| Depressive episodes associated with bipolar I disorder; treatment-resistant depression (label). View labelExact | Administer once daily in the evening. Label describes a common adult starting dose of 6 mg olanzapine / 25 mg fluoxetine (6/25) (label). | Fixed-dose combination of olanzapine (second-generation antipsychotic; D2/5-HT2A antagonism) and fluoxetine (SSRI). Indicated for bipolar I depression and treatment-resistant depression (label). | CYP1A2 (olanzapine), UGT1A4 (olanzapine), CYP2D6 (fluoxetine; and minor olanzapine pathway) | Single-dose mean 30 h | No | | - Metabolic monitoring (weight/BMI, lipids, glucose/A1c) is standard because olanzapine carries high risk for weight gain and metabolic effects (label/class).
- Assess sedation, orthostasis, and functional safety (driving/work) during initiation and after dose changes (label/clinical).
- Monitor mood and suicidality early in treatment, and screen for mania/hypomania activation in patients with bipolar risk (label/clinical).
- Re-check interactions when medications or smoking status change: fluoxetine inhibits CYP2D6, and smoking can lower olanzapine exposure (label/clinical).
| No | 2026-02-22 |
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| Schizophrenia; acute treatment of manic or mixed episodes (bipolar I) and maintenance; in combination with fluoxetine for bipolar depression. View labelExact | Schizophrenia (adults): initiate 5–10 mg once daily; titrate by 5 mg increments at ≥24-hour intervals to 10–20 mg/day (max 20 mg). | Antagonist at serotonin 5‑HT2A and dopamine D2 receptors; strong H1 and muscarinic activity. | CYP1A2, CYP2D6 (minor) | Steady-state mean 30 h | No | | - Metabolic monitoring (weight/BMI, waist circumference, blood pressure, fasting glucose/A1c, lipids) at baseline and periodically (early and then ongoing) because weight and glycemic changes can occur quickly.
- Appetite changes, sedation, and falls risk—reassess driving and occupational safety after dose changes and when other CNS depressants are added.
- Smoking status and CYP1A2 modulators; reduce dose when smoking stops and reassess if smoking restarts or if CYP1A2 inhibitors are introduced.
- AIMS/EPS monitoring at routine intervals, especially in older adults and at higher doses (EPS risk is lower than FGAs but not zero).
- For depot olanzapine pamoate, adhere to REMS observation and PDSS counseling requirements, including post-injection monitoring and “no driving” instructions on injection day.
| q2–4wk | 2025-12-28 |
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| Major depressive disorder; OCD; panic disorder; use with olanzapine for bipolar depression. View labelExact | Typical adult start is 20 mg once daily (often morning); may increase to 40–60 mg/day after several weeks if needed and tolerated. | Selective serotonin reuptake inhibitor (SSRI). | CYP2D6 (inhibitor) | No | — | - Suicidality and psychiatric activation (anxiety, agitation, mood elevation) during initiation and dose changes, especially in younger patients.
- Sodium in older adults or patients on diuretics if symptoms suggest hyponatremia (confusion, fatigue, gait change).
- Bleeding/bruising risk when combined with NSAIDs, antiplatelets, or anticoagulants; early symptom reporting is often reinforced.
- Medication reconciliation to avoid serotonergic combinations and to anticipate prolonged interaction windows after stopping.
| No | 2026-02-01 |
|---|
| Schizophrenia; acute manic/mixed episodes; bipolar depression; adjunct for major depressive disorder. View labelExact | Schizophrenia (IR): day 1 25 mg BID, titrate to 300–400 mg/day by day 4; maintenance 300–800 mg/day divided BID. | Antagonist at 5‑HT2A and D2 (transient), strong H1 and alpha‑1 activity. | CYP3A4 | Steady-state mean 6 h | No | | - Metabolic: weight/BMI, fasting glucose/HbA1c, and lipids (baseline and periodic).
- Sedation: assess next-day impairment and fall risk, especially with other sedatives.
| No | 2025-09-23 |
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