patients younger than 10 years old will need to have their dose determined by a doctor.

Patients taking Olanzapine and Fluoxetine for depression which is resistant to treatment will start taking one capsule orally per day, usually in the evening. This dose may be adjusted upwards as needed. Most adult patients will take no more than 2 capsules per day. Child patients will need to have their dose determined by a doctor.

If you miss a dose of Olanzapine and Fluoxetine, take it as soon as you remember. If it is almost time to take your next dose of Olanzapine and Fluoxetine, skip the dose you missed and take the next dose on the regular schedule. Do not take a double dose of Olanzapine and Fluoxetine. If you are unsure of a safe time to take your Olanzapine and Fluoxetine, contact your doctor.

Interactions

Drug interactions may change the way your medications work in your body, and can increase your risk of unwanted side effects. Keep a list of the drugs, medications, and supplements you are taking, whether they have been prescribed to you by a medical professional or you are taking them over the counter, and show it to your doctor and pharmacist when being prescribed new drugs or undergoing any change in your regimen. Your doctor and pharmacist will be able to identify any potential drug interactions. Not all interactions with Olanzapine and Fluoxetine may be listed here.

Fluoxetine may stay in your body for weeks even after you cease taking Fluoxetine. If you have ingested Fluoxetine in the last 5 weeks, even if you have stopped taking it, you are likely to have sufficient quantities of Fluoxetine in your system to cause unwanted interactions with other drugs that can interact with Fluoxetine. Consult your doctor or pharmacist before taking a new drug or medication if you have taken Fluoxetine in the past 5 weeks.

Olanzapine and Fluoxetine can cause serious interactions when taken with drugs that are removed from your body through certain liver enzymes. Ask your doctor before you take medications such as:

  • Antipsychotic medications such as clozapine, haloperidol, ripiprazole, or perphenazine
  • Antiarrhythmics such as flecainide or propafenone
  • Tricyclic or TCA antidepressants such as desipramine or imipramine
  • Drugs that can cause bruising or bleeding such as aspirin, NSAIDs such as ibuprofen, antiplatelet drugs such as clopidogrel, or blood thinners such as warfarin or heparin
  • Medicines for Parkinson's disease such as cabergoline
  • Drugs for high blood pressure
  • Water pills or diuretics such as furosemide
  • Cimetidine
  • Phenytoin
  • Vinblastine

Fluoxetine may cause undesirable interactions when used with Cimetidine, a drug that is commonly used to treat excess stomach acid. If you are taking Cimetidine while considering a regimen of Olanzapine and Fluoxetine, ask your doctor or pharmacist about other effective products for your excess stomach acid.

OFluoxetine include:lanzapine and Fluoxetine can cause a serious and possibly fatal interaction when combined with MAO inhibitors or medications that contain MAO inhibitors. These medications should not be taken for 2 weeks before you begin taking Olanzapine and Fluoxetine, and should not be taken for 5 weeks after you discontinue taking Olanzapine and Fluoxetine. Ask your doctor when it is safe to take MAO inhibitors when taking Olanzapine and Fluoxetine. MAO inhibitors that can interact with Olanzapine and

  • Isocarboxazid
  • Linezolid
  • Methylene blue
  • Moclobemide
  • Phenelzine
  • Procarbazine
  • Rasagiline
  • Safinamide
  • Selegiline
  • Tranylcypromine

Fluoxetine may trigger QT prolongation, which affects the rhythm of the heart and can lead to potentially dangerous episodes of an erratic or chaotic heartbeat. Olanzapine and Fluoxetine should not be taken with medications that may also trigger this condition. Other drugs that may trigger this condition include:

Pimozide

Thioridazine

Olanzapine and Fluoxetine may increase your risk of bleeding or bruising when taken with aspirin. If you are on a regimen of low-dose (usually from 81 milligrams per day to 325 milligrams per day) aspirin prescribed by your doctor to prevent a heart attack or stroke, you may not need to cease taking the medication unless your doctor has instructed you to stop. Discuss the benefits and risks of taking Olanzapine and Fluoxetine along with your low-dose aspirin regimen with your doctor.

