Monitoring Parameters for Symbyax (Olanzapine/Fluoxetine)

Psychiatric Monitoring

The American Academy of Child and Adolescent Psychiatry recommends assessing for manic or hypomanic symptoms at every visit, particularly during the first 8-12 weeks of treatment, and monitoring for symptoms including decreased need for sleep, increased energy, racing thoughts, impulsivity, or increased goal-directed activity 1
The American Academy of Child and Adolescent Psychiatry suggests screening for suicidal ideation and behavior at baseline and at every visit, especially in the first few months of treatment, given FDA warnings about antidepressants and suicidality in youth and young adults 1

The American Geriatrics Society recommends monitoring elderly patients for orthostatic hypotension, falls, sedation, and respiratory depression more frequently (at least monthly initially), and dramatically reduced starting doses and heightened vigilance in this population 2
The American Academy of Child and Adolescent Psychiatry recommends monitoring growth parameters (height, weight, BMI percentile) at every visit in adolescent patients, as adolescents may be particularly vulnerable to metabolic effects 1

During the initial phase (first 3 months), weight/waist circumference should be monitored every visit, psychiatric assessment (mood, suicidality, EPS) every visit, fasting glucose and lipids at 3 months, according to Praxis Medical Insights 2
During the maintenance phase (after 3 months), weight/waist circumference should be monitored quarterly, psychiatric assessment every 3 months minimum, fasting glucose and lipids annually, and EPS assessment every 3 months, according to Praxis Medical Insights 2