For non-emergencies, contact your local or regional poison control center at Drug Interactions Taking other sedative medications with olanzapine may result in added drowsy effects.

Certain antibiotics, fluroquinolones , fluvoxamine Luvox can cause olanzapine toxicity. Medicines that decrease the effects of olanzapine are omeprazole Prilosec and rifampin.

Talk to your doctor or pharmacist if you are taking lithium or have further questions about drug interactions with this medicine. It is also available as a disintegrating tablet in 5 mg, 10 mg, 15 mg, 20 mg. This tablet dissolves in the mouth. An immediate-release injection is also available, and it comes in 10 mg vials.

The tablet or disintegrating tablet should be taken at the same time, once per day. Dry your hands thoroughly before handling the disintegrating tablet. However, the magnitude and frequency of some changes were greater in children and adolescents than adults.

These included increases in lipids, hepatic enzymes, and prolactin, as well as increases in the QT interval. The safety and effectiveness of Symbyax for the treatment of bipolar I depression in patients under 10 years of age have not been established. The safety and effectiveness of Symbyax for treatment resistant depression in patients under 18 years of age have not been established. QT Prolongation Patients should be advised that QT interval prolongation and ventricular arrhythmia including Torsade de Pointes have been reported in patients treated with fluoxetine.

The following data are based on findings in studies performed with the individual components, therefore all dose multiples based on body surface area reflect the maximum recommended human dose MRHD of 20 mg olanzapine, or 80 mg fluoxetine, when each drug is administered separately. Carcinogenesis Olanzapine — Oral carcinogenicity studies were conducted in mice and rats. Rats were dosed for 2 years at doses of 0. Antipsychotic drugs have been shown to chronically elevate prolactin levels in rodents.

Serum prolactin levels were not measured during the olanzapine carcinogenicity studies; however, measurements during subchronic toxicity studies showed that olanzapine elevated serum prolactin levels up to 4-fold in rats at the same doses used in the carcinogenicity study.

An increase in mammary gland neoplasms has been found in rodents after chronic administration of other antipsychotic drugs and is considered to be prolactin-mediated. Mutagenesis Olanzapine — No evidence of genotoxic potential for olanzapine was found in the Ames reverse mutation test, in vivo micronucleus test in mice, the chromosomal aberration test in Chinese hamster ovary cells, unscheduled DNA synthesis test in rat hepatocytes, induction of forward mutation test in mouse lymphoma cells, or in vivo sister chromatid exchange test in bone marrow of Chinese hamsters.

Fluoxetine — Fluoxetine and norfluoxetine have been shown to have no genotoxic effects based on the following assays: Decreased ovary weight, and corpora luteal depletion and uterine atrophy were observed to a greater extent in the females receiving the high-dose combination than in females receiving either olanzapine or fluoxetine alone. Olanzapine — In an oral fertility and reproductive performance study in rats, male mating performance, but not fertility, was impaired at a dose of Discontinuance of olanzapine treatment reversed the effects on male-mating performance.

Diestrous was prolonged and estrous was delayed at 1. Fluoxetine — Two fertility studies conducted in adult rats at doses of up to 7. A number of published epidemiological studies assessing the risk of fluoxetine exposure during the first trimester of pregnancy have demonstrated inconsistent results. Neonates exposed to fluoxetine, a component of SYMBYAX, and other SSRIs and SNRIs late in the third trimester have developed complications arising immediately upon delivery respiratory distress, cyanosis , apnea , seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia , hypotonia , hypertonia , hyperreflexia, tremor, jitteriness, irritability, and constant crying requiring prolonged hospitalization, respiratory support, and tube feeding.

In some cases, the clinical picture is consistent with serotonin syndrome. These complications have varied in severity; while in some cases symptoms have been self-limited, in other cases neonates have required intensive care unit support and prolonged hospitalization. Seven pregnancies were observed during premarketing clinical studies with olanzapine, including 2 resulting in normal births, 1 resulting in neonatal death due to a cardiovascular defect, 3 therapeutic abortions, and 1 spontaneous abortion.

Results of a number of published epidemiological studies assessing the risk of fluoxetine exposure during the first trimester of pregnancy have demonstrated inconsistent results. More than 10 cohort studies and case-control studies failed to demonstrate an increased risk for congenital malformations overall.

