*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Symbyax is a medication combining an antipsychotic (olanzapine) and an antidepressant (fluoxetine) used primarily to treat depressive episodes associated with bipolar disorder and treatment-resistant depression. It helps regulate neurotransmitter balance in the brain, alleviating symptoms of psychosis and improving mood. Common side effects include drowsiness, weight gain, and changes in appetite. Typical dosing begins with a 6 mg/25mg capsule taken once daily in the evening.1
If you’re considering Symbyax, online psychiatry platforms such as Talkiatry and Brightside Health can connect you with a provider quickly. They offer assessments and can provide a prescription if they determine Symbyax or another medication may help your symptoms.
Boxed Warning: Symbyax – Risk of suicidality in children, adolescents, and young adults, risk of dementia-related psychosis in elderly patients
Symbyax has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA). Symbyax can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults.
What Is Symbyax (Olanzapine-Fluoxetine)?
Symbyax is a medication that combines olanzapine and fluoxetine. It is primarily used to treat depressive episodes associated with bipolar disorder and treatment-resistant depression. Olanzapine belongs to the class of antipsychotic medications, while fluoxetine is a selective serotonin reuptake inhibitor (SSRI), commonly used as an antidepressant. Symbyax is not approved for use in children less than 10 years of age.1
Olanzapine works by blocking certain receptors in the brain, including dopamine and serotonin receptors, which helps to regulate the balance of these neurotransmitters. It helps alleviate symptoms of psychosis, such as hallucinations and delusions, commonly associated with bipolar disorder. Fluoxetine, on the other hand, increases the levels of serotonin in the brain by inhibiting its reuptake, thereby improving mood and reducing symptoms of depression.
What Is Olanzapine?
Olanzapine is a medication that belongs to a group known as atypical antipsychotics. It is commonly prescribed to treat conditions such as schizophrenia and bipolar disorder. Antipsychotics like olanzapine work by blocking certain receptors in the brain, particularly dopamine and serotonin receptors, This may help to regulate the balance of these chemicals in the brain and potentially relieve symptoms.2
By affecting the amount of these chemicals, olanzapine may help alleviate symptoms of psychosis, including hallucinations, delusions, and disorganized thinking. Like all medications, it is important to be aware of potential side effects and to take olanzapine as directed under the guidance of a healthcare provider.
What Is Fluoxetine?
Fluoxetine is a medication that belongs to the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). It is commonly prescribed as an antidepressant to treat conditions such as major depressive disorder, anxiety disorders, and obsessive-compulsive disorder. SSRIs like fluoxetine work by increasing the levels of a chemical called serotonin in the brain. This helps improve mood, reduce symptoms of depression and anxiety, and restore the balance of chemicals in the brain. 3
Fluoxetine is available in various forms, including capsules and tablets. It is important to note that fluoxetine should be taken as prescribed and under the guidance of a healthcare provider, as it may have potential side effects and interactions with other medications.
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How Does Symbyax Work?
Symbyax works in a special way by combining both fluoxetine and olanzapine to treat symptoms. Olanzapine helps affect the balance of dopamine and serotonin while fluoxetine works to increase the levels of serotonin in the brain. This helps to improve mood, reduce anxiety and alleviate depression symptoms. Together two medications work to target both the mood-related symptoms of depression and associated psychotic symptoms. This can provide a more comprehensive treatment of depression or bipolar disorder.1
What Is Symbyax Used to Treat?
A doctor may prescribe an antidepressant such as Symbyax in the treatment of depression or bipolar disorder when a patient is either experiencing acute depressive episodes in Bipolar 1 Disorder or not responding well to two separate trials of different antidepressants. Typically, antidepressants are considered when the symptoms significantly impact daily functioning, cause distress, or pose a risk to the person’s well-being.
Symbyax is not approved for use in children less than 10 years of age.1 Symbyax may also be given off-label for other conditions. An off-label use of a medication is a use not approved by the FDA. If a prescriber believes a medication may benefit a patient, they can prescribe it off-label.
Symbyax is used as an FDA-approved medication to treat:1
- Depression episodes in bipolar disorder
- Treatment-resistant depression
Symbyax is not known to have any off-label uses. However, olanzapine and fluoxetine are each used as treatments other than their FDA-approved uses.
Off-label uses for olanzapine may include:4
- Preventing chemotherapy-induced nausea and vomiting
Off-label uses for fluoxetine may include treating:5
- Body dysmorphic disorder
- Binge eating disorder
- Generalized anxiety disorder (GAD)
- Social anxiety
- Posttraumatic stress disorder (PTSD)
Who Should Not Take Symbyax?
