Olanzapine/fluoxetine | Side Effects, Dosage, Uses & More
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Generic Name:

fluoxetine-olanzapine, Oral capsule

All Brands

  • Symbyax
SECTION 1 of 4

Highlights for fluoxetine-olanzapine

Oral capsule
1

Olanzapine/fluoxetine is a combination of two drugs in a single form. It’s used to treat depression that hasn’t responded to two other medications. It’s also used to treat depressive episodes associated with bipolar I disorder.

2

This drug is available as a capsule you take by mouth.

3

Olanzapine/fluoxetine is available as the brand-name drug Symbyax. It’s also available as a generic drug.

4

The more common side effects of this drug include dry mouth, tiredness, sleeping for long periods of time, increased hunger, and swelling of your hands and feet. Symptoms can also include drowsiness, blurred vision, and tremors (uncontrollable movements in one part of your body).

5

In some cases, olanzapine/fluoxetine can cause serious side effects. These include serotonin syndrome, neuroleptic malignant syndrome, and worsening depression.

IMPORTANT INFORMATION

FDA warning

This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous. 

Suicidal thoughts and behavior warning. This drug can increase the risk of suicidal thoughts and behaviors in children, teenagers, and young adults. Suicidal thoughts are thoughts of harming yourself. This risk may be higher during the first few months of treatment and during dose changes. Your doctor should closely monitor you for new or worsening suicidal thoughts and behaviors while you take this medication.

Death in seniors with dementia-related psychosis warning. This drug may increase the risk of death in seniors with dementia-related psychosis. This drug isn’t approved to treat people with dementia-related psychosis.

Stopping treatment

Don’t stop taking this drug without talking to your doctor first. If you need to stop taking this medication, your doctor will slowly lower your dose over time. Stopping it suddenly can cause withdrawal symptoms. These include irritability, agitation, sadness, and tingling sensations. They also include anxiety, confusion, headache, tiredness, and not being able to sleep. Your doctor should watch you for these symptoms when stopping your treatment.

Serotonin syndrome

This drug can cause the life-threatening condition serotonin syndrome. Symptoms include agitation, delirium, coma, fast heart rate, dizziness, and sweating. They include skin flushing and hallucinations (seeing or hearing something that isn’t there). They also include stiff muscles, seizures, nausea, vomiting, diarrhea, and tremors (uncontrollable movement in one part of your body). If you have any of these symptoms, call your doctor right away.

Neuroleptic malignant syndrome

This drug can cause the life-threatening condition neuroleptic malignant syndrome. Symptoms include high fever, heavy sweating, stiff muscles, confusion, and changes in breathing and heart rate. If you have any of these symptoms, call your doctor right away.

Worsening depression and suicide risk

This drug may make your depression worse or cause to you have suicidal ideas and behaviors. Suicidal thoughts are thoughts of harming yourself. Your doctor should watch you closely for worsening depression, suicidal thoughts, and unusual changes in your behavior (such as agitation or irritability) while you take this drug. This risk may be higher during your first few months of treatment and during dose changes.

Drug features

This drug is a prescription drug. It’s available as an oral capsule.

This drug is available as the brand-name drug Symbyax. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version. 

This drug is a combination drug. It contains two drugs: olanzapine and fluoxetine. It’s important to know about both drugs in the combination because each drug may affect you in a different way.

Why it's used

This drug is used to treat depression that hasn’t responded to two other medications. It’s also used short-term to treat depressive episodes associated with bipolar I disorder.

Symptoms of depression can include decreased mood, a loss of interest in things you used to enjoy, guilt, decreased energy, trouble concentrating, changes in appetite, and suicidal thoughts or behavior.

How it works

This drug is a combination drug. Olanzapine belongs to a class of drugs called atypical antipsychotics. Fluoxetine belongs to a class of drugs called selective serotonin reuptake inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions. 

More Details

How it works

This drug is a combination drug. Olanzapine belongs to a class of drugs called atypical antipsychotics. Fluoxetine belongs to a class of drugs called selective serotonin reuptake inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions. 