Olanzapine and Fluoxetine can interact with other drugs that increase the serotonin in your body in a way that may cause serotonin syndrome or serotonin toxicity. This is a life-threatening condition that can lead to death. Consult with your doctor before taking drugs or supplements that can increase serotonin in the brain, such as:

St. John's Wort

  • SSRI antidepressants such as citalopram or paroxetine
  • SNRI antidepressants such as duloxetine or venlafaxine
  • Street drugs such as Ecstasy or MDMA
  • Tryptophan

Olanzapine and Fluoxetine can cause drowsiness, which may be exacerbated by other drugs or substances that cause drowsiness. Make sure to check the labels on your prescribed and over-the-counter medications, especially cough and cold products or allergy products, to see if any medications in the ingredients may cause drowsiness. Let your doctor or pharmacist know if you are using other substances that may cause drowsiness such as:

  • Pain relievers or cough medication with opiates, such as codeine or hydrocodone
  • Alcoholic drinks or medications that include alcohol as an ingredient
  • Marijuana
  • Drugs that aid in sleep or relieve anxiety such as alprazolam, lorazepam, or zolpidem
  • Muscle relaxants such as carisoprodol or cyclobenzaprine
  • Antihistamines such as cetirizine or diphenhydramine

The levels of Olanzapine and Fluoxetine in your bloodstream may decrease in response to the use of tobacco products, especially smoking. If you smoke cigarettes or if you have recently stopped smoking, let your doctor know. You may need a dose adjustment of Olanzapine and Fluoxetine.

Olanzapine and Fluoxetine may interfere with some medical tests such as brain scans that diagnose Parkinson's disease, possibly causing false results. If you are receiving a medical test or test in a laboratory, make sure your doctor and all laboratory personnel are aware that you are taking Olanzapine and Fluoxetine.

Warnings

Progress Checks

You will need to keep regular appointments with your doctor while taking Olanzapine and Fluoxetine. These appointments will be needed to ensure that the medication is working correctly, as well as to check for unwanted side effects that may not immediately show up as symptoms. You may need to have blood tests done in order to check on your progress and condition.

MAO Inhibitors

Olanzapine and Fluoxetine should not be taken at the same time as MAO inhibitors. Check with your doctor or pharmacist to see if medications you are taking or are planning to take contain MAO inhibitors. Taking Olanzapine and Fluoxetine with MAO inhibitors may cause serious side effects such as confusion, agitation or restlessness, a sudden fever or high body temperature, severe convulsions, extremely high blood pressure, or gastrointestinal problems. Medications that are MAO inhibitors include:

  • Isocarboxazid
  • Linezolid
  • Methylene blue injection
  • Phenelzine
  • Selegiline
  • Tranylcypromine

Serotonin Syndrome

Olanzapine and Fluoxetine can cause serotonin syndrome when taken along with other medications which can raise levels of serotonin in the brain. Serotonin syndrome or serotonin toxicity can be fatal. Symptoms include confusion, agitation or restlessness, extremely high blood pressure, severe convulsions, a high body temperature or fever, and problems with the intestine or stomach.

Check with your doctor before taking new medications, drugs, or supplements to avoid the risk of serotonin syndrome. Medications or substances which can raise serotonin levels in the brain include:

  • Buspirone
  • Fentanyl
  • Lithium
  • Tryptophan
  • St. John's wort
  • Rizatriptan
  • Sumatriptan
  • Tramadol
  • Some pain or migraine medications

Alcohol

Patients using Olanzapine and Fluoxetine should not drink or consume alcohol. If you have questions about alcohol use on Olanzapine and Fluoxetine, contact your doctor.

Other Interactions

Patients taking Olanzapine and Fluoxetine should not begin taking new prescription or over-the-counter drugs, medications, or supplements unless you have discussed their risks, benefits, and potential of interaction with your doctor.

Olanzapine and Fluoxetine should not be taken with thioridazine or with pimozide. Using these medications together may trigger serious heart problems. If you need to begin taking thioridazine, you will need to wait 5 weeks after stopping Olanzapine and Fluoxetine in order to take thioridazine safely.

Suicidal Thoughts

Olanzapine and Fluoxetine can increase suicidal thoughts in some children, teenagers, or young adults. Tell your doctor if you start to feel more depressed or have new or unusual thoughts or behaviors that are troubling. Tell your doctor if you have thoughts about hurting yourself. Tell your doctor if you become irritable, get upset easily, have trouble sleeping, or are acting recklessly. Tell your doctor if you feel angry, restless, nervous, scared, or violent. Tell your doctor if you have a family history of bipolar disorder or if anyone in your family has tried to commit suicide.

Neuroleptic Malignant Syndrome

Olanzapine and Fluoxetine may trigger a serious condition called neuroleptic malignant syndrome, or NMS. Symptoms of neuroleptic malignant syndrome include difficulty breathing, a high fever, a fast heartbeat, unusually high or low blood pressure, unusually pale skin, tiredness, severe muscle stiffness, loss of bladder control, and convulsions. If you experience any of these symptoms while using Olanzapine and Fluoxetine, contact your doctor or seek medical help right away.

