SYMBYAX (OLANZAPINE/FLUOXETINE HCL)

Moderate

• abciximab

• Abilify

• Abilify Discmelt

• Abilify Maintena

• Abstral

• acetaminophen-codeine

• Actiq

• Activase

• Added Strength Headache Relief

• Added Strength Pain Reliever

• Adderall

• Adderall Xr

• Adipex-p

• Adult Low Dose Aspirin

• Advil

• Advil Allergy Sinus

• Advil Allergy-congestion Rlf

• Advil Cold & Sinus

• Advil Congestion Relief

• Advil Liqui-gel

• Advil Migraine

• Advil Pm

• Advil Pm Liqui-gels

• Aggrastat In Sodium Chloride

• Aggrenox

• Aleve

• Aleve Cold & Sinus

• Aleve Sinus & Headache

• Aleve-d Sinus & Cold

• Aleve-d Sinus & Headache

• Alka-seltzer

• Alka-seltzer Extra Strength

• Alka-seltzer Original

• Alka-seltzer Plus C/c(pe,dm)

• Alka-seltzer Plus Cold (pe)

• Alka-seltzer Plus Day-night

• Alka-seltzer Plus Night

• Alka-seltzer Pm

• All Day Pain Relief

• All Day Pain Relief Sinus & Co

• All Day Relief

• almotriptan malate

• Alsuma

• alteplase

• Amerge

• Amphetamine Salt Combo

• Anacin

• Anacin Maximum Strength

• Analgesic

• Anaprox

• Anaprox Ds

• Ansaid

• Antacid & Pain Relief

• Aplenzin

• aripiprazole

• Arthri-flex

• Arthrotec 50

• ASA-acetaminophen-caff-buffers

• ASA-acetaminophen-salicyl-caff

• Ascomp With Codeine

• Aspir-81

• Aspir-low

• Aspir-trin

• aspirin

• Aspirin Childrens

• Aspirin Low Dose

• Aspirin Low-strength

• aspirin, buffered

• aspirin-acetaminophen-caffeine

• aspirin-caffeine

• aspirin-calcium carbonate

• aspirin-diphenhydramine

• aspirin-diphenhydramine citrat

• aspirin-sod bicarb-citric acid

• Axert

• Back & Body Pain Reliever

• Bayer Advanced

• Bayer Aspirin

• Bayer Aspirin (with Caffeine)