It isn’t known exactly how this drug works. It’s thought that it increases three chemicals in your body that are responsible for reducing symptoms of depression. These chemicals are called serotonin, norepinephrine, and dopamine. This combination drug increases norepinephrine and dopamine better than either drug would by itself. 

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SECTION 2 of 4

fluoxetine-olanzapine Side Effects

Oral capsule

More Common Side Effects

The more common side effects of olanzapine/fluoxetine can include:

  • dry mouth

  • tiredness

  • sleeping for long periods of time

  • increased hunger

  • swelling of your hands and feet

  • drowsiness

  • tremors (uncontrollable movements in one part of your body)

  • blurred vision

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • New or worsening depression. Symptoms can include:

    • thoughts of suicide or dying
    • attempts to commit suicide
  • New or worsening anxiety. Symptoms can include:

    • feeling very agitated or restless
    • panic attacks
  • Mania. Symptoms can include:

    • trouble sleeping
    • new or worsening irritability
    • aggressive, angry, or violent behavior
    • acting on dangerous ideas
    • extreme increase in activity and talking
  • High blood sugar levels. Symptoms can include:

    • urinating more often than normal
    • increased thirst
    • increased hunger
    • fruity-smelling breath
    • blurred vision
    • weakness or tiredness
    • confusion
  • High cholesterol and triglyceride (fats in your blood) levels

  • Unexpected weight gain

  • Neuroleptic malignant syndrome. Symptoms can include:

    • high fever
    • heavy sweating
    • stiff muscles
    • confusion
    • changes in breathing, heartbeat, and blood pressure
  • Tardive dyskinesia (uncontrollable body movements). This condition may happen during treatment or after stopping treatment with this drug. It may be permanent or go away after you stop taking this drug. You have a higher risk of this condition if you’re a female over age 65. Symptoms can include:

    • uncontrollable body movements, especially in your face and tongue
  • Severe allergic reactions. Symptoms can include:

    • swelling of your face, eyes, or mouth
    • trouble breathing
  • Vision problems. Symptoms can include:

    • eye pain
    • changes in vision
    • swelling or redness in or around your eye
  • Abnormal bleeding. Symptoms can include:

    • bruising more easily than normal
    • nosebleeds
    • blood in your stool
  • Low salt levels in your blood. Symptoms can include:

    • headache
    • weakness
    • confusion
    • trouble concentrating
    • memory problems
    • feeling unsteady
  • Changes in your heart beat or heart rhythm (QT prolongation and arrhythmia). Symptoms can include:

    • fast, slow, or irregular heart rate
    • shortness of breath
    • dizziness or fainting
  • Orthostatic hypotension (low blood pressure when you stand up from a sitting or lying position). Symptoms can include:

    • dizziness
    • fast or slow heart rate
    • fainting
  • Trouble swallowing

  • Seizures

  • Problems with body temperature control. Symptoms can include:

    • sweating too much or not at all
    • dry mouth
    • feeling very hot
    • intense thirst
    • not being able to produce urine
  • Serotonin syndrome. Symptoms can include:

    • agitation
    • hallucinations (seeing or hearing something that isn’t there)
    • delirium
    • coma
    • fast heart rate
    • dizziness
    • sweating
    • flushing
    • tremors
    • muscle stiffness
    • seizures
    • nausea
    • vomiting
    • diarrhea
  • Low levels of white blood cells or neutrophils. This raises your risk for infections. Symptoms can include:

    • fever
    • cough
    • chills
    • sore throat
  • Increased prolactin levels. This can cause fertility problems in men and women. If prolactin levels stay high for a long period of time, they can decrease your bone density. Symptoms can include:

    • decreased libido (sex drive) in men and women
    • breast growth in men
    • loss of menstrual period in women
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug may cause drowsiness or sleepiness. These might affect your ability to think clearly, make decisions, or react quickly. You shouldn’t drive, use machinery, or do other activities that require alertness until you know how this drug affects you.

This drug can increase suicidal thoughts and actions. This risk may be higher during the first few months of your treatment and during dose changes.

This medication may cause a sudden drop in your blood pressure when you stand up from a sitting or lying position. This is called orthostatic hypotension. This may cause dizziness, fainting, or a slow heart rate. Your risk is higher when you first start taking this drug and during dose increases. You should stand up carefully. If you feel dizzy or faint, lie down until you feel better.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 4

fluoxetine-olanzapine May Interact with Other Medications

Oral capsule

This drug can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well. 