Blood Sugar

Olanzapine and Fluoxetine may increase your blood sugar levels. If you experience increased thirst or increased urination while taking Olanzapine and Fluoxetine, check with your doctor right away. Diabetics may notice a change in the results of blood sugar or urine tests. Check with your doctor if you have any questions about blood sugar levels on Olanzapine and Fluoxetine.

Cholesterol

Olanzapine and Fluoxetine may increase the amount of fats and cholesterol in the blood. This can be detected by consistent blood tests from your doctor. If you do experience an elevated amount of fats and cholesterol in your blood, your doctor may prescribe a medication for you that can lower the amount of fats and cholesterol in your blood.

Weight

Olanzapine and Fluoxetine may cause an increase in your body weight. Your doctor may need to monitor your weight regularly during your regimen of treatment with Olanzapine and Fluoxetine.

Tardive Dyskinesia

Olanzapine and Fluoxetine may trigger a movement disorder called tardive dyskinesia in some patients. The symptoms of tardive dyskinesia include uncontrolled chewing movements, compulsive smacking or puckering of the lips, puffing of the cheeks, worm-like or rapid movements of the tongue, or uncontrolled movements of the legs and arms. If you experience any of these symptoms while using Olanzapine and Fluoxetine, contact your doctor as soon as possible.

Allergies

Olanzapine and Fluoxetine may trigger an allergic reaction in some patients. Symptoms of an allergic reaction include hives or a rash on the skin, trouble breathing or labored breathing, and swelling of the face, mouth, or eyes. If you experience any of these symptoms after taking Olanzapine and Fluoxetine, tell your doctor as soon as possible.

Dizziness

Olanzapine and Fluoxetine may cause some patients to experience lightheadedness, dizziness, or fainting, especially when getting up after sitting or lying down. Getting up more slowly from these positions may reduce the risk of an episode. If this side effect does not go away or gets worse, contact your doctor for assistance.

Risk of Infection

Olanzapine and Fluoxetine may temporarily lower the number of white blood cells in your blood, which can heighten your risk of contracting an infection. Avoid individuals who have infections or who have been sick. Symptoms of an infection include a fever or chills, pain in the lower back or side, urination that is difficult or painful, and a cough or hoarseness. If you experience any of these symptoms while taking Olanzapine and Fluoxetine, check with your doctor as soon as possible.

Bleeding Problems

Olanzapine and Fluoxetine can increase your risk for problematic bleeding or bleeding problems. Tell your doctor if you are taking other medications or drugs which thin your blood, such as NSAIDs like aspirin, ibuprofen, naproxen, or warfarin.

Low Blood Sodium

Olanzapine and Fluoxetine may cause hyponatremia, or low sodium levels in the blood. The symptoms of this condition include confusion, difficulty concentrating, memory problems, headaches, weakness, and unsteadiness. If you experience any of these symptoms while taking Olanzapine and Fluoxetine, contact your doctor as soon as possible.

Heat Warning

Olanzapine and Fluoxetine can make it more difficult for your body to release heat and cool itself. Overheating while using Olanzapine and Fluoxetine may result in heat stroke. Take caution that you do not become overheated during hot weather or while performing exercise or other strenuous activities

Heart Rhythm Problems

Olanzapine and Fluoxetine may affect the heart. Tell your doctor if you or a family member have ever had a problem with heart rhythm such as QT prolongation, low blood pressure, a heart attack, heart failure, or a stroke. Contact your doctor immediately if you experience a fast, pounding, or uneven heartbeat, episodes of fainting, or any dizziness while taking Olanzapine and Fluoxetine.

Drowsiness

Olanzapine and Fluoxetine can cause drowsiness, difficulty seeing clearly, difficulty in controlling movements, or trouble thinking or remaining alert. Make sure you know how you react to a dose of Olanzapine and Fluoxetine before you operate heavy machinery, drive a vehicle, or perform other tasks that require you to be alert and coordinated while taking Olanzapine and Fluoxetine. If you do not feel alert or coordinated while using Olanzapine and Fluoxetine, do not perform these tasks. Contact your doctor if these side effects become unsustainable.

Stopping Medication

Do not suddenly stop taking Olanzapine and Fluoxetine without the advice of your doctor. Withdrawal symptoms from the sudden cessation of Olanzapine and Fluoxetine include breathing problems, chest pain, a runny nose, muscle pain, headaches, unusual tiredness or weakness, trembling or shaking, nausea, diarrhea, vomiting, vision changes, difficulty sleeping, agitation, confusion, dizziness, or lightheadedness, or increased sweating. If you decide to discontinue Olanzapine and Fluoxetine or your doctor has instructed you to stop taking Olanzapine and Fluoxetine, ask your doctor how to slowly decrease your daily dose safely.