• Bayer Back & Body

• Bayer Chewable Aspirin

• Bayer Childrens Aspirin

• Bayer Plus Extra Strength

• Bayer Pm

• Bc

• Bc Arthritis

• Brilinta

• bromphen-pseudoephed-codeine

• brompheniramine-PE-codeine

• Buffered Aspirin

• Bufferin

• Buproban

• bupropion HBr

• bupropion HCl

• Butalbital Compound W/codeine

• Butalbital Compound-codeine

• butalbital-acetaminop-caf-cod

• butalbital-aspirin-caffeine

• Bystolic

• Caldolor

• Cambia

• Capcof

• Capital With Codeine

• carbamazepine

• Carbatrol

• carisoprodol-ASA-codeine

• carisoprodol-aspirin

• Cataflam

• Celebrex

• celecoxib

• Celexa

• Cerebyx

• Cheratussin Ac

• Cheratussin Dac

• Child Aspirin

• Child Ibuprofen

• Children's Advil

• Children's Aspirin

• Children's Ibu-drops

• Children's Ibuprofen

• Children's Medi-profen

• Children's Motrin

• Children's Profen Ib

• chlorcyclizine-codeine

• chlorphen-phenyleph-DM-aspirin

• chlorphen-phenyleph-ibuprofen

• chlorphen-pseudoeph-ibuprofen

• chlorphen-pseudoephed-codeine

• chlorphenir-phenylephrn-aspirn

• chlorpheniramine-codeine

• chlorpheniramine-PE-codeine

• cilostazol

• clobazam

• clrcycliz-pseudoephed-codeine

• codeine sulfate

• codeine-butalbital-ASA-caff

• codeine-guaifenesin

• codeine-pyrilamine

• Cold & Sinus Pain Relief

• Cold Relief

• Cold Relief Plus

• Cold-sinus Relief

• Conzip

• Cymbalta

• Daypro

• Desoxyn

• dexbrompheniramine-PSE-codeine

• dexchlorphen-phenyleph-codeine

• Dexedrine Spansule

• dextroamphetamine

• dextroamphetamine-amphetamine

• diclofenac epolamine

• diclofenac potassium

• diclofenac sodium

• diclofenac submicronized

• diclofenac-misoprostol

• dihydrocodeine-aspirin-caff

• Dilantin

• Dilantin Extended

• Dilantin Infatabs

• Dilantin Kapseal

• Dilantin-125

• dipyridamole-aspirin

• doxylamine-phenylep-DM-aspirin

• Duexis

• duloxetine

• Duragesic

• E.c. Prin

• Ec-naprosyn

• Ecotrin

• Ecotrin Low Strength

• Efferves Pain Relief Antacid

• Effervescent Antacid

• Effervescent Pain Relief

• Effervescent Pain Reliever

• eletriptan HBr

• Endodan

• Enteric Coated Aspirin

• Epitol

• eptifibatide

• Equetro

• escitalopram oxalate

• ethotoin

• etodolac

• Excedrin Extra Strength

• Excedrin Migraine

• Extra Strength Bayer

• Feldene

• fenoprofen

• fentanyl

• fentanyl citrate

• fentanyl citrate (PF)

• Fentora

• Fioricet With Codeine

• Fiorinal

• Fiorinal-codeine #3

• Flanax

• Flector

• flurbiprofen

• fluvoxamine

• Forfivo Xl

• fosphenytoin

• Frova

• frovatriptan

• gluc-msm-coll2-hyal-antiarthr3

• glucos-msm-C-Mn-ginger-willow

• glucos-msm-C-Mn-herb#21

• glucos-msm-collagen-C-Mn-hrb21

• Glucosamine-msm Complex

• Goody's Extra Strength

• Goody's Migraine Relief

• Guaiatussin Ac

• Guaifenesin Ac

• Guaifenesin Dac

• Guiatuss Ac

• Haldol

• Haldol Decanoate

• haloperidol

• haloperidol decanoate

• haloperidol lactate

• Headache Formula

• Headache Formula Added Str

• Headache Relief

• heparin (porcine)

• heparin (porcine) in D5W

• heparin(porcine) in 0.45% NaCl

• heparin, porcine (PF)

• hydrocodone-ibuprofen

• I-prin

• Ibu-drops

• Ibudone

• ibuprofen

• Ibuprofen Cold

• Ibuprofen Cold-sinus(with Pse)

• Ibuprofen Ib

• Ibuprofen Jr Strength

• ibuprofen lysine (PF)

• Ibuprofen Pm

• ibuprofen-diphenhydramine

• ibuprofen-diphenhydramine HCl

• ibuprofen-famotidine

• ibuprofen-oxycodone

• ibuprofen-phenylephrine HCl

• Imitrex

• Imitrex Statdose Kit Refill

• Imitrex Statdose Pen

• Indocin

• indomethacin

• indomethacin sodium

• Infant's Ibuprofen

• Infant's Medi-profen

• Infant's Motrin

• Infants Ibu-drops

• Infants Profenib

• Integrilin

• Iophen C-nr

• Juxtapid

• ketoprofen

• ketorolac

• Lamisil

• Lazanda

• Levacet

• levmetamfetamine

• Lexapro

• lisdexamfetamine

• Lite Coat Aspirin

• lithium carbonate

• lithium citrate

• Lithobid

• Lo-dose Aspirin

• lomitapide

• Lortuss Ex

• Luvox Cr

• M-clear Wc

• M-end Max D

• M-end Pe

• Mar-cof Bp

• Mar-cof Cg

• Maxalt

• Maxalt-mlt

• Medi-profen

• Medi-seltzer

• Mediproxen

• mefenamic acid

• meloxicam

• methamphetamine

• Midol (naproxen)

• Migraine Formula

• Migraine Pain Reliever

• Migraine Relief

• Mobic

• Motrin Ib

• Motrin Pm

• Msm Glucosamine Complex

• nabumetone

• Nalfon

• Naprelan Cr

• Naprosyn

• naproxen

• naproxen sodium

• naproxen-esomeprazole

• naproxen-pseudoephedrine

• naratriptan

• nebivolol

• Neoprofen (ibuprofen Lysn)(pf)

