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Generic Name for SYMBYAX 3mg/25mg
Olanzapine 3mg, fluoxetine (as HCl) 25mg; caps.
Thienobenzodiazepine + SSRI.
INDICATIONS FOR SYMBYAX 3MG/25MG
Depressive episodes associated with bipolar disorder. Treatment-resistant depression (TRD); see literature.
ADULT DOSE FOR SYMBYAX 3MG/25MG
≥18yrs: Take once daily in the PM. Bipolar depression: initially one 6mg/25mg cap; range: 6–12mg/25–50mg. TRD: initially one 6mg/25mg cap; range: 6–18mg/25–50mg. Both: max 18mg/75mg per day. Risk of hypotension, hepatic impairment, slow metabolizers, or sensitive to olanzapine: initially 3mg/25mg to 6mg/25mg; increase cautiously.
CHILDREN'S DOSING FOR SYMBYAX 3MG/25MG
<18yrs: not recommended.
CONTRAINDICATIONS FOR SYMBYAX 3MG/25MG
During or within 14 days of MAOIs. Concomitant pimozide or thioridazine (may cause QTc prolongation).
WARNINGS/PRECAUTIONS FOR SYMBYAX 3MG/25MG
Monitor for serotonin syndrome or neuroleptic malignant syndrome-like signs/symptoms; discontinue if occurs. Cardio- or cerebrovascular disease. Hepatic impairment (monitor ALT/AST). Hypovolemia. Dehydration. History of seizures or mania/hypomania. Conditions that affect metabolism or hemodynamic response. Diabetes. Monitor for hyperglycemia, hyperlipidemia; do fasting blood glucose and lipids testing at beginning, and during therapy. Monitor for weight gain. Narrow angle glaucoma. Prostatic hypertrophy. History of paralytic ileus or breast cancer. Exposure to extreme heat. Dysphagia. Suicidal ideation (monitor). Reevaluate periodically. Write ℞ for smallest practical amount. Avoid abrupt cessation. Elderly (not for dementia-related psychosis; may increase risk of death). Neonates: risk of extrapyramidal and/or withdrawal symptoms post delivery (due to exposure during 3rd-trimester pregnancy). Labor & delivery. Pregnancy (Cat.C; avoid in 3rd trimester or consider lower dose; see literature). Nursing mothers: not recommended.
INTERACTIONS FOR SYMBYAX 3MG/25MG
See Contraindications. Do not start MAOI or thioridazine within at least 5 weeks of discontinuing olanzapine/fluoxetine. Concomitant SSRIs, SNRIs, tryptophan: not recommended. May increase phenytoin, carbamazepine, haloperidol, clozapine levels. May potentiate other protein bound drugs and those metabolized by CYP2D6 (eg, tricyclics). May be potentiated by CYP1A2 inhibitors (eg, fluvoxamine). May antagonize levodopa, dopamine agonists. May be antagonized by carbamazepine, rifampin, omeprazole, other CYP1A2 or glucuronyl transferase inducers. Increased risk of bleeding with NSAIDs, aspirin, warfarin, others that affect coagulation. Orthostatic hypotension with antihypertensives, benzodiazepines, alcohol, others. Hyponatremia with diuretics. Caution with triptans, linezolid, lithium, tramadol, or St. John's wort; may cause serotonin syndrome (eg, agitation, tachycardia, incoordination, hyperreflexia). Caution with other antipsychotics, benzodiazepines, drugs that lower seizure threshold, other CNS drugs, hepatotoxic agents, anticholinergics, other forms of olanzapine or fluoxetine. Smokers may have increased metabolism.
ADVERSE REACTIONS SYMBYAX 3MG/25MG
Disturbance in attention, dry mouth, fatigue, hypersomnia, increased appetite, peripheral edema, sedation, somnolence, tremor, blurred vision, weight gain, orthostatic hypotension; rare: neuroleptic malignant syndrome, tardive dyskinesia, hyponatremia, hyperprolactinemia, mania/hypomania, elevated liver enzymes.
HOW IS SYMBYAX 3MG/25MG SUPPLIED
6mg/25mg, 6mg/50mg, 12mg/25mg, 12mg/50mg—30, 100, 1000
SEE ALSO:SYMBYAX 12mg/25mg