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Several cases of hyponatremia (some with serum sodium lower than 110 mmol/L) have been reported. Fluoxetine should be taken with food at doses specifically directed by your physician. As in adults, fluoxetine and norfluoxetine accumulated extensively following multiple oral dosing; steady-state concentrations were achieved within 3 to 4 weeks of daily dosing.
As a rule, patients with psychotic depression follow the standard chronic disease path and present a higher number of readmissions during the first year of post - hospitalization for psychiatric or medical causes (22. Clinically significant suicidal thