(BPT) – The story you are about to read is that of Ben, a person living with bipolar 1. The experiences and opinions expressed here may not be representative of all people living with bipolar 1 and are not a substitute for medical advice or judgment. Always talk to your healthcare provider about available and appropriate treatment options. Individual results may vary.
Staying in all day and going out all night. Spending money and drinking to excess. Episodes of frustration and anger that didn’t make sense. I didn’t know it at the time, but my behaviors were associated with some of the changes in mood and energy that are symptoms of bipolar I disorder.¹ It took finding the right healthcare provider, who diagnosed me, to begin my journey towards finding a treatment option that works for me.
My mental health journey started in my late teen years when I would cycle through feelings of being “low,” also known as depressive symptoms, and then I would experience “highs,” or manic symptoms. My manic episodes could be really frightening — I’d become irrationally and extremely angry, sometimes falling into a blind rage and lashing out.
I knew that what I was experiencing and how I was feeling weren’t normal. I was hospitalized multiple times and I wanted answers and help.
When I was 19, I started seeing a new healthcare provider and I found in him someone I thought would be a good partner. He was young and approachable, and I knew he really wanted to help me reach my treatment goals. Ultimately, my healthcare provider diagnosed me with bipolar 1 and while it was difficult to hear, having the diagnosis was a big relief because then we could work together on a treatment plan.
From the outset, I trusted and felt supported by my healthcare provider. He always listened to my concerns, which were typical of anyone starting a treatment journey. We worked together to consider different medications and he took the time to explain how each one worked, as well as the potential benefits and side effects and how I might feel when taking the medication.
Following my diagnosis, I began treatment with medication, but it was hard to find one that worked for me. One medicine helped reduce my bipolar 1 symptoms; but, unfortunately, it came with side effects I couldn’t tolerate. I tried several other medications, but for me, they didn’t help to manage my condition and my symptoms as much as I wanted them to, so I stopped taking them and my symptoms returned. My wife, who has been by my side every step of the way before and after my diagnosis, could tell when I stopped taking medication. When my symptoms weren’t managed, I’d become more easily frustrated and agitated, which would make her worry.
Then my healthcare provider told me about LYBALVI^® (olanzapine and samidorphan) and together we decided I should try it. In 2021, LYBALVI was approved as an oral medication used in adults to treat manic or mixed episodes that happen with bipolar 1 disorder, either alone for short-term (acute) or maintenance treatment or in conjunction with valproate or lithium.²
My healthcare provider shared with me some important safety information about LYBALVI, including that LYBALVI has a boxed warning. More specifically, LYBALVI may cause serious side effects, including increased risk of death in elderly people with dementia-related psychosis. LYBALVI increases the risk of death in elderly people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). LYBALVI is not approved for the treatment of people with dementia-related psychosis.²
Since starting LYBALVI, I have noticed improvement in my bipolar 1 symptoms, which my wife and family have also noticed. I take LYBALVI every day as prescribed because I see that it works for me and the side effects have been manageable. However, this is just my experience, so it is important to talk with your healthcare provider about what may work for you.
My bipolar 1 journey hasn’t been easy and I still have good and bad days, but I try to focus on the people who support me and things in my life that are fulfilling to me. I enjoy spending time with my family and helping them with their restaurant. I’m also focused on developing my skills in my career as a software engineer. When I’m not working, I like going to the gym for exercise and when I want to relax and unplug, I enjoy playing video games.
With the support of my loved ones and a strong relationship with my healthcare provider, I feel hopeful about my path forward.
I believe mental health is just as important as physical health and should be taken as seriously. Unfortunately, the stigma around mental illness persists and can prevent people from getting the help they need. By sharing my story, I hope to do my part to help raise awareness and encourage others to get the help they may need.
For anyone experiencing symptoms of mental illness, including bipolar 1, I encourage you to reach out for help. Be your own best advocate, or advocate for a loved one. Talk with a medical professional about concerns and symptoms, ask questions and be honest – so they can help determine the treatment option that may work for you.
To learn more about LYBALVI, visit www.LYBALVI.com and talk with your doctor.
INDICATIONS AND IMPORTANT SAFETY INFORMATION
Important Safety Information
LYBALVI may cause serious side effects, including increased risk of death in elderly people with dementia-related psychosis. LYBALVI increases the risk of death in elderly people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). LYBALVI is not approved for the treatment of people with dementia-related psychosis.
Do not take LYBALVI if you are taking opioids or are experiencing acute opioid withdrawal.
LYBALVI may cause serious side effects, including:

