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Drug Guide    S   SYMBYAX

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   SYMBYAX

SYMBYAX
Oral


This medication is a combination of 2 drugs, olanzapine (an antipsychotic drug) and fluoxetine (a selective serotonin reuptake inhibitor-SSRI). It is used to treat a certain type of mental/mood disorder (depression associated with bipolar disorder). This medication may help you sleep, improve your mood, improve your concentration, and decrease nervousness. It works by helping to restore the balance of certain natural substances in the brain (neurotransmitters).



 
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 SYMBYAX images:

OverviewPhotosHow To UseSide EffectsPrecautionsMissed DoseDrug Interactions



SYMBYAX

Uses
This medication is a combination of 2 drugs, olanzapine (an antipsychotic drug) and fluoxetine (a selective serotonin reuptake inhibitor-SSRI). It is used to treat a certain type of mental/mood disorder (depression associated with bipolar disorder). This medication may help you sleep, improve your mood, improve your concentration, and decrease nervousness. It works by helping to restore the balance of certain natural substances in the brain (neurotransmitters).
Notes
  • Psychiatric/medical checkups and laboratory/medical tests (e.g., liver function tests, blood sugar, weight, blood pressure, blood cholesterol/triglyceride levels) should be done periodically to monitor your progress and check for side effects.
  • Consult your doctor for more details.Do not share this medication with others.

Storage
  • Store at room temperature at 77 degrees F (25 degrees C) away from light and moisture.
  • Brief storage between 59-86 degrees F (15-30 degrees C) is permitted.
  • Do not store in the bathroom.
  • Keep all medicines away from children and pets.

Overdose
  • Symptoms of overdose may include: irregular heartbeat, seizures, loss of consciousness.

How To Use
  • Read the Medication Guide provided by your pharmacist before you start using olanzapine/fluoxetine and each time you get a refill.
  • If you have any questions, consult your doctor or pharmacist.Take this medication by mouth, with or without food, usually once daily in the evening or as directed by your doctor.The dosage is based on your medical condition and response to treatment.Use this medication regularly in order to get the most benefit from it.
  • Remember to use it at the same time each day.It may take up to several weeks before the full benefit of this drug takes effect.
  • It is important to continue taking this medication as prescribed even if you feel well.
  • Do not stop taking this medication without consulting your doctor.
  • Some conditions may become worse when the drug is abruptly stopped.
  • Your dose may need to be gradually decreased.If your condition persists or worsens, contact your doctor or pharmacist.

Side Effects
  • See also the Warning section.Dizziness, drowsiness, diarrhea, dry mouth, constipation, increased appetite, weight gain, or trouble sleeping may occur.
  • If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects.
  • Many people using this medication do not have serious side effects.Tell your doctor immediately if any of these unlikely but serious side effects occur: fainting, unusual or severe mental/mood changes (e.g., nervousness, trouble concentrating, rare thoughts of suicide), swelling hands/ankles/feet, restlessness, shaking (tremor), inability to keep still, decreased interest in sex, changes in sexual ability.Tell your doctor immediately if any of these rare but very serious side effects occur: black stools, vomit that looks like coffee grounds, easy bruising/bleeding, muscle spasm, change in the amount of urine, yellowing eyes/skin, dark urine, severe stomach/abdominal pain, weakness on one side of body, slow/irregular/fast heartbeat, sudden vision changes, severe headache, seizures.This drug may infrequently make your blood sugar level rise, an effect that may cause or worsen diabetes.
  • This high blood sugar can rarely cause serious conditions such as diabetic coma.
  • Tell your doctor immediately if you develop symptoms of high blood sugar, such as increased thirst/urination or unexplained weakness.
  • If you already have diabetes, be sure to check your blood sugars regularly and share the results with your doctor.
  • Your doctor may need to adjust your medication, diet, and exercise program when you start or stop this medication.This drug may also cause significant weight gain and a rise in your blood cholesterol (or triglyceride) levels.
  • These effects, along with diabetes, may increase your risk for developing heart disease.
  • Discuss the risks and benefits of treatment with your doctor.
  • (See also Notes section.)This medication may rarely cause a very serious condition called serotonin syndrome.
  • The risk increases when this medication is used with certain other drugs such as "triptans" used to treat migraine headaches (e.g., sumatriptan, eletriptan), certain antidepressants including other SSRIs (e.g., citalopram, paroxetine) and SNRIs (e.g., duloxetine, venlafaxine), lithium, tramadol, tryptophan, or a certain drug to treat obesity (sibutramine).
  • See also Drug Interactions section.
  • Before taking this drug, tell your doctor if you take any of these medications.
  • Serotonin syndrome may be more likely when you start or increase the dose of any of these medications.
  • Seek immediate medical attention if you develop any of the following symptoms: hallucinations, unusual restlessness, severe dizziness, unexplained fever, loss of coordination, severe nausea/vomiting/diarrhea, twitchy muscles.This medication may rarely cause a serious condition called neuroleptic malignant syndrome (NMS).
  • Seek immediate medical attention if you develop the following: confusion, high fever, muscle stiffness, severe sweating, fast or irregular heartbeat.Olanzapine may rarely cause a condition known as tardive dyskinesia.
  • In some cases, this condition may be permanent.
  • Tell your doctor immediately if you develop any unusual/uncontrolled movements (especially of the face/lips/tongue).In rare cases, this medication may increase your blood level of a certain hormone (prolactin).
  • For females, this rare increase in prolactin levels may result in unwanted breast milk, irregular/stopped menstrual periods, or difficulty becoming pregnant.
  • For males, it may result in decreased sexual ability, inability to produce sperm, or enlarged breasts.
  • If you develop any of these symptoms, tell your doctor immediately.For males, in the very unlikely event you have a painful or prolonged erection lasting 4 or more hours, stop using this drug and seek immediate medical attention, or permanent problems could occur.A very serious allergic reaction to this drug is rare.
  • However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching, swelling, severe dizziness, trouble breathing.If you notice other effects not listed above, contact your doctor or pharmacist.

