Comprehensive medication guide to Fluoxetine/Olanzapine including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$60–$80 copay for generic; covered by approximately 74% of commercial insurance plans, typically Tier 2–3. Prior authorization is commonly required with documentation of bipolar I disorder diagnosis or treatment-resistant depression (failure of 2+ antidepressants). Medicare Part D coverage varies by plan.
Estimated Cash Pricing
$346–$359 retail for generic combination capsule (30 count); as low as $86–$88 with GoodRx or SingleCare coupons for a 30-day supply. Separate generic olanzapine and fluoxetine prescriptions can cost as low as $19–$50 combined.
Medfinder Findability Score
60/100
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Fluoxetine/Olanzapine — sold under the brand name Symbyax — is an FDA-approved combination prescription capsule that pairs two well-established psychiatric medications: fluoxetine (an SSRI antidepressant, the active ingredient in Prozac) and olanzapine (an atypical antipsychotic, the active ingredient in Zyprexa). Together, they form a fixed-dose combination that targets both the serotonin and dopamine systems in the brain.
Symbyax holds the distinction of being the first drug ever FDA-approved specifically for treatment-resistant depression (TRD), receiving that indication in 2009. It was also the first FDA-approved treatment for bipolar depression, approved for that use in 2003. It is available in five strength combinations ranging from 3 mg/25 mg to 12 mg/50 mg (olanzapine/fluoxetine), in both brand-name Symbyax (Eli Lilly) and generic forms from Teva and Par Pharmaceuticals.
Fluoxetine/Olanzapine is not a controlled substance and can be prescribed by any licensed prescriber, including via telehealth. It is taken once daily in the evening and is used for long-term maintenance therapy in both bipolar I disorder and treatment-resistant major depressive disorder.
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Fluoxetine/Olanzapine works through two complementary mechanisms that together produce a more robust antidepressant effect than either drug alone. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI): it blocks the serotonin transporter (SERT), preventing the reabsorption of serotonin back into the releasing neuron. This keeps serotonin in the synaptic space longer, where it can bind to receptors and help regulate mood, sleep, and emotional processing.
Olanzapine is an atypical antipsychotic from the thienobenzodiazepine class. It blocks multiple receptor types simultaneously: dopamine D1, D2, and D4 receptors; serotonin 5-HT2A and 5-HT2C receptors; histamine H1 receptors; and muscarinic and alpha-1 adrenergic receptors. Critically, blocking the serotonin 5-HT2C receptor releases a natural "brake" on both serotonin and dopamine release in the prefrontal cortex — the brain region responsible for mood regulation, motivation, and cognition.
The combination is synergistic: fluoxetine raises serotonin at the synapse while olanzapine simultaneously enhances both serotonin and dopamine signaling in the prefrontal cortex. Additionally, fluoxetine is a potent CYP2D6 enzyme inhibitor, which slows olanzapine's metabolism by approximately 14–17%, resulting in slightly higher olanzapine blood levels when the two are taken together. Clinical trials demonstrated this synergy directly — the combination achieved a 56.1% response rate in bipolar depression versus 39% for olanzapine alone and 30.4% for placebo.
3 mg/25 mg — capsule
Olanzapine 3 mg / Fluoxetine 25 mg — starting dose for pediatric patients ages 10-17 and low-risk adults
6 mg/25 mg — capsule
Olanzapine 6 mg / Fluoxetine 25 mg — most common adult starting dose
6 mg/50 mg — capsule
Olanzapine 6 mg / Fluoxetine 50 mg — intermediate adult dose
12 mg/25 mg — capsule
Olanzapine 12 mg / Fluoxetine 25 mg — higher olanzapine dose variant
12 mg/50 mg — capsule
Olanzapine 12 mg / Fluoxetine 50 mg — higher combined dose; near maximum studied
As of 2026, there is no active FDA-declared national shortage of Fluoxetine/Olanzapine (Symbyax). However, many patients experience difficulty filling prescriptions because Symbyax is a niche combination product that pharmacies stock based on local demand. Since prescribing volume is relatively low compared to its individual components (fluoxetine and olanzapine), many retail pharmacies — particularly independent and smaller chain stores — do not routinely carry all five strength combinations.
Large chain pharmacies (CVS, Walgreens, Walmart) are more likely to carry it. Mail-order pharmacies affiliated with insurance plans maintain larger inventories and are often the most reliable source for long-term patients. When a pharmacy is out of stock, most can special-order it from their wholesale distributor within 1–2 business days. Patients who need the separate components — generic olanzapine and generic fluoxetine — will find them universally available at any pharmacy at much lower cost.
To quickly identify which pharmacies near you have Fluoxetine/Olanzapine in stock, use medfinder — a service that calls pharmacies on your behalf and texts you the results. This eliminates the frustration of calling multiple pharmacies while running low on a critical psychiatric medication.
Because Fluoxetine/Olanzapine (Symbyax) is not a controlled substance, any licensed prescriber with full prescribing authority can write a prescription — there are no DEA requirements or special licensing needed. However, due to the complexity of its indications (bipolar I disorder and treatment-resistant depression), it is most commonly initiated by mental health specialists.
Psychiatrists — the most common prescribers; manage both initial prescribing and dose titration
Primary care physicians (PCPs) — often manage stable patients in maintenance therapy
Psychiatric nurse practitioners (PMHNPs) — prescribe independently in most states
Physician assistants (PAs) — may prescribe under supervising physician protocols
Pediatric psychiatrists — for patients ages 10–17 with bipolar I depression
Telehealth availability: Because Symbyax is not a controlled substance, it can be prescribed via telehealth without in-person visit requirements. Platforms such as Talkiatry, Brightside Health, and Cerebral provide psychiatric prescribing services online and can manage Symbyax prescriptions. This is particularly useful for patients in areas with limited access to in-person psychiatry.
