Symbyax is a drug that combines the antidepressant Prozac and antipsychotic Zyprexa. The drug is used to treat bipolar depression, but it has been linked to severe side effects, including birth defects when taken during pregnancy.
What is Symbyax?While researchers are not exactly sure how Symbyax works, makers of the drug say that it works by altering the levels of three chemicals in the brain that lessen feelings of depression: serotonin, norepinephrine and dopamine. According to Eli Lilly, animals that were given the drug in studies had an increase in all three of these chemicals. The two medicines in Symbyax are delivered in a pill with different dosages of each medicine depending on the patient's needs. If you are a female, are older and are a nonsmoker, this medicine may take longer to work or take longer to leave the body. The drug is mostly metabolized in the liver. Adults take one dose once a day in the evening, and it can be taken with or without food. Eli Lilly did not test the safety of using the drug for longer than 8 weeks before putting it on the market. However, most people with bipolar depression or treatment-resistant depression have a chronic illness and may have to take Symbyax for the rest of their lives.
Use in Children and Black-Box WarningSymbyax has a black box warning – the FDA's most severe warning – for suicidal thoughts and behaviors in children, adolescents and young adults 24 or younger. The drug is made for use in both adults and children 10-17 years of age, but the dose for children is lower than the dose recommended for adults and has only been tested for effectiveness and safety in controlling bipolar depression. The use of Symbyax in children younger than 18 for depression was not tested. Children tend to suffer more side effects than adults, especially when it comes to weight gain, fatigue and an increase in cholesterol and triglyceride levels. For this reason, the risks and benefits of using the drug in children should be carefully considered. In animal studies, Symbyax was toxic to muscle tissue, reproductive organs and bones in young animals. These risks exist for human children as well, and there have been some reports of these side effects.
Use in Elderly Adults and Black-Box WarningThere have not been enough clinical trials involving people 65 or older to determine whether Symbyax works the same in them as in younger patients. There is a black-box warning on the medication for older adults with dementia because Symbyax almost doubles the risk of death in these patients. Researchers also found an increase in stroke and mini strokes in dementia patients who took Symbyax. Older patients are also at risk for hyponatremia – a condition where there is too little salt in the blood. When this happens, patients can suffer from symptoms, including:
- Muscle weakness
Symbyax Birth DefectsSince Symbyax combines two drugs, there is a longer list of potential side effects and drug interactions. Some of the side effects are severe and can be life threatening. Because Symbyax contains an SSRI antidepressant called fluoxetine, known by the brand-name Prozac, the drug carries a low risk of birth defects when taken by a pregnant woman. Other SSRIs like Zoloft and Paxil also have been linked to severe birth defects, including:
- Respiratory distress
- Feeding disorders
Other Side Effects of SymbyaxSymbyax may also cause a number of serious side effects, including high blood pressure, pneumonia, seizures and bleeding. Less serious complications can include weight gain.
Neuroleptic Malignant Syndrome (NMS)This is a side effect of antipsychotics like olanzapine and can be fatal. The symptoms of this syndrome include:
- Irregular pulse
- Altered mental state
- Muscle tightness and rigidity
- Irregular blood pressure
High Blood Sugar (Hyperglycemia)Symbyax may cause high blood sugar in adults and children, which may lead to type 2 diabetes. Some patients even had to continue treatment for high blood sugar after discontinuing Symbyax. The drug is also risky for people who have type 2 diabetes. There were some severe cases reported that led to coma or death.
High Cholesterol and Triglycerides (Hyperlipidemia)Triglycerides are a type of fat found in your blood, and normal limits are less than 150 milligrams per deciliter. In studies, researchers found Symbyax increased triglyceride levels to as much as 500 milligrams per deciliter. It is also known to increase cholesterol. High triglycerides and cholesterol increase the risk for heart attack and stroke.
Serotonin SyndromeSerotonin syndrome is a potentially fatal condition that occurs when the body makes too much serotonin. Because Symbyax works by increasing serotonin, there is a chance that the body may have too much. Taking Symbyax with other medicines that increase serotonin increases this risk. For this reason, all medications must be discussed with your doctor.
|Symptoms of serotonin syndrome include:|
|Restlessness or agitation||Irregular heartbeat|
|High blood pressure||Nausea|