There was no specific pattern of cardiovascular malformations. Overall, however, a causal relationship has not been established. Such complications can arise immediately upon delivery. Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying.

PPHN occurs in 1—2 per 1, live births in the general population and is associated with substantial neonatal morbidity and mortality. Other studies do not show a significant statistical association. There have been reports of agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress and feeding disorder in these neonates.

Physicians should also note the results of a prospective longitudinal study of pregnant women with a history of major depression , who were either on antidepressants or had received antidepressants less than 12 weeks prior to their last menstrual period , and were in remission. Women who discontinued antidepressant medication during pregnancy showed a significant increase in relapse of their major depression compared to those women who remained on antidepressant medication throughout pregnancy.

When treating a pregnant woman with SYMBYAX, the physician should carefully consider both the potential risks of taking an SSRI, along with the established benefits of treating depression with an antidepressant. Animal Data Symbyax — Embryo fetal development studies were conducted in rats and rabbits with olanzapine and fluoxetine in low-dose and high-dose combinations. In rats, the doses were: In the rabbit, there was no evidence of teratogenicity; however, the high-dose combination produced decreases in fetal weight and retarded skeletal ossification in conjunction with maternal toxicity.

Similarly, in the rat there was no evidence of teratogenicity; however, a decrease in fetal weight was observed with the high-dose combination. Among the surviving progeny , there were no adverse effects on physical or neurobehavioral development and reproductive performance at any dose. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Placental transfer of olanzapine occurs in rat pups. Fluoxetine — In oral embryo-fetal development studies in rats and rabbits, there was no evidence of teratogenicity following administration of fluoxetine at doses up to Olanzapine — The effect of olanzapine on labor and delivery in humans is unknown. Parturition in rats was not affected by olanzapine.

Fluoxetine — The effect of fluoxetine on labor and delivery in humans is unknown. Fluoxetine crosses the placenta; therefore, there is a possibility that fluoxetine may be associated with adverse effects on the newborn. Because of the potential for serious adverse reactions in nursing infants from SYMBYAX, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Olanzapine — In a study in lactating, healthy women, olanzapine was excreted in breast milk. Mean infant dose at steady state was estimated to be 1. It is recommended that women receiving olanzapine should not breast-feed. Fluoxetine — Fluoxetine is excreted in human breast milk. In 1 breast milk sample, the concentration of fluoxetine plus norfluoxetine was The concentration in the mother's plasma was No adverse effects on the infant were reported.

In another case, an infant nursed by a mother on fluoxetine developed crying, sleep disturbance, vomiting, and watery stools. The average dose was olanzapine 7. The safety and efficacy of olanzapine and fluoxetine in combination for the treatment of bipolar I depression in patients under the age of 10 years have not been established. The safety and effectiveness of olanzapine and fluoxetine in combination for treatment resistant depression in patients less than 18 years of age have not been established.

Compared to patients from adult clinical trials, adolescents treated with oral olanzapine were likely to gain more weight, experience increased sedation, and have greater increases in total cholesterol, triglycerides, LDL cholesterol, prolactin and hepatic aminotransferase levels. Animal Data Fluoxetine — Juvenile animal toxicity studies were performed for fluoxetine alone.

Significant toxicity on muscle tissue, neurobehavior, reproductive organs, and bone development has been observed following exposure of juvenile rats to fluoxetine from weaning through maturity. When animals were evaluated after a drug-free period up to 11 weeks after cessation of dosing , fluoxetine was associated with neurobehavioral abnormalities decreased reactivity at AUC as low as approximately 0.

In addition, the testicular and epididymal microscopic lesions and decreased sperm concentrations found in high dose group were also observed, indicating that the drug effects on reproductive organs are irreversible.

The reversibility of fluoxetine-induced muscle damage was not assessed. These fluoxetine toxicities in juvenile rats have not been observed in adult animals. Rat exposures to the major metabolite, norfluoxetine, are approximately 0.

A specific effect on bone development was reported in juvenile mice administered fluoxetine by the intraperitoneal route to 4 week old mice for 4 weeks at doses 0. There was a decrease in bone mineralization and density at both doses, but the overall growth body weight gain or femur length was not affected.

Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In patients with Schizophrenia, there was no indication of any different tolerability of olanzapine in the elderly compared with younger patients.