• Stroke (cerebrovascular problems) in elderly people with dementia-related psychosis that can lead to death.
• Opioid withdrawal. Do not take LYBALVI for at least 7 days after you stopped taking short-acting opioids and for at least 14 days after you stopped taking long-acting opioids. One of the medicines in LYBALVI (samidorphan) can cause opioid withdrawal that may be severe and cause hospitalization in people who are physically dependent on opioids. Talk to your healthcare provider if you have questions about the type of opioid you take.
• Risk of life-threatening opioid overdose. You should not start taking opioids for at least 5 days after you stop treatment with LYBALVI. One of the medicines in LYBALVI (samidorphan) can increase your chance of having an opioid overdose that can cause death if you take opioids during treatment or within 5 days after stopping treatment with LYBALVI.

  You can accidentally overdose in 2 ways:

  • LYBALVI blocks the effects of opioids, such as heroin, methadone, or opioid pain medicines. Do not take large amounts of opioids to try to overcome the opioid-blocking effects of LYBALVI. This can lead to serious injury, coma, or death.
  • After you take LYBALVI, its blocking effect slowly decreases and completely goes away over time. You may be more sensitive to the effects of opioids. If you have used opioid street drugs or opioid-containing medicines in the past, using opioids in amounts that you used before treatment with LYBALVI can lead to overdose or death.

  It is important that you tell your family and the people closest to you of this increased sensitivity to opioids and the risk of overdose.
  
  You or someone close to you should get emergency medical help right away if you:

  • have trouble breathing
  • become very drowsy with slowed breathing
  • have slow, shallow breathing (little chest movement with breathing)
  • feel faint, very dizzy, confused, or have unusual symptoms

  
  Tell your healthcare provider if you are taking LYBALVI before a medical procedure or surgery.

• Neuroleptic malignant syndrome (NMS), a serious condition that can lead to death. Call your healthcare provider or go to the nearest hospital emergency room right away if you have some or all of the following signs and symptoms of NMS:
  • high fever
  • stiff muscles
  • confusion
  • sweating
  • changes in your breathing, pulse, heart rate, and blood pressure
• Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): One of the medicines in LYBALVI (olanzapine) can cause DRESS which can cause death. Tell your healthcare provider right away if you develop any of the following symptoms of DRESS, including:
  • rash
  • swollen glands
  • liver problems
  • heart problems
  • fever
  • kidney problems
  • lung problems
• Problems with your metabolism such as:
  • high blood sugar (hyperglycemia) and diabetes. Increases in blood sugar can happen in some people who take LYBALVI. Extremely high blood sugar can lead to coma or death. Your healthcare provider should check your blood sugar before you start and regularly during treatment with LYBALVI.

    Call your healthcare provider if you have any of these symptoms of high blood sugar during treatment with LYBALVI:

    • feel very thirsty
    • feel very hungry
    • feel sick to your stomach
    • need to urinate more than usual
    • feel weak or tired
    • feel confused, or your breath smells fruity
  • increased fat levels (cholesterol and triglycerides) in your blood. Your healthcare provider should check the fat levels in your blood before you start and regularly during treatment with LYBALVI.
  • weight gain. You and your healthcare provider should check your weight before you start and often during treatment with LYBALVI.
• Uncontrolled body movements (tardive dyskinesia). LYBALVI may cause movements that you cannot control in your face, tongue, or other body parts. Tardive dyskinesia may not go away, even if you stop taking LYBALVI. Tardive dyskinesia may also start after you stop taking LYBALVI.
• Decreased blood pressure (orthostatic hypotension) and fainting. You may feel lightheaded or faint when you rise too quickly from a sitting or lying position.
• Falls. LYBALVI may make you sleepy or dizzy, may cause a decrease in your blood pressure when changing position (orthostatic hypotension), and can slow your thinking and motor skills which may lead to falls that can cause fractures or other injuries.
• Low white blood cell count. Your healthcare provider may do blood tests during the first few months of treatment with LYBALVI.
• Difficulty swallowing that can cause food or liquid to get into your lungs.
• Seizures (convulsions).
• Problems controlling your body temperature so that you feel too warm.
• Increased prolactin levels in your blood. Your healthcare provider may do blood tests to check your prolactin levels during treatment with LYBALVI.

