olanzapine/fluoxetine

Action and Spectrum

Actions and Spectrum 

olanzapine is an antipsychotic drug. It works by antagonizing certain receptors in the brain, specifically serotonin (5-HT2A/2C), dopamine (D1-4), histamine (H1), and alpha-adrenergic receptors. 

fluoxetine is a selective serotonin reuptake inhibitor (SSRI). It works by inhibiting the reuptake of serotonin in the brain, leading to increased levels of serotonin in the synapses.

Drug Interaction

Adverse Reaction

Frequency not defined  

For fluoxetine 

Erythema multiforme 

Cataract, cerebrovascular accident 

Pulmonary hypertension 

Stevens-Johnson syndrome 

Aplastic anemia 

Cholestatic jaundice 

Eosinophilic pneumonia 

Violent behavior, atrial fibrillation 

Epidermal necrolysis 

Hypoglycemia 

Kidney failure  

Memory impairment, optic neuritis 

Erythema nodosum   

Heart arrest  

For olanzapine 

Stuttering  

Diabetic ketoacidosis 

Drug reaction with eosinophilia and systemic symptoms  

Salivary hypersecretion 

Diabetic coma 

Jaundice 

Allergic reaction  

Black Box Warning

Black Box Warning 

Patients should be continuously watched for behavioural changes, clinical deterioration, and suicidal ideation. Short-term controlled trials have indicated that patients with dementia-related psychosis who are treated with antipsychotic medications have an increased risk of death. This combination drug is not approved for the treatment of patients with dementia-related psychosis 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• olanzapine/fluoxetine should not be used in individuals who have a known hypersensitivity or allergy to either olanzapine or fluoxetine or any other components of the medication. 
• olanzapine/fluoxetine should not be used in combination with MAOIs or within 14 days of discontinuing MAOIs due to the risk of serotonin syndrome. 

Caution: 

• olanzapine/fluoxetine should be used with caution in patients with a history of mania or hypomania.  
• olanzapine/fluoxetine should be used cautiously in individuals with a history of heart rhythm abnormalities. 
• Individuals with diabetes or at risk for diabetes should take more caution while taking this drug. 

Pregnancy / Lactation

Pregnancy consideration: 

Pregnancy category: N/A 

Lactation: both drugs are excreted into human breast milk  

Pregnancy Categories:         

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 

<b>Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women.  

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women. 

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits. 

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women. 

Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology  

olanzapine blocks these serotonin (5-HT2A/2C), dopamine (D1-4), histamine (H1) receptors and exerts its therapeutic effects by modulating the levels of various neurotransmitters, particularly serotonin and dopamine.  

fluoxetine works by selectively inhibiting the reuptake of serotonin in the brain. The enhancement of serotonin neurotransmission helps to regulate mood, emotions, and anxiety by influencing various serotonin pathways in the brain. 

Pharmacodynamics 

olanzapine helps to alleviate positive and negative symptoms of psychosis, such as hallucinations and delusions, while also stabilizing mood and reducing agitation. 

By targeting serotonin pathways, fluoxetine alleviates symptoms of depression and certain anxiety disorders.  

Pharmacokinetics 

Absorption   

olanzapine is well-absorbed and reaches peak plasma concentrations within 5 to 8 hours after taking orally. 

while fluoxetine is also well-absorbed after oral administration and has a long half-life.  

Distribution 

olanzapine/fluoxetine both are extensively distributed throughout the body’s tissues. 

Metabolism 

olanzapine undergoes extensive hepatic metabolism, primarily via the cytochrome P450 enzyme CYP1A2.  

fluoxetine is also extensively metabolized in the liver by CYP2D6 and CYP2C19 enzymes.  

Elimination and excretion 

olanzapine/ fluoxetine both eliminated through the feces and urine.

Adminstartion

Administration 

olanzapine/fluoxetine drug mainly available in capsules for oral administration.

Patient Information Leaflet

Patient information leaflet 

Generic Name: olanzapine/fluoxetine 

Why do we use olanzapine/fluoxetine? 

olanzapine/fluoxetine is a combination drug which used in treatment for certain types of depression, particularly bipolar depression, which involves episodes of both depression and mania or hypomania.  

olanzapine is used to treat conditions such as schizophrenia, bipolar disorder including both manic and mixed episode. fluoxetine is mainly used to treat major depressive disorder, obsessive-compulsive disorder (OCD), bulimia nervosa, and panic disorder.