Precautions
  • Before taking olanzapine/fluoxetine, tell your doctor or pharmacist if you are allergic to olanzapine or fluoxetine; or if you have any other allergies.Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal or family history of suicide attempts, breast cancer, diabetes or family history of diabetes, heart disease (e.g., chest pain, heart attack, heart failure, irregular heartbeat), intestinal problems (e.g., paralytic ileus, chronic constipation), kidney disease, liver problems, low blood pressure, neuroleptic malignant syndrome, narrow-angle glaucoma, prostate problems, seizures, stomach/intestinal ulcers, brain problems (e.g., dementia, stroke), severe loss of body water (dehydration).This drug may make you dizzy or drowsy.
  • Use caution while driving, using machinery, or doing other activities that require alertness.
  • Avoid alcoholic beverages.To reduce dizziness and lightheadedness, get up slowly when rising from a sitting or lying position, especially when you first start taking this medication.This medication can make it harder to control your body temperature.
  • Avoid activities that might cause you to overheat (e.g., doing strenuous work, exercising in hot weather, or using hot tubs).
  • Drink plenty of fluids to avoid becoming dehydrated.Caution is advised when using this product in the elderly because they may be more sensitive to its side effects.
  • The elderly are more likely to develop a type of mineral imbalance (hyponatremia), especially if they are also taking "water pills" or diuretics with this medication.This medication is not recommended for use during pregnancy.
  • It may harm an unborn baby.
  • Also, babies born to mothers who have used this drug during the last 3 months of pregnancy may infrequently develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying.
  • If you notice any of these symptoms in your newborn, tell the doctor promptly.Since untreated depression can be a serious condition, do not stop taking this medication unless directed by your doctor.
  • If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss the benefits and risks of using this medication during pregnancy with your doctor.One of the drugs (fluoxetine) in this product passes into breast milk.
  • Because of the possible risk to the infant, breast-feeding while using this drug is not recommended.
  • Consult your doctor before breast-feeding.

Missed Dose
  • If you miss a dose, use it as soon as you remember.
  • If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule.
  • Do not double the dose to catch up.

Drug Interactions
  • Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.
  • Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.Fluoxetine (one of the drugs in this medication) can stay in your body for many weeks after your last dose and may interact with many other medications.
  • If you have taken this medication in the previous 5 weeks, consult your doctor or pharmacist before using any other medication.Certain medications could result in serious (rarely fatal) drug interactions if taken with this product.
  • Avoid taking MAO inhibitors (e.g., furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) for 2 weeks before treatment, during treatment, and at least 5 weeks after treatment with this medication.
  • Consult your doctor or pharmacist for more information.The following medications should not be used with this product or for 5 weeks after your last dose because very serious (possibly fatal) interactions may occur: pimozide, sibutramine, thioridazine.If you are currently using any of these medications listed above, tell your doctor or pharmacist before starting this medication.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: drugs removed from your body by certain liver enzymes (e.g., carbamazepine, cimetidine, phenytoin, vinblastine, drugs for anxiety such as alprazolam and diazepam, antipsychotics such as aripiprazole/clozapine/haloperidol/perphenazine, antiarrhythmics such as propafenone/flecainide, TCA antidepressants such as desipramine/imipramine), fosamprenavir/ritonavir, metoprolol, "water pills" (diuretics such as furosemide), drugs that can cause bleeding/bruising (e.g., aspirin, antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, "blood thinners" such as heparin, warfarin), drugs for high blood pressure, medicines for Parkinson's disease (e.g., levodopa, cabergoline).Aspirin can increase the risk of bleeding when used with this medication (see above).
  • If your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81-325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise.
  • Discuss the risks and benefits with your doctor.Also tell your doctor if you take any other drugs that increase serotonin, such as bromocriptine, buspirone, dextromethorphan, lithium, meperidine, propoxyphene, phentermine, SSRIs, SNRIs, tryptophan, St.
  • John's wort, drugs used to treat migraines such as "triptans" and dihydroergotamine, street drugs such as MDMA/"ecstasy," amphetamine.
  • (See also Side Effects section.)Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., carbamazepine), medicine for sleep or anxiety (e.g., lorazepam, zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), other psychiatric medicines (e.g., chlorpromazine, quetiapine, nortriptyline, trazodone).Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain ingredients that cause drowsiness.Dextromethorphan is a commonly used cough medication and may interact with fluoxetine.
  • Ask your pharmacist about using those products safely.Cimetidine is a nonprescription drug that is commonly used to treat extra stomach acid.
  • Because it may cause undesirable interactions when used with fluoxetine, ask your pharmacist about other products to treat stomach acid.Cigarette smoking may decrease blood levels of this medication.
  • Tell your doctor if you smoke or if you have recently stopped smoking.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgement of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

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