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 | |
| Combination of | |
|---|---|
| Olanzapine | Atypical antipsychotic |
| Fluoxetine | SSRI |
| (verify) | |
The drug combination olanzapine/fluoxetine (trade name Symbyax, created by Eli Lilly and Company) is a single capsule containing the atypical antipsychotic olanzapine and the selective serotonin reuptake inhibitor (SSRI) fluoxetine. Symbyax is primarily used to treat the depressive episodes of bipolar disorder as well as treatment-resistant depression.
Indications
Symbyax was approved by the U.S. Food and Drug Administration (FDA) to treat the depressive episodes of bipolar I disorder in 2003. In 2009, it was granted approval for the treatment of treatment-resistant depression.
Symbyax, or other antidepressant/antipsychotic combinations, are sometimes prescribed off-label for anxiety disorders, eating disorders, OCD, and PTSD.
Available dosages
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.
Synergistic effects
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).
Side effects
Possible side effects of Symbyax include all those of its two component drugs: olanzapine and fluoxetine. Common side effects include increased appetite, weight gain, drowsiness, fatigue, dry mouth, swelling, tremor, blurred vision and difficulty concentrating.
Symbyax 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.
Olanzapine, one of Symbyax's components, is correlated with an increase in blood sugar. Patients with diabetes, or those at risk for developing it, require careful monitoring.
In rare cases, Symbyax may cause neuroleptic malignant syndrome.
Like other SSRIs, Symbyax carries a black box warning stating that it could increase the risk of suicide in patients ages 24 and under. The warning also states that Symbyax may increase the risk of death in elderly patients with dementia-related psychosis.
References
- ^ Symbyax Prescribing Information. Eli Lilly and Company. 2010. http://pi.lilly.com/us/symbyax-pi.pdf
- Grohol, J. "FDA Approves Symbyax for Treatment Resistant Depression." Psych Central. http://psychcentral.com/blog/archives/2009/03/23/fda-approves-symbyax-for-treatment-resistant-depression/
- McIntyre R, Katzman M. (2003). "The role of atypical antipsychotics in bipolar depression and anxiety disorders". Bipolar Disord. 5 Suppl 2: 20–35. PMID 14700010.
- Pederson KJ, Roerig JL, Mitchell JE. (2003). "Towards the pharmacotherapy of eating disorders". Expert Opin Pharmacother. 4 (10): 1659–78. doi:10.1517/14656566.4.10.1659. PMID 14521477.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - Koran LM, Ringold AL, Elliott MA. (2000). "Olanzapine augmentation for treatment-resistant obsessive-compulsive disorder". J Clin Psychiatry. 61 (7): 514–7. doi:10.4088/JCP.v61n0709. PMID 10937610.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - Stein MB, Kline NA, Matloff JL. (2003). "Adjunctive olanzapine for SSRI-resistant combat-related PTSD: a double-blind, placebo-controlled study". Am J Psychiatry. 159 (10): 1777–9. PMID 12359687.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - "Symbyax Mechinism of Action. Lilly USA. 2010. http://www.insidesymbyax.com/Pages/symbyaxmechanismofaction.aspx
- ^ Drugs.com http://www.drugs.com/pdr/symbyax.html