• Nucynta

• Nucynta Er

• Onfi

• Orphenadrine Compound Forte

• Orphenadrine Compound-ds

• orphenadrine-ASA-caffeine

• oxaprozin

• oxycodone-aspirin

• Pain Relief

• Pain Relief Extra Strength

• Pain Reliever

• Pain Reliever Extra Strength

• Pain Reliever Plus

• Pain-off

• Pamprin Max

• PE-DM-ASA/doxyla-PE-DM-ASA

• Peganone

• Pennsaid

• Percodan

• phentermine

• phentermine-topiramate

• Phenylhistine

• Phenylhistine Dh

• Phenytek

• phenytoin

• phenytoin sodium

• phenytoin sodium extended

• piroxicam

• Pletal

• Poly-tussin

• Poly-tussin Ac

• Poly-tussin D

• Ponstel

• Pro-clear Ac

• Pro-clear Caps

• Pro-red Ac (w/ Dexchlorphenir)

• Procentra

• Promethazine Vc-codeine

• promethazine-codeine

• promethazine-phenyleph-codeine

• propafenone

• Provil

• pseudoephedrine-codeine-GG

• pseudoephedrine-ibuprofen

• Qsymia

• Relcof C

• Relpax

• Reopro

• Reprexain

• Retavase

• reteplase

• Risperdal

• Risperdal Consta

• Risperdal M-tab

• risperidone

• risperidone microspheres

• rizatriptan

• Rydex

• Rythmol

• Sinus & Cold-d

• Solaraze

• Sprix

• St Joseph Aspirin

• St. Joseph Aspirin

• Statuss Green (codeine)

• Sublimaze (pf)

• Subsys

• sulindac

• sumatriptan

• sumatriptan succinate

• Sumavel Dosepro

• Super Pain Relief

• Suprenza

• Synalgos-dc

• Synapryn

• tapentadol

• Tegretol

• Tegretol Xr

• tenecteplase

• terbinafine

• tetrabenazine

• ticagrelor

• ticlopidine

• tirofiban-0.9% sodium chloride

• Tnkase

• tolmetin

• tramadol

• tramadol-acetaminophen

• tramadol-glucosamine

• Tri-buffered Aspirin

• Trymine Cg

• Tusnel C

• Tylenol-codeine #3

• Tylenol-codeine #4

• Ultracet

• Ultram

• Ultram Er

• Vanquish

• Vapor Inhaler

• Vicoprofen

• Vimovo

• Virtussin Ac

• Voltaren-xr

• Vyvanse

• Wal-profen

• Wal-profen Cold-sinus

• Wal-proxen

• Wellbutrin

• Wellbutrin Sr

• Wellbutrin Xl

• Women's Aspirin With Calcium

• Xenazine

• Z-tuss Ac

• Z-tuss E

• Zenzedi

• Zipsor

• Zodryl Ac 25

• Zodryl Ac 30

• Zodryl Ac 35

• Zodryl Ac 40

• Zodryl Ac 50

• Zodryl Ac 60

• Zodryl Ac 80

• Zodryl Dac 25

• Zodryl Dac 30

• Zodryl Dac 35

• Zodryl Dac 40

• Zodryl Dac 50

• Zodryl Dac 60

• Zodryl Dac 80

• Zodryl Dec 25

• Zodryl Dec 30

• Zodryl Dec 35

• Zodryl Dec 40

• Zodryl Dec 50

• Zodryl Dec 60

• Zodryl Dec 80

• zolmitriptan

• Zomig

• Zomig Zmt

• Zorvolex

• Zyban

Moderate

• Abnormal hepatic function tests

• Acute decompensated heart failure

• Bradycardia

• Congenital long QT syndrome

• CYp2d6 poor metabolizer

• Diabetes mellitus

• Hyperprolactinemia

• Hypomania

• Hyponatremia

• Increased risk of bleeding

• Manic disorder

• Obesity

• Prolonged QT interval

• Seizure disorder

• SIADH syndrome

• Sinus tachycardia

• Tobacco smoker

• Weight gain

Fluoxetine

• Severity Level:

  C

• Additional Notes: Risk of persistent pulm htn after 20 wks; neonate behavior syndr 3rd trimester

Olanzapine

• Severity Level:

  2

• Additional Notes: Non-teratogenic complications (resp, gi,cns) with exposure during 3rd trimester

Contraindicated

None

General	Excretion Potential	Effect on Infant	Notes
			None

Precaution Exists

Fluoxetine

Can cause colic, irritability, feeding and sleep disorders, slow weight gain

Limited data suggest low levels excreted resulting in infant sedation

General	Excretion Potential	Effect on Infant	Notes
Evaluate use carefully	Excreted	Drug shown to have adverse effect	Can cause colic, irritability, feeding and sleep disorders, slow weight gain