No — Fluoxetine/Olanzapine (Symbyax) is not a controlled substance and has no DEA schedule. Neither fluoxetine (an SSRI antidepressant) nor olanzapine (an atypical antipsychotic) has a recognized potential for abuse, addiction, or physical dependence in the traditional sense that would require DEA scheduling.
This has important practical implications for patients: any licensed prescriber with prescribing authority can write a prescription without special DEA certification. It can also be prescribed via telehealth without the in-person visit requirements that apply to Schedule II–V controlled substances (such as stimulants or benzodiazepines). Refills are permitted, and prescriptions can be transmitted electronically to any pharmacy.
Note: While not addictive, Fluoxetine/Olanzapine should not be stopped abruptly. The fluoxetine component can cause SSRI discontinuation syndrome, and olanzapine discontinuation can cause rebound symptoms. Always taper under your prescriber's guidance.
The following side effects were reported in 5% or more of patients in clinical trials:
Somnolence/drowsiness (~21%) — most common; taking dose in the evening helps
Weight gain (~17%) — significant concern with long-term olanzapine use
Dry mouth (~16%)
Increased appetite (~13%)
Fatigue/asthenia (~13%)
Orthostatic hypotension (dizziness when standing up)
Elevated blood glucose, HbA1c, and cholesterol (metabolic effects)
Serious side effects requiring immediate medical attention:
Neuroleptic Malignant Syndrome (NMS) — high fever, severe muscle rigidity, altered consciousness
Serotonin syndrome — agitation, rapid heart rate, hyperthermia, muscle twitching
Tardive dyskinesia — involuntary repetitive movements; may be irreversible
Severe hyperglycemia/diabetic ketoacidosis — excessive thirst, frequent urination, fruity breath
DRESS syndrome — widespread rash, fever, lymph node swelling, organ involvement
Increased suicidal thoughts — particularly in children, adolescents, and young adults (FDA boxed warning)
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Quetiapine (Seroquel XR)
FDA-approved for bipolar I depression as monotherapy; widely available generic; can cause significant sedation and weight gain but less so than olanzapine
Lurasidone (Latuda)
FDA-approved for bipolar I depression in adults and children 10+; generally weight-neutral; must be taken with 350+ calories; generic available since 2023
Cariprazine (Vraylar)
FDA-approved for bipolar I depression and MDD augmentation; partial dopamine/serotonin agonist with activating properties; once-daily dosing
Brexpiprazole (Rexulti)
FDA-approved as adjunctive therapy for MDD (TRD); favorable metabolic profile compared to olanzapine; can be combined with any SSRI/SNRI
Prefer Fluoxetine/Olanzapine? We can find it.
MAO Inhibitors (phenelzine, tranylcypromine)
majorAbsolutely contraindicated — can cause life-threatening serotonin syndrome. Require 14-day washout before starting Symbyax; 5-week washout after stopping.
Pimozide
majorContraindicated — fluoxetine dramatically increases pimozide blood levels, causing potentially fatal QTc prolongation and cardiac arrhythmias.
Thioridazine
majorContraindicated — similar to pimozide; risk of fatal cardiac arrhythmias from elevated drug levels.
Linezolid
majorContraindicated — acts as MAO inhibitor; combined with SSRI fluoxetine causes serotonin syndrome risk.
Carbamazepine
majorTwo-way interaction: carbamazepine reduces olanzapine levels (decreasing efficacy); fluoxetine raises carbamazepine levels (increasing toxicity risk).
NSAIDs / Aspirin / Warfarin
moderateIncreased bleeding risk due to fluoxetine's antiplatelet effect via reduced platelet serotonin uptake. Use with caution and monitor for GI bleeding.
CNS Depressants / Alcohol
moderateAdditive CNS depression and sedation. Diazepam specifically enhances orthostatic hypotension. Avoid alcohol.
Serotonergic drugs (triptans, tramadol, St. John's Wort)
moderateIncreased risk of serotonin syndrome; use with caution and monitor for symptoms of excessive serotonin activity.
Antihypertensives
moderateEnhanced blood pressure lowering effect due to olanzapine's alpha-1 adrenergic blockade; monitor for orthostatic hypotension.
Tricyclic antidepressants
moderateFluoxetine's CYP2D6 inhibition can significantly raise TCA blood levels, increasing toxicity risk. Use with caution and consider dose reductions.
Fluoxetine/Olanzapine (Symbyax) occupies a unique and important place in psychiatry: it was the first FDA-approved treatment for both bipolar I depression (2003) and treatment-resistant depression (2009). For patients who have not responded to multiple antidepressants, or who need targeted treatment for the depressive phase of bipolar I disorder, it remains a clinically validated option backed by strong randomized trial evidence.
The primary challenges are practical: finding the medication at a local pharmacy, managing the cost (retail price can exceed $350/month for the combination capsule), and monitoring for metabolic side effects including weight gain, elevated blood glucose, and cholesterol increases. These are manageable with the right clinical support and cost strategies — including the option to take separate generic olanzapine and fluoxetine prescriptions, which can reduce costs to as low as $19–$50/month while providing identical clinical benefit.
If you're struggling to locate Fluoxetine/Olanzapine (Symbyax) at your local pharmacy, medfinder can help by calling pharmacies near you to find which ones have your specific dose in stock — saving you time and ensuring you stay on this important medication without interruption.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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