Due to drug interactions and other risks, some people should avoid taking Symbyax. This medication has not been tested for safety and efficacy in children under the age of 10. Using Symbyax during pregnancy (later stage) may increase the risk for persistent blood pressure problems in neonates and also cause extrapyramidal symptoms (repetitive, involuntary facial movements).1
Symbyax should also be avoided with glaucoma as it can increase pressure inside the eye. Severe liver disease patients should also avoid this medication as it is processed through the liver.
People who should avoid taking Symbyax include:1
- Pregnant and breastfeeding women
- People with certain pre-existing health conditions
- Children under 10 years of age
- People taking monoamine oxidase inhibitor (MAOIs) antidepressants or within 14 days of discontinuing an MAOI
- Those taking other antidepressant or antipsychotic medications
- People with severe liver disease
- People with glaucoma
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Symbyax Dosages for FDA-Approved Treatment
The dose of Symbyax given to patients may vary for each individual. The typical dosage range starts at 6 mg/25 mg (olanzapine/fluoxetine) once daily in the evening for both bipolar 1 disorder and treatment-resistant depression. This dose can then be adjusted based on individual response up to a maximum dose of 12 mg/50 mg per day. The safety of doses above 18 mg of olanzapine and 75 mg of fluoxetine has not been evaluated in adult clinical studies.1
Factors that affect dosing for individuals may include interactions with other medications and substances, and liver function. Symbyax is considered an FDA-approved medication. When a medication is FDA-approved, it means that it has undergone rigorous testing and evaluation for safety and efficacy by the U.S. Food and Drug Administration (FDA).
Symbyax Forms & Strengths
The medication comes in the form of capsules, and the strength of the active ingredients, olanzapine and fluoxetine, are primarily in either 3 mg/25 mg or 6 mg/25 mg combinations.1
The 3 mg form of the medication is used for the treatment of bipolar 1 disorder in patients aged 10-17.1 This medication does not come in extended release, delayed-release, or sustained release. The severity of symptoms, age of the patient, and potential interactions with other medications are taken into account when determining the appropriate dosage for an individual.
Symbyax is available in the following forms and strengths:
- 3 mg/25 mg (milligram) oral capsule
- 6 mg/25 mg (milligram) oral capsule
As a general reminder, it is important to take medications exactly as prescribed. Symbyax is taken by mouth, generally at night once daily, but be sure to follow the directions of your provider and take your medication as it is written on your prescription.
How Should I Take Symbyax?
Symbyax should be taken by mouth once daily in the evening, generally beginning with either 6 mg/25 mg or 3 mg/25 mg strengths. This medication may be taken with or without food. It is important to note that this medication should be taken at the same time each day. If Symbyax must be stopped or discontinued, it should be gradually reduced and tapered as directed by the prescriber.1
What Happens If I Miss a Dose of Symbyax?
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses as this may increase side effects and potentially cause other conditions. Symbyax should never be stopped abruptly as this can cause a relapse of psychotic symptoms.1
Side Effects of Symbyax
Symbyax may cause several side effects due to its direct action on the body. It is important to note that not all individuals will experience these side effects, and the severity and frequency can vary. It is recommended to discuss any concerns or side effects with a healthcare professional. 1
Common Side Effects of Symbyax
Some individuals taking Symbyax may experience physical side effects, especially those affecting digestion. While some side effects are common, it is essential to consult with a healthcare professional if they become severe, persistent, or concerning. They can provide guidance and make medication adjustments if necessary.
Common side effects of Symbyax include:1
- Drowsiness
- Dizziness
- Weight gain
- Dry mouth
- Increased appetite
- Fatigue
- Nausea
- Tremors
- Insomnia
- Sexual dysfunction or changes in performance
Severe Side Effects of Symbyax
While taking Symbyax, it is important to be aware of potentially severe side effects that require immediate medical care. These include rare but serious conditions such as Neuroleptic Malignant Syndrome (NMS), characterized by fever, muscle stiffness, and changes in blood pressure; Serotonin Syndrome, marked by agitation, hallucinations, and rapid heartbeat; and severe allergic reactions, indicated by swelling, difficulty breathing, and rash. If any of these severe side effects occur, seeking immediate medical attention is crucial for appropriate management and treatment.1
Severe side effects of Symbyax may include:1
- Serotonin syndrome: Characterized by agitation, hallucinations, rapid heartbeat and high blood pressure, fever, tremors, and confusion. If you suspect you are experiencing serotonin syndrome you should immediately call your provider or head to the nearest emergency room.
- Blurred vision: A person who experiences any blurred vision while taking Symbyax should seek immediate medical care.
- Neuroleptic malignant syndrome (NMS): Rare but serious condition characterized by fever, muscle stiffness, and changes in blood pressure. Requires immediate medical attention.