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Alcohol interaction

You shouldn’t drink alcohol while you’re taking this drug. Drinking alcohol can increase your chance of sleepiness and orthostatic hypotension from this drug. With orthostatic hypotension, your blood pressure drops when you stand up from a sitting or lying position. If you drink alcohol, talk to your doctor. 

Medications that might interact with this drug

Drugs you should not use with olanzapine/fluoxetine

Do not take these drugs with olanzapine/fluoxetine. Doing so can cause dangerous effects in the body. Examples of these drugs include:

  • Pimozide. Taking these drugs together may cause serious abnormal heart rhythms. Olanzapine/fluoxetine may increase the levels of pimozide in your body. You need to wait at least 5 weeks after stopping olanzapine/fluoxetine before you start taking pimozide.  
  • Thioridazine. Olanzapine/fluoxetine increases the levels of thioridazine in your body. Taking these drugs together can cause serious abnormal heart rhythms or death. You need to wait at least 5 weeks after stopping olanzapine/fluoxetine before you start taking thioridazine. 
  • Monoamine oxidase inhibitors (MAOIs). Don’t take an MAOI for 5 weeks after you stop taking olanzapine/fluoxetine. Don’t start olanzapine/fluoxetine if you’ve stopped taking an MAOI in the last 2 weeks. Doing so can cause life-threatening side effects. These include a high fever, muscle spasms, muscle stiffness, quick changes in your heart rate or blood pressure, confusion, and unconsciousness.
  • Linezolid or intravenous methylene blue. Taking these drugs with olanzapine/fluoxetine can increase your risk of serotonin syndrome.

Interactions that increase your risk of side effects

Increased side effects from other drugs: Taking olanzapine/fluoxetine with certain medications raises your risk of side effects from these drugs. Examples of these drugs include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or warfarin. Taking these drugs with olanzapine/fluoxetine may increase your risk of bleeding. Your doctor should monitor you closely when you start or stop taking olanzapine/fluoxetine if you’re also taking warfarin.
  • Carbamazepine. Your doctor may monitor the levels of carbamazepine in your body to make sure they don’t get too high.
  • Blood pressure drugs such as atenolol, metoprolol, propranolol, enalapril, fosinopril, Lisinopril, losartan, and valsartan. Olanzapine/fluoxetine can decrease your blood pressure. Taking olanzapine/fluoxetine with other blood pressure drugs may cause your blood pressure to drop to a dangerously low level.
  • Fluvoxamine. Fluvoxamine can stop your body from clearing olanzapine/fluoxetine as quickly as it should. This could cause more side effects. Your doctor may give you a lower dose of olanzapine/fluoxetine. 

Increased side effects from olanzapine/fluoxetine: Take olanzapine/fluoxetine with certain medications raises your risk of side effects from olanzapine/fluoxetine. This is because the amount of olanzapine/fluoxetine in your body is increased. Examples of these drugs include: 

  • Benzodiazepines, such as diazepam and alprazolam. Taking these drugs with olanzapine/fluoxetine may cause a sudden drop in blood pressure when you stand up. This is called orthostatic hypotension. Olanzapine/fluoxetine may also increase the levels of alprazolam in your body. This can lead to trouble with coordination.
  • Triptans, such as sumatriptan. Taking these drugs with olanzapine/fluoxetine can increase your risk of serotonin syndrome. This risk is higher at the start of treatment with either drug and during dose increases.
  • Anticonvulsants, such as lithium. Taking these drugs with olanzapine/fluoxetine can increase your risk of serotonin syndrome. This risk is higher at the start of treatment with either drug and during dose increases.
  • Pain medications, such as tramadol and fentanyl. Taking these drugs with olanzapine/fluoxetine can increase your risk of serotonin syndrome. This risk is higher at the start of treatment and during dose increases.
  • Tricyclic antidepressants, such as amitriptyline, imipramine, and nortriptyline. Taking these drugs with olanzapine/fluoxetine can increase your risk of serotonin syndrome. This risk is higher at the start of treatment with either drug and during dose increases. Your doctor will monitor the level of the tricyclic antidepressant in your body if you’re taking these drugs together or if you recently stopped taking olanzapine/fluoxetine.
  • Buspar. Taking these drugs together can increase your risk of serotonin syndrome. This risk is higher at the start of treatment with either drug and during dose increases.
  • Selective serotonin reuptake inhibitors (such as citalopram, paroxetine, and sertraline) and selective norepinephrine reuptake inhibitors (such as desvenlafaxine, duloxetine, and venlafaxine). Taking these drugs with olanzapine/fluoxetine can increase your risk of serotonin syndrome. This risk is higher at the start of treatment with either drug and during dose increases.
  • St. John’s wort. Taking these drugs together can increase your risk of serotonin syndrome. This risk is higher at the start of treatment with either drug and during dose increases.

