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Symbyax
Symbyax is a combination medication containing olanzapine (an atypical antipsychotic) and fluoxetine (a selective serotonin reuptake inhibitor, SSRI) used to treat depression in individuals with bipolar I disorder and treatment-resistant depression (TRD). Olanzapine helps manage the mood swings associated with bipolar disorder, while fluoxetine helps alleviate depressive symptoms by increasing serotonin levels in the brain. Together, they provide a comprehensive treatment for the depressive episodes of bipolar disorder and cases where other antidepressants have failed.
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Frequently Asked Questions
How long does it take for Symbyax to start working?
It may take 2 to 4 weeks before you start noticing improvements in depressive symptoms, though some patients may experience improvements sooner. Full therapeutic effects may take longer.
Can I drink alcohol while taking Symbyax?
It is best to avoid alcohol while taking Symbyax, as it can increase drowsiness and impair motor skills and judgment.
What should I do if I miss a dose of Symbyax?
If you miss a dose, take it as soon as you remember. If it is close to your next dose, skip the missed dose and take your next dose at the regular time. Do not double up on doses.
Can Symbyax cause weight gain?
Yes, weight gain is a common side effect, primarily due to the olanzapine component. Your healthcare provider may monitor your weight and metabolic parameters regularly during treatment.
Is Symbyax safe for long-term use?
Symbyax may be used long-term for the management of bipolar depression or treatment-resistant depression. However, long-term use requires monitoring for side effects such as weight gain, metabolic changes, and movement disorders (tardive dyskinesia).
Comprehensive Drug Guide
How Does Symbyax Work?
- Olanzapine: An atypical antipsychotic that blocks certain receptors in the brain, including dopamine (D2) and serotonin (5-HT2), helping to balance neurotransmitters involved in mood regulation. This helps stabilize mood swings and reduce symptoms of mania.
- Fluoxetine: An SSRI that increases the level of serotonin in the brain by blocking its reuptake, which helps alleviate depression and improve mood.
Together, these actions help manage the depressive episodes of bipolar disorder and treatment-resistant depression.
Common Dosages
- 3 mg olanzapine / 25 mg fluoxetine
- 6 mg olanzapine / 25 mg fluoxetine
- 6 mg olanzapine / 50 mg fluoxetine
- 12 mg olanzapine / 25 mg fluoxetine
- 12 mg olanzapine / 50 mg fluoxetine
Typical Dosing
- For bipolar depression, the typical starting dose is 6 mg/25 mg once daily, taken in the evening.
- For treatment-resistant depression (TRD), the typical starting dose is 6 mg/25 mg once daily. The dose may be increased based on response and tolerability.
- Dosage adjustments are made based on the patient's response and the occurrence of side effects.
Typical Dosing
FDA Approved Indications
- Depressive episodes associated with bipolar I disorder in adults and children aged 10 years and older.
- Treatment-resistant depression (TRD) in adults who have not responded adequately to two or more antidepressant treatments.
Who Shouldn't Take Symbyax?
- Known hypersensitivity to olanzapine, fluoxetine, or any component of the formulation.
- Concurrent use of monoamine oxidase inhibitors (MAOIs), or within 14 days of discontinuing an MAOI, due to the risk of serotonin syndrome.
- Thioridazine or pimozide use, as fluoxetine can increase levels of these medications, leading to serious heart rhythm abnormalities.
Advice From The Pharmacist
- Take Symbyax once daily, preferably in the evening, as it may cause drowsiness.
- It may take several weeks before you notice the full effects of Symbyax. Continue taking the medication as prescribed, even if you don’t see immediate improvements.
- Do not stop taking Symbyax suddenly, as this may lead to withdrawal symptoms or a return of depressive or manic symptoms. Consult your healthcare provider if discontinuation is needed.
- Avoid drinking alcohol while taking Symbyax, as it may increase drowsiness and impair cognitive and motor functions.
- Be cautious with driving or operating heavy machinery until you know how Symbyax affects you, as it can cause drowsiness and dizziness.
- Regular monitoring of weight, blood sugar, and lipid levels may be necessary, as olanzapine can increase the risk of metabolic side effects.
Side Effects of Symbyax
Common Side Effects
- Drowsiness or sedation
- Weight gain
- Increased appetite
- Dry mouth
- Constipation
- Dizziness
- Restlessness
Uncommon/Severe Side Effects
- Metabolic syndrome: Increased blood sugar, cholesterol, and triglyceride levels, leading to an increased risk of diabetes and heart disease.
- Tardive dyskinesia: Involuntary movements, particularly of the face and tongue, associated with long-term use of antipsychotics.
- Serotonin syndrome: Symptoms include agitation, confusion, rapid heartbeat, and sweating.
- Suicidal thoughts: Particularly in young adults under the age of 24 during the early stages of treatment.
Risks and Warnings of Symbyax
- Suicidal thoughts and behaviors: Like other antidepressants, Symbyax may increase the risk of suicidal thoughts and behaviors, especially in adolescents and young adults under 24. Close monitoring is essential during the first few months of treatment.
- Metabolic changes: Olanzapine may cause weight gain, increased blood sugar levels, and elevated cholesterol or triglyceride levels. Regular monitoring of metabolic parameters is recommended.
- Tardive dyskinesia: Prolonged use of antipsychotics like olanzapine may lead to involuntary muscle movements, which may be irreversible.
- Orthostatic hypotension: Symbyax may cause a sudden drop in blood pressure when standing up, leading to dizziness or fainting.
Interactions with Symbyax
Common Drug Interactions
- MAOIs: Symbyax should not be used with MAOIs (such as phenelzine or tranylcypromine) due to the risk of serotonin syndrome.
- Thioridazine or pimozide: Concurrent use can cause serious heart rhythm abnormalities.
- NSAIDs or anticoagulants: Fluoxetine can increase the risk of bleeding when used with blood-thinning medications like warfarin or aspirin.
- Alcohol: Combining alcohol with Symbyax can enhance drowsiness and impair cognitive function.
Alternatives to Symbyax
- Quetiapine (Seroquel): Another atypical antipsychotic used for bipolar depression and schizophrenia.
- Aripiprazole (Abilify): An atypical antipsychotic used for bipolar disorder, schizophrenia, and treatment-resistant depression.
- Lamotrigine (Lamictal): A mood stabilizer commonly used to treat bipolar disorder.
- Lithium: A mood stabilizer often used to manage bipolar disorder.
- Electroconvulsive therapy (ECT): A treatment option for severe, treatment-resistant depression or bipolar disorder.