Studies in patients with dementia-related psychosis have suggested that there may be a different tolerability profile in this population compared with younger patients with Schizophrenia. In placebo-controlled studies of olanzapine in elderly patients with dementia-related psychosis, there was a higher incidence of cerebrovascular adverse reactions e. Also, the presence of factors that might decrease pharmacokinetic clearance or increase the pharmacodynamic response to olanzapine should lead to consideration of a lower starting dose for any geriatric patient.

No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.

Hepatic Impairment In subjects with cirrhosis of the liver, the clearances of fluoxetine and its active metabolite, norfluoxetine, were decreased, thus increasing the elimination half-lives of these substances. Four of the 5 subjects experienced loss of consciousness 3 or coma 1.

Adverse reactions associated with these reports included somnolence sedation , impaired consciousness coma , impaired neurologic function ataxia , confusion, convulsions, dysarthria , arrhythmias, lethargy , essential tremor , agitation, acute psychosis , hypotension , hypertension , and aggression.

Fatalities have been confounded by exposure to additional substances including alcohol, thioridazine, oxycodone , and propoxyphene. Olanzapine In postmarketing reports of overdose with olanzapine alone, symptoms have been reported in the majority of cases. Among less commonly reported symptoms were the following potentially medically serious reactions: Eli Lilly and Company has received reports of fatality in association with overdose of olanzapine alone.

In 1 case of death, the amount of acutely ingested olanzapine was reported to be possibly as low as mg of oral olanzapine; however, in another case, a patient was reported to survive an acute olanzapine ingestion of approximately 2 g of oral olanzapine. Fluoxetine Worldwide exposure to fluoxetine is estimated to be over 38 million patients circa Of the cases of overdose involving fluoxetine, alone or with other drugs, reported from this population, there were deaths.

Among adult patients who overdosed on fluoxetine alone, 34 resulted in a fatal outcome, completely recovered, and 15 patients experienced sequelae after overdose, including abnormal accommodation , abnormal gait , confusion, unresponsiveness, nervousness, pulmonary dysfunction, vertigo , tremor , elevated blood pressure, erectile dysfunction , movement disorder, and hypomania. The remaining patients had an unknown outcome. The most common signs and symptoms associated with non-fatal overdose were seizures, somnolence, nausea, tachycardia, and vomiting.

The largest known ingestion of fluoxetine in adult patients was 8 grams in a patient who took fluoxetine alone and who subsequently recovered. However, in an adult patient who took fluoxetine alone, an ingestion as low as mg has been associated with lethal outcome, but causality has not been established.

Among pediatric patients ages 3 months to 17 years , there were cases of overdose involving fluoxetine alone or in combination with other drugs.

Six patients died, patients completely recovered, 1 patient experienced renal failure, and 22 patients had an unknown outcome. One of the 6 fatalities was a 9-year-old boy who had a history of OCD , Tourette's Syndrome with tics, attention deficit disorder , and fetal alcohol syndrome.

It can also make you flush, breathe faster, or have a fruit-like breath odor. If these symptoms occur, tell your doctor right away. Zyprexa may lower the ability of your body to fight infection. Avoid contact with people who have colds or infections. Tell your doctor if you notice signs of infection like fever, sore throat, rash, or chills.

NMS is a possibly fatal syndrome that can be caused by Zyprexa. Symptoms may include fever; stiff muscles; confusion; abnormal thinking; fast or irregular heartbeat; and sweating.

Contact your doctor at once if you have any of these symptoms. Some patients who take Zyprexa may develop muscle movements that they cannot control. This is more likely to happen in elderly patients, especially women. The chance that this will happen or that it will become permanent is greater in those who take Zyprexa in higher doses or for a long time. Muscle problems may also occur after short-term treatment with low doses.

Tell your doctor at once if you have muscle problems with your arms; legs; or your tongue, face, mouth, or jaw eg, tongue sticking out, puffing of cheeks, mouth puckering, chewing movements while taking Zyprexa. Lab tests, including fasting blood glucose, cholesterol, complete blood cell counts, and liver function, may be performed while you take Zyprexa.

These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

Use Zyprexa with caution in the elderly; they may be more sensitive to its effects, especially uncontrolled muscle movements. Caution is advised when using Zyprexa in children; they may be more sensitive to its effects, especially drowsiness, increased cholesterol and lipid levels, increased levels of prolactin a hormone , and weight gain.

Children may need regular weight checks while they take Zyprexa.

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