- Allergic reactions: In rare cases, severe allergic reactions can occur, resulting in swelling, difficulty breathing, and rash. Seeking immediate medical help is important.
- Antidepressant withdrawal: If Symbyax is suddenly discontinued individuals may experience flu-like symptoms, mood, sensory or sleep disturbances. This should be brought to the attention of your provider so they can create a plan for you to taper off the medication safely or provide assistance.
- Worsened anxiety symptoms: In some cases, Symbyax may cause worsened anxiety symptoms. If you experience this you should discuss this with your provider so they may evaluate your symptoms and see if a change is in order.
- Drug reaction with eosinophilia and systemic symptoms (DRESS): Symbyax-induced hypersensitivity reaction characterized by a widespread rash, fever, swelling of lymph nodes and involvement of internal organs. If any symptoms occur seek immediate medical attention.
Symbyax Withdrawal
Symbyax withdrawal refers to the symptoms that can occur when abruptly stopping or rapidly reducing the dosage of the medication. This is also known as antidepressant discontinuation syndrome. The main symptoms of Symbyax withdrawal can include flu-like symptoms, mood, sensory and sleep disturbances, and gastrointestinal symptoms. It is important to seek immediate medical care if experiencing withdrawal symptoms from Symbyax as a healthcare professional can provide appropriate guidance and support in managing the withdrawal process.
Allergic Reactions to Symbyax
Symbyax, like any medication, has the potential to cause allergic reactions in some individuals. Especially in patients with a known allergy to SSRIs or olanzapine. Allergic reactions can manifest as swelling of the face, lips, tongue, or throat, difficulty breathing, and rash. It is important to inform providers of any drug allergies before starting treatment. If an allergic reaction to Symbyax occurs, immediate medical attention should be sought, and the medication discontinued.1
Allergic reactions to Symbyax may include:1
- Breathing trouble
- Swelling of face, lips, tongue, or throat
- Fever
- Hives
- Widespread rash
- Swelling of lymph nodes
If someone experiences an allergic reaction it is important to take immediate action and seek emergency medical care. Either call 911 or go to the nearest emergency room if symptoms appear severe. Individuals should also discontinue the medication and follow up about alternative options after being evaluated by a healthcare professional.
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Symbyax Warnings & Precautions
When taking Symbyax, there are important warnings and precautions that should be considered. Symbyax carries a boxed warning regarding an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders. Close monitoring is necessary during treatment, especially at the beginning or when the dosage is adjusted. It is essential to report any unusual changes in mood, behavior, or thoughts to a healthcare professional immediately.1
Lead-in sentence: Precautions for taking Symbyax include:1
- Symptoms of mania or bipolar disorder: If someone experiences symptoms of mania or bipolar disorder while taking Symbyax, it is crucial to contact a healthcare professional immediately.
- Increased risk of suicidal thoughts and behaviors: Symbyax carries a boxed warning for an increased risk of suicidal thoughts and behaviors, particularly in children, adolescents, and young adults. Close monitoring and immediate reporting of any changes in mood or behavior are essential.
- Serotonin syndrome: There is a risk of developing serotonin syndrome, a serious condition that can occur with the use of Symbyax. Symptoms include agitation, hallucinations, rapid heartbeat, and muscle stiffness. Prompt medical attention is necessary if serotonin syndrome is suspected.
- Blood sugar levels: Symbyax may affect blood sugar levels, so regular monitoring is recommended, especially in individuals with diabetes or at risk for developing diabetes.
- Orthostatic hypotension: Symbyax can cause a drop in blood pressure upon standing, leading to dizziness or fainting. Caution should be exercised, especially in individuals prone to low blood pressure or who are taking medications that can lower blood pressure.
- Seizure risk: Symbyax should be used with caution in individuals with a history of seizures or those at risk for seizures. Close monitoring is necessary.
- Cataract risk: Symbyax may increase the risk of developing cataracts. Regular eye examinations are recommended for individuals taking Symbyax, particularly those with pre-existing risk factors for cataracts.
- Avoid alcohol use: Both Symbyax and alcohol have some similar effects on the body, so combining them can enhance these effects and potentially increase the risk of accidents or other adverse outcomes.
- Pregnancy: Symbyax is generally not recommended during pregnancy or breastfeeding unless the potential benefits outweigh the potential risks. It is important to discuss the risks and benefits with your provider should you become pregnant on this medication.
Interactions With Symbyax
Symbyax can interact with various medications, substances, and herbs, potentially leading to harmful effects or reducing the effectiveness of the medication. It is crucial to inform healthcare professionals about all the medications, vitamins, herbs, supplements, and substances you are taking to minimize the risk of interactions.