Interactions that can make your drugs less effective

When olanzapine/fluoxetine is less effective: When olanzapine/fluoxetine is used with certain drugs, it may not work as well to treat your condition. This is because the amount of olanzapine/fluoxetine in your body may be decreased. Examples of these drugs include: 

  • Levodopa and dopamine agonists, such as pramipexole and ropinirole. Olanzapine/fluoxetine interferes with how these drugs work. They may not work as well to treat your condition.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Drug warnings
diabetes or high blood sugar
People with diabetes or high blood sugar

This drug can increase your blood sugar levels. You should monitor your blood sugar levels closely during treatment. Tell your doctor if your blood sugar level is high or if you have symptoms of high blood sugar. Symptoms include feeling very thirsty or hungry, needing to urinate more often than normal, and weakness. Your doctor may have to start you on diabetes medications or adjust your diabetes medications.

liver problems
People with liver problems

If you have chronic liver damage, you may not be able to process this drug well. This may increase the levels of this drug in your body. This buildup can cause more side effects. Your doctor may decrease your dose or have you take this drug less often.

Alzheimer’s disease
People with Alzheimer’s disease

Seniors with dementia-related psychosis who take this drug have a higher risk of death. These deaths are usually due to heart events or infections. This drug isn’t approved for treating people with dementia-related psychosis or Alzheimer’s disease.

seizures
People with seizures

This drug can cause seizures. If you have a history of seizures or epilepsy, ask your doctor if this drug is safe for you.

heart problems
People with heart problems

This drug can cause changes in your heart beat (QT prolongation), an abnormal heart rhythm, and a sudden drop in blood pressure. Ask your doctor if this drug is safe for you if you have heart problems. Heart problems include abnormal heart rhythm, heart disease, a history of heart attack or stroke, heart failure, problems with blood flow through your heart, or a family history of sudden death due to heart problems. Your doctor may check your heart function before and during treatment with this drug.

high cholesterol
People with high cholesterol

This drug can cause high cholesterol levels, especially in people 13–17 years old. This often doesn’t cause symptoms. Have your cholesterol checked as often as your doctor recommends.

blood problems
People with blood problems

This drug can cause low levels of white blood cells or neutrophils. Having low levels of these blood cells increases your risk of infections. Your doctor should check your blood often during the first few months of treatment if you have a history of blood problems or if you are taking other drugs that can decrease cell counts. Your doctor should also monitor you for a fever or any signs of an infection. Your doctor might have to take you off this drug for a short time if your white blood cell levels become too low.

enlarged prostate
People with an enlarged prostate

This drug may make the symptoms of your enlarged prostate or benign prostatic hypertrophy worse. Talk with your doctor before starting this drug if you have an enlarged prostate.

angle-closure glaucoma
People with angle-closure glaucoma

If you have glaucoma, ask your doctor if this drug is safe for you. This drug may make your glaucoma symptoms worse.

bowel problems
People with bowel problems

This drug may make any bowel obstructions or blockages worse. If you have any bowel problems, talk with your doctor before starting this medication.

Pregnant women
Pregnant women

This drug is a category C pregnancy drug. That means two things: 

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should only be used if the potential benefit justifies the potential risk to the fetus. 

breast-feeding
Women who are breast-feeding

This drug passes into breast milk and may cause side effects in a child who is breastfed.

Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

seniors
For seniors

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

children
For children

The safety and effectiveness of this drug hasn’t been established for bipolar depression in children younger than 10 years.

This safety and effectiveness of this drug hasn’t been established for treatment-resistant depression in people younger than 18 years.

call the doctor
When to call the doctor

If you don’t think you’re getting better even though you’re taking this drug, call your doctor. It may take up to 4 weeks for this drug to start working.

allergies
Allergies

This drug can cause a severe allergic reaction. Symptoms can include: 

  • trouble breathing
  • swelling of your throat or tongue 

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room. 

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

SECTION 4 of 4

How to Take fluoxetine-olanzapine (Dosage)

Oral capsule

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on: 

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Depression associated with bipolar I disorder

Generic: olanzapine/fluoxetine

Form: Oral capsule
Strengths:
  • 3 mg olanzapine/25 mg fluoxetine
  • 6 mg olanzapine/25 mg fluoxetine
  • 12 mg olanzapine/25 mg fluoxetine
  • 3 mg olanzapine/50 mg fluoxetine
  • 12 mg olanzapine/50 mg fluoxetine

Brand: Symbyax

Form: Oral capsule
Strengths:
  • 3 mg olanzapine/25 mg fluoxetine
  • 6 mg olanzapine/25 mg fluoxetine
  • 12 mg olanzapine/25 mg fluoxetine
  • 3 mg olanzapine/50 mg fluoxetine
  • 12 mg olanzapine/50 mg fluoxetine
Adult dosage (ages 18–64 years)
  • Typical starting dose: 6 mg olanzapine/25 mg fluoxetine taken once per day
  • Dose increases: Your doctor will increase your dose based on your response to it.
  • Maximum dose: 18 mg olanzapine/75 mg fluoxetine taken once per day 
Child dosage (ages 10–17 years)
  • Typical starting dose: 3 mg olanzapine/25 mg fluoxetine taken once per day  
  • Dose increases: Your doctor will increase your child’s dose based on your child’s response to it.  
  • Maximum dose: 12 mg olanzapine/50 mg fluoxetine taken once per day
Child dosage (ages 0–9 years)

The safety and effectiveness of this drug hasn’t been established in children younger than 10 years of age. 

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

  • Typical starting dose: 3 mg olanzapine/25 mg fluoxetine or 6 mg olanzapine/25 mg fluoxetine
  • Dose adjustments: Your doctor will adjust your dose as needed.
Special considerations

People with liver disease: Your starting dose will be 3 mg olanzapine/25 mg fluoxetine or 6 mg olanzapine/25 mg fluoxetine. Your doctor will adjust your dose as needed. 

People at risk for low blood pressure: Your starting dose will be 3 mg olanzapine/25 mg fluoxetine or 6 mg olanzapine/25 mg fluoxetine. Your doctor will adjust your dose as needed.

People who might be sensitive to this drug: Your starting dose will be 3 mg olanzapine/25 mg fluoxetine or 6 mg olanzapine/25 mg fluoxetine. Your doctor will adjust your dose as needed.

People who might not be able to break down this drug easily: Your starting dose will be 3 mg olanzapine/25 mg fluoxetine or 6 mg olanzapine/25 mg fluoxetine. Your doctor will adjust your dose as needed.

Treatment-resistant depression

Generic: olanzapine/fluoxetine

Form: Oral capsule
Strengths:
  • 3 mg olanzapine/25 mg fluoxetine
  • 6 mg olanzapine/25 mg fluoxetine
  • 12 mg olanzapine/25 mg fluoxetine
  • 3 mg olanzapine/50 mg fluoxetine
  • 12 mg olanzapine/50 mg fluoxetine

Brand: Symbyax

Form: Oral capsule
Strengths:
  • 3 mg olanzapine/25 mg fluoxetine
  • 6 mg olanzapine/25 mg fluoxetine
  • 12 mg olanzapine/25 mg fluoxetine
  • 3 mg olanzapine/50 mg fluoxetine
  • 12 mg olanzapine/50 mg fluoxetine
Adult dosage (ages 18–64 years)
  • Typical starting dose: 6 mg olanzapine/25 mg fluoxetine taken once per day
  • Dose increases: Your doctor will increase your dose based on your response to it.
  • Maximum dose: 18 mg olanzapine/75 mg fluoxetine taken once per day 
Child dosage (ages 0–17 years)