The most common side effects of LYBALVI when used to treat people with schizophrenia include:

• weight gain
• dry mouth
• sleepiness
• headache

The most common side effects of LYBALVI when used alone to treat people with mixed or manic episodes that happen with bipolar I disorder include:

• weakness
• constipation
• sleepiness
• shaking
• dry mouth
• increased appetite
• dizziness

The most common side effects of LYBALVI when used in combination with lithium or valproate to treat people with mixed or manic episodes that happen with bipolar I disorder include:

• dry mouth
• increased appetite
• back pain
• problems speaking
• memory problems
• weight gain
• dizziness
• constipation
• mouth watering
• numbness and tingling in your arm and legs

Do not drive a car, operate machinery, or do other dangerous activities until you know how LYBALVI affects you. LYBALVI may make you feel drowsy.
Avoid drinking alcohol during treatment with LYBALVI.
Avoid getting over-heated or dehydrated.

• • Do not exercise too much.
  • In hot weather, stay inside in a cool place if possible.
  • Stay out of the sun. Do not wear too much clothing or heavy clothing.
  • Drink plenty of water.

Before taking LYBALVI, tell your healthcare provider about all of your medical conditions, including if you:

• have or had heart problems or a stroke
• use or abuse street (illegal) drugs
• have or had low or high blood pressure
• have kidney problems
• have diabetes or high blood sugar or a family history of diabetes or high blood sugar
• have or have had high levels of total cholesterol, LDL cholesterol, or triglycerides or low levels of HDL cholesterol
• have or had a low white blood cell count
• have problems swallowing
• have or had seizures (convulsions)
• have or had problems with urination or prostate problems
• have or had breast cancer
• have or had constipation or a bowel obstruction
• have or had high prolactin levels
• are pregnant or plan to become pregnant. Talk to your healthcare provider about the risks to you and your unborn or newborn baby if you take LYBALVI during pregnancy.
  • Tell your healthcare provider right away if you become pregnant or think you are pregnant during treatment with LYBALVI.
  • If you become pregnant during treatment with LYBALVI, talk to your healthcare provider about registering with the National Pregnancy Registry for Atypical Antipsychotics. You can register by calling 1-866-961-2388 or visit
    https://womensmentalhealth.org/clinical-and-research-programs/pregancyregistry/
• are breastfeeding or plan to breastfeed. LYBALVI passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby during treatment with LYBALVI.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
LYBALVI and other medicines may affect each other causing possible serious side effects.
LYBALVI may affect the way other medicines work, and other medicines may affect how LYBALVI works.
Especially tell your healthcare provider if you:

• take opioids or have stopped taking opioids in the past 14 days
• take or plan to take other olanzapine containing medicines

Your healthcare provider can tell you if it is safe to take LYBALVI with your other medicines. Do not start or stop any medicines while taking LYBALVI without first talking to your healthcare provider.
These are not all the possible side effects of LYBALVI.
Call your healthcare provider for medical advice about side effects. You may report side effects to
FDA at 1-800-FDA-1088.
Indications
LYBALVI is a prescription medicine which contains 2 medicines (olanzapine and samidorphan) used in adults:

• to treat schizophrenia
• alone for short­ term (acute) or maintenance treatment of manic or mixed episodes that happen with bipolar I disorder
• in combination with valproate or lithium to treat manic or mixed episodes that happen with bipolar I disorder

It is not known if LYBALVI is safe or effective in children.
Please see full Prescribing Information, including Boxed Warning, and Medication Guide.
References
¹ American Psychiatric Association. What is Bipolar disorder? Accessed March 29, 2023. https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders
² LYBALVI^® [Prescribing Information]. Alkermes, Inc. Waltham, MA:2021
ALKERMES^® is a registered trademark of Alkermes, Inc. LYBALVI^® and logo are registered trademarks of Alkermes Pharma Ireland Limited, used by Alkermes, Inc., under license. ©2023 Alkermes, Inc. All rights reserved. LYB-002472