Olanzapine

Can cause colic, irritability, feeding and sleep disorders, slow weight gain

Limited data suggest low levels excreted resulting in infant sedation

General	Excretion Potential	Effect on Infant	Notes
Evaluate use carefully	Excreted	Drug shown to have adverse effect	Limited data suggest low levels excreted resulting in infant sedation

No Known Risk

None

General	Excretion Potential	Effect on Infant	Notes
			None

Contraindicated

None

Precaution Exists

Fluoxetine

Hepatic-Accumulation may be greater in the elderly due to long half-life. Start at lower doses and titrate upward more slowly. Endocrine-May exacerbate or cause SIADH or hyponatremia. Monitor sodium level closely when starting or changing dosage. Cardiovascular-Risk of QT prolongation. Caution with underlying cardiac condition, electrolyte abnormalities. General-May increase fall risk.

Neuro/Psych-Higher risk of tardive dyskinesia. CNS effects; sedation, cognit impair and inc fall risk. Avoid use for behav probs of dementia or delirium unless fail nonpharm options. Inc risk of stroke, cognitive decline, and death when used w/senile dementia.Max 7.5mg/day. Endocrine-May exacerbate or cause SIADH or hyponatremia. Cardiovascular-May cause orthostatic hypotens, bradycardia. Gastrointestinal-Monitor for constipation. Genitourinary-Avoid in patients w/urinary retention.

Organ / System	HEP	REN	CARD	ENDO	NEURO / PSYCH	PULM
Increased Risk / Adverse Effects	N	Y	Y	Y	N	Y

BEERS: Y     HEDIS: Y     STOPP: Y

Olanzapine

Hepatic-Accumulation may be greater in the elderly due to long half-life. Start at lower doses and titrate upward more slowly. Endocrine-May exacerbate or cause SIADH or hyponatremia. Monitor sodium level closely when starting or changing dosage. Cardiovascular-Risk of QT prolongation. Caution with underlying cardiac condition, electrolyte abnormalities. General-May increase fall risk.

Neuro/Psych-Higher risk of tardive dyskinesia. CNS effects; sedation, cognit impair and inc fall risk. Avoid use for behav probs of dementia or delirium unless fail nonpharm options. Inc risk of stroke, cognitive decline, and death when used w/senile dementia.Max 7.5mg/day. Endocrine-May exacerbate or cause SIADH or hyponatremia. Cardiovascular-May cause orthostatic hypotens, bradycardia. Gastrointestinal-Monitor for constipation. Genitourinary-Avoid in patients w/urinary retention.

Organ / System	HEP	REN	CARD	ENDO	NEURO / PSYCH	PULM
Increased Risk / Adverse Effects	N	N	Y	Y	N	Y

BEERS: Y     HEDIS: Y     STOPP: Y

No Known Risk

None

0-9	A-Z
F31.3	Bipolar disorder, current episode depressed, mild or moderate severity
F31.30	Bipolar disorder, current episode depressed, mild or moderate severity, unspecified
F31.31	Bipolar disorder, current episode depressed, mild
F31.32	Bipolar disorder, current episode depressed, moderate
F31.4	Bipolar disorder, current episode depressed, severe, without psychotic features
F31.5	Bipolar disorder, current episode depressed, severe, with psychotic features
F32	Major depressive disorder, single episode
F32.0	Major depressive disorder, single episode, mild
F32.1	Major depressive disorder, single episode, moderate
F32.2	Major depressive disorder, single episode, severe without psychotic features
F32.3	Major depressive disorder, single episode, severe with psychotic features
F32.4	Major depressive disorder, single episode, in partial remission
F32.5	Major depressive disorder, single episode, in full remission
F32.9	Major depressive disorder, single episode, unspecified
F33	Major depressive disorder, recurrent
F33.0	Major depressive disorder, recurrent, mild
F33.1	Major depressive disorder, recurrent, moderate
F33.2	Major depressive disorder, recurrent severe without psychotic features
F33.3	Major depressive disorder, recurrent, severe with psychotic symptoms
F33.4	Major depressive disorder, recurrent, in remission
F33.40	Major depressive disorder, recurrent, in remission, unspecified
F33.41	Major depressive disorder, recurrent, in partial remission
F33.42	Major depressive disorder, recurrent, in full remission
F33.9	Major depressive disorder, recurrent, unspecified