Some of these include medications like MAOIs or other antidepressants, central nervous system depressants like alcohol, benzodiazepines, or opioids, medications that affect liver enzymes and over-the-counter herbal products such as St. John’s Wort.1
6 substances you should avoid while taking Symbyax include:1
- St John’s Wort: St. John’s Wort, a herbal supplement used for depression, can interact with Symbyax, reducing its effectiveness and potentially leading to a recurrence of depressive symptoms.
- Other antidepressants: Taking other medications for depression may have an additive effect, potentially leading to an overdose. If an individual is taking MAOIs they should wait at least 14 days before starting Symbyax.
- Alcohol: Symbyax and alcohol are both central nervous system depressants. Together they may increase sedation or cause low blood pressure.
- Benzodiazepines: Similar to alcohol, Symbyax may interact with benzodiazepines by increasing sedation and cause low blood pressure.
- Opioids: Caution is advised if the administration of Symbyax and other medications that affect the central nervous system are taken together.
- Medications that affect liver enzymes: Certain medications that affect liver enzymes, such as fluvoxamine and ciprofloxacin, can alter the metabolism of Symbyax, leading to increased levels of the medication in the body and potentially increasing the risk of side effects.
Can You Overdose on Symbyax?
An overdose of Symbyax can occur if the medication is taken in excessive amounts. It is important to take Symbyax exactly as prescribed by a healthcare professional to avoid the risk of overdose. Signs and symptoms of a Symbyax overdose may include drowsiness, dizziness, rapid heartbeat, low blood pressure, agitation, confusion, seizures, and respiratory distress.
In severe cases, it can lead to coma or life-threatening complications. If an overdose is suspected, immediate medical attention should be sought by calling emergency services or going to the nearest emergency room.
What Should You Do If You Take Too Much Symbyax?
If you take too much Symbyax, seek immediate medical help. This may include calling 911, going to an emergency room, and following up by contacting poison control. Explain the situation and provide information about the medication taken, dosage, and any other substances involved. Be honest and provide accurate information to the best of your ability in order to best assist healthcare professionals should they need to provide treatment or manage overdose symptoms.
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Questions to Ask Your Healthcare Provider About Symbyax
When considering the use of Symbyax for the treatment of depression or bipolar disorder, it is important to have open and honest discussions with your providers, including your doctor, psychiatrist, or therapist. Symbyax is generally only reserved for patients who fit the criteria of having either treatment-resistant depression or bipolar 1 disorder. Your provider will screen you to see if you are eligible for this medication and explain what sort of side effects you may experience and how this medication may differ from ones you may have taken previously.
Finding the right therapist can be a valuable and beneficial part of depression treatment. A therapist can offer a supportive and non-judgmental space to explore and address underlying psychological factors contributing to depression. They can help develop coping strategies, provide emotional support, and assist in developing healthier thought patterns and behaviors.
Questions to ask your care team about Symbyax include:
- Can I use Symbyax along with therapy to treat depression?
- How soon might I notice side effects from taking Symbyax?
- Am I at risk for more severe symptoms if I am already taking other anxiety/depression medications?
- What is the best dosage to ensure fewer side effects?
- Are there drugs I am taking that could have negative interactions?
- When should I reach out to you if I am experiencing side effects?
- Is there anything I should tell my therapist about this new medication?
- How soon should I start to see benefit from this medication?
- What is the recommended dosage and duration of treatment?
- Are there any lifestyle changes or precautions I should consider while taking Symbyax?
- Are there any specific goals or strategies we should focus on during therapy?
- How long will I remain on this medication?
How to Get a Symbyax Prescription
When considering a medication like Symbyax as a treatment for depression, the process typically begins with a consultation with a healthcare professional, such as a psychiatrist or primary care physician. They will conduct a comprehensive evaluation to assess your symptoms, medical history, and overall mental health.
This evaluation helps determine if Symbyax is a suitable option for you. The healthcare professional will discuss the potential benefits, risks, and side effects of Symbyax, considering your individual circumstances. Online psychiatry services may provide a viable alternative for those who have limited access to in-person appointments or prefer the convenience of virtual consultations.
In My Experience
As a pharmacist, I believe it is important to speak with your healthcare team if you believe Symbyax would be a good medication for you. Depression and bipolar disorder can affect life for individuals in many different ways and if therapy is an option I believe it is always worth pursuing to achieve a better quality of life. In my experience, your provider can provide guidance on if this medication would be beneficial for someone as opposed to just taking two separate medications that achieve the same effect.
There are many benefits to being able to potentially only take one capsule once daily for individuals who struggle to remember to take multiple medications.
Additional Resources
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