The safety and effectiveness of this drug hasn’t been established in children younger than 18 years of age.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

  • Typical starting dose: 3 mg olanzapine/25 mg fluoxetine or 6 mg olanzapine/25 mg fluoxetine
  • Dose adjustments: Your doctor will adjust your dose as needed.
Special considerations

People with liver disease: Your starting dose will be 3 mg olanzapine/25 mg fluoxetine or 6 mg olanzapine/25 mg fluoxetine. Your doctor will adjust your dose as needed. 

People at risk for low blood pressure: Your starting dose will be 3 mg olanzapine/25 mg fluoxetine or 6 mg olanzapine/25 mg fluoxetine. Your doctor will adjust your dose as needed.

People who might be sensitive to this drug: Your starting dose will be 3 mg olanzapine/25 mg fluoxetine or 6 mg olanzapine/25 mg fluoxetine. Your doctor will adjust your dose as needed.

People who might not be able to break down this drug easily: Your starting dose will be 3 mg olanzapine/25 mg fluoxetine or 6 mg olanzapine/25 mg fluoxetine. Your doctor will adjust your dose as needed.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all

Your depression won’t improve. If you suddenly stop taking the drug, you may be at risk for withdrawal symptoms. These include irritability, agitation, sadness, tingling or “pins and needles” sensations, anxiety, confusion, headache, tiredness, and not being able to sleep.

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much

You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • extreme drowsiness
  • coma
  • confusion
  • irregular heart rhythm
  • tremors
  • agitation or aggression
  • uncontrollable muscle movements

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room right away. 

What to do if you miss a dose

Take your dose as soon as you remember. If you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working

Your depression symptoms should improve.

This drug is used for short-term treatment of depressive episodes associated with bipolar I disorder.

 

This drug is used for long-term treatment of treatment-resistant depression. 

Important considerations for taking this drug
this drug with or without food
You can take this drug with or without food
timing
Take this drug at the time recommended by your doctor. You will likely take this drug in the evening
storage
Store this drug carefully
See Details
medication is refillable
A prescription for this medication is refillable
See Details
Travel
Travel
See Details
Self-management
Self-management
See Details
Clinical monitoring
Clinical monitoring
See Details
not usually stocked
Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead
Hidden costs
Hidden costs
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prior authorization
Insurance
See Details

Store this drug carefully

  • Store this drug at room temperature. Keep it between 59°F and 86°F (15°C and 30°C).
  • Keep it away from light.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

A prescription for this medication is refillable

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

This drug can cause high blood sugar levels. Your doctor may have you test your blood sugar at home using a blood glucose (sugar) monitor. Your doctor will tell you what to do if your blood sugar level is too low or high. They’ll also ask you to keep a log of your blood sugar levels. Based on your results, your doctor may start you on diabetes drugs or adjust your diabetes drugs.

This drug can cause weight gain. Your doctor may have you check your weight at home.

Clinical monitoring

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

  • Blood sugar. Your doctor should check your blood sugar before and during your treatment with this drug. This will make sure your levels are within the range your doctor feels is best for you.
  • Cholesterol levels. Your doctor should check your cholesterol before and during treatment with this drug. This will make sure your levels are within the range your doctor feels is best for you.
  • Weight. Your doctor should check your weight during your treatment. This drug can cause weight gain.
  • Movement disorders. Tell your doctor if you have any body movements that you can’t control. They may be a sign of a movement disorder called tardive dyskinesia.
  • Mental health and behavioral problems. You and your doctor should watch for any unusual changes in your behavior and mood, especially suicidal thoughts or behaviors. The risk for mood problems is higher when you first start taking this drug and during dose changes.
  • Liver function. Your doctor may do blood tests to check how well your liver is working. If your liver isn’t working well, your doctor may lower your dose or stop treatment with this drug.

Hidden costs

You may need to buy a blood glucose (sugar) monitor to check your blood sugar levels at home.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

What does the pill look like?

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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on January 31, 2016

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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