Storage

Olanzapine and Fluoxetine should be stored in its original container. Keep the container tightly closed and do not expose medication to moisture. This medication is best stored at 77°F, but may be stored at temperatures as low as 59°F or as high as 86°F.

Summary

Olanzapine and Fluoxetine is a combination antidepressant prescribed to patients with bipolar I syndrome or with treatment-resistant depression. Olanzapine is an antipsychotic. Fluoxetine is a selective serotonin reuptake inhibitor. Together, these medications help to increase the activity of serotonin, dopamine, and norepinephrine in the brain.

Olanzapine and Fluoxetine comes in capsules which are to be taken orally. Each capsule contains 3 mg of Olanzapine and 25 mg of Fluoxetine. Most patients will begin taking one capsule at bedtime. Adults with bipolar disorder may take up to 3 capsules per day. Adults with treatment-resistant depression and any children taking Olanzapine and Fluoxetine will take up to 2 capsules per day. Do not stop taking Olanzapine and Fluoxetine without consulting with your doctor about safe cessation.

Store Olanzapine and Fluoxetine in a tightly closed container away from moisture. Keep this medication at room temperature and do not expose to excessive heat or freezing temperatures.

Olanzapine and Fluoxetine may cause suicidal thoughts in children, teenagers, or young adults. Adults or caretakers should watch for irritability, reckless actions, or other changes in behavior.

Olanzapine and Fluoxetine can cause tardive dyskinesia. Watch for unusual movements, especially in the face, mouth, or legs and arms.

Olanzapine and Fluoxetine can increase the blood sugar levels and levels of fats or cholesterol in the blood. Your doctor may prescribe medications to help with these conditions.

Olanzapine and Fluoxetine may make some patients light-headed or dizzy. Take caution when rising from a sitting or prone position, and do not drive or use heavy machinery until you know how this medication affects you.

Olanzapine and Fluoxetine can lower the white blood cell count, which can heighten the risk of infection in some patients and increase the risk of bleeding. Avoid spending time around individuals who are sick or may have infections. Tell your doctor if you are taking medications which thin the blood, or if you experience a fever, chills, pain in the lower back or side, difficulty urinating, or a cough.

Olanzapine and Fluoxetine may cause low blood sodium. Tell your doctor if you feel confused, have difficulty concentrating or remembering things, experience headaches, and feel weak or unsteady.

Olanzapine and Fluoxetine can make it difficult for your body to cool down. Take caution that you do not overheat.

Olanzapine and Fluoxetine may affect the heart. Tell your doctor if you or a family member have ever had heart problems such as low blood pressure, QT prolongation, heart attack, heart failure, or a stroke.

Olanzapine and Fluoxetine may cause mild side effects that do not usually require medical intervention. Check with your doctor if these side effects get worse or become bothersome. Some patients may experience diarrhea, weight gain, dry mouth that may lead to tooth disorders, a decreased interest in sex or ability to have sex, pain or stiffness in the muscle, weakness, or difficulty moving.

Olanzapine and Fluoxetine may cause side effects that may require medical attention. Check with your doctor immediately if you experience rapid weight gain or weight loss, stomach pain, stools or vomiting that are black or tarry or include blood, difficulty breathing or a sore throat, cognitive problems, nervousness, difficulty sleeping, impaired vision, headaches, a fast, slow, or irregular pulse, tender or swollen glands, swelling or bloating in the extremities, a fever, and unusual or uncontrolled movements of the extremities or face.

Olanzapine and Fluoxetine may interact with some drugs and cause unwanted effects or change the way drugs work in your body. Ask your doctor before you take:

  • Antipsychotic medications
  • Antiarrhythmic medications
  • Tricyclic antidepressants
  • SSRI antidepressants
  • SNRI antidepressants

Drugs that thin the blood or may cause bruising, such as aspirin, ibuprofen, or warfarin

  • Medications for Parkinson's disease
  • High blood pressure drugs
  • Diuretics
  • Cimetidine
  • Phenytoin
  • Vinblastine
  • Pimozide
  • Thioridazine
  • St. John's Wort
  • Tryptophan
  • Alcohol

MAO inhibitors (these should not be taken for 2 weeks before starting Olanzapine and Fluoxetine or for 5 weeks after stopping Olanzapine and Fluoxetine)