Olanzapine and Fluoxetine are combined in this medicine.
This medicine is used to treat episodes of depression associated with bipolar I disorder (mental condition that causes extreme mood changes between feeling very high or mania and very low or depression) in adults and children.
Olanzapine + Fluoxetine may also be used to treat a certain type of depression in adult individuals who do not respond to two other medicines for depression.
Take Olanzapine + Fluoxetine exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.
You may take this medicine with or without food, usually in the evening. Try to take it at the same time each day.
The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on your condition and your response to the medication.
Olanzapine + Fluoxetine must be taken regularly for it to be effective. Continue taking this medicine even when you feel better. Do not stop taking it suddenly as this may worsen your condition.
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.
DO NOT double a dose under any circumstances.
If you often forget to take your medicine, let your doctor and pharmacist know.
Do not take Olanzapine + Fluoxetine with medicines used to treat depression known as a monoamine oxidase inhibitor (MAOI), medicines for mood disorders, blood disorder, and certain antibiotics. Please see the section "Can I take this with other medicines?" below for more information.
Inform your doctor if you have the following conditions:
- epilepsy (fits or seizures) or predisposing conditions to fits or seizures e.g. head injury, brain damage, alcoholism
- Alzheimer's disease (a progressive disease which destroys memory and other important mental functions)
- heart disease e.g. recent heart attack, heart failure (weakness and inability of the heart to pump blood)
- current or history of heart rhythm disorder e.g. slow heartbeat, congenital long QT syndrome (an inherited disease causing abnormally fast and erratic heartbeats)
- low potassium or magnesium levels in the blood
- high cholesterol levels in the blood
- disease of the blood vessels supplying the brain
- dehydration (excessive water loss from the body)
- low volume of circulating fluids in the body
- diabetes
- glaucoma (increased pressure in the eye)
- current or history of bleeding problems
- urinary retention (inability to completely empty the bladder when urinating)
- prostate enlargement
- bowel obstruction
- liver disease
This medicine is not approved for the treatment of individuals with mood disorders related to dementia (a group of symptoms affecting thinking, memory, and social abilities).
Let your doctor know if you are pregnant or breastfeeding.
Be sure to check with your doctor or pharmacist before giving Olanzapine + Fluoxetine to a child or the elderly. Children and elderly people may be more sensitive to the side effects.
Notify your doctor if you are a smoker.
Medicines for depression such as Olanzapine + Fluoxetine may increase the risk of suicidal thoughts and behaviour. As depression and some psychiatric disorders are themselves associated with an increased risk of suicide, it is important for you or your family members to monitor your condition, especially at the start of treatment and if your dosage is still being adjusted. If you experience new or sudden changes in mood, behaviour, thoughts, or feelings or a worsening of your depression with suicidal thoughts or attempts, harm to self or harm to others, contact your doctor immediately.
Some genetic traits can affect the level of Olanzapine + Fluoxetine in the blood. A certain enzyme called CYP2D6 is involved in the breakdown of this medicine in the body. Individuals who are poor metabolisers of CYP2D6 may develop drug interactions when Olanzapine + Fluoxetine is taken together with other medicines broken down by the CYP2D6 enzyme. If you know you have this gene type, inform your doctor.
Why is it important to keep my appointments with the doctor?
Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.
- Routine tests (e.g. liver or kidney function, complete blood count, blood cholesterol, sugar, and electrolyte levels) may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
- Your blood pressure may fall to unsafe levels without you noticing it. Monitor your blood pressure regularly during treatment.
What lifestyle changes should I make?
Regular exercise and eating a healthy diet will help increase energy and hormones in the body such as serotonin, endorphins, and other feel-good chemicals that minimise mood swings. Get enough sleep, as lack of sleep may cause irritability, moodiness, sadness, and tiredness.
Olanzapine + Fluoxetine may affect the ability of your body to adjust to temperature changes in the environment. Avoid exposure to very cold or very hot environments. Avoid strenuous exercise and activities like going to the sauna. Drink more water to prevent dehydration.
Olanzapine + Fluoxetine may cause drowsiness. If affected, do not drive or take part in any activity in which you need to be alert.
This medicine may cause your blood pressure to fall suddenly when you get up from a sitting or lying down position and you may feel giddy. To minimise this problem, stand up slowly.
Other side effects may include any of the following: nausea, vomiting, diarrhoea, stomach wind, indigestion, swollen abdomen, increased appetite, weight gain, tiredness, joint pain, pain in the back or limbs, swelling of hands or feet, dry skin, and sensitivity to sunlight.
Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:
- signs and symptoms of allergic reaction e.g. rashes, breathlessness, swelling of the face, eyes, mouth or throat
- signs and symptoms of heart rhythm problems e.g. irregular heartbeat, shortness of breath, dizziness, fainting
- weakness or numbness on one side of the body, trouble speaking, vision problems, changes in balance or coordination
- uncontrollable body movements that usually affect the face, tongue, or mouth like sticking out of the tongue, puffing of cheeks, mouth puckering, or chewing
- changes in vision, eye pain, swelling in or around the eye
- agitation, confusion, hallucinations (seeing, hearing, or feeling things that are not existent), fast heartbeat, fever, muscle stiffness or spasms, tremors, severe diarrhoea, excessive sweating, fits or seizures
- having thoughts of self-harm
- unusual changes in mood or behaviour (being too depressed, agitated, or having compulsive and impulsive behaviour)
- reduced sex drive, delayed or inability to have orgasm, erection problems, menstrual changes
- increased thirst or hunger, passing urine more often, sleepiness, flushing, rapid breathing or breath that smells like fruit
- headache, difficulty concentrating, confusion, weakness, memory problems
- dry mouth, difficulty passing urine, not sweating during activities or in warm temperatures
- rashes, fever, tender or enlarged lymph nodes, swelling of the face
Olanzapine + Fluoxetine may cause the level of your white blood cells and platelets to drop.
White blood cells help your body to fight infections. A fall in the level of your white blood cells may put you at higher risk for infections, such as coughs, colds and flu, which may lead to more serious infections. Avoid crowded places and people who are sick. Inform your doctor if you have a fever, cough, or flu that does not go away.
Platelets help your blood to clot when there is a cut in the skin. A fall in the level of your platelets may put you at risk of bleeding more than usual. Do not take part in activities where you may fall or get injured, such as contact sports. Inform your doctor if you get any unusual bruising (large bruises or several bruises, especially if the bruises appeared on their own) or bleeding that takes a long time to stop (for example, too much bleeding when you floss or brush your teeth).
Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Do not take Olanzapine + Fluoxetine if you are currently taking or have taken a medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine and tranylcypromine in the last 14 days. Do not take MAOIs within 5 weeks of stopping Olanzapine + Fluoxetine.
Do not take this medicine with thioridazine (medicine for mood disorders). Thioridazine must also not be taken within 5 weeks after stopping treatment with Olanzapine + Fluoxetine.
Do not take Olanzapine + Fluoxetine with the following medicines:
- pimozide (medicine for mood disorders)
- linezolid (an antibiotic)
- injectable methylthioninium chloride (medicine for certain blood disorder)
Inform your doctor and pharmacist if you are taking any of these medicines:
- other medicines used to treat depression e.g. fluvoxamine, sertraline, paroxetine
- other medicines for mood disorders e.g. lithium, chlorpromazine, clozapine, haloperidol
- medicines for irregular heartbeat e.g. procainamide, quinidine, amiodarone, sotalol
- medicines to treat malaria (a disease characterised by chills, fever, and sweating that is transmitted to people through the bite of an infected mosquito) e.g. halofantrine, mefloquine
- medicines for epilepsy (fits or seizures) e.g. carbamazepine, phenytoin
- medicines for anxiety e.g. diazepam, alprazolam, buspirone
- certain antibiotics e.g. erythromycin, gatifloxacin, moxifloxacin, sparfloxacin
- strong painkillers e.g. tramadol, fentanyl, methadone
- blood-thinning medicines e.g. aspirin, warfarin
- NSAIDs (medicines for pain and inflammation)
- medicines for high blood pressure
- tacrolimus (medicine used in organ transplants or certain immune disorders)
- levodopa (medicine for Parkinson's disease, a disorder that affects the movement of a person, causing symptoms such as tremors, muscle stiffness, slowed movement, and impaired balance or walking)
- dolasetron (medicine for nausea or vomiting)
- St. John's wort (herbal medicine)
This list does not include all medicines that may interact with Olanzapine + Fluoxetine.
Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.
Avoid alcohol. Alcohol intake may worsen the drowsiness caused by Olanzapine + Fluoxetine.
Store in a cool, dry place away from the reach of children.
Keep the container tightly closed. Protect from moisture.
Medicines must not be used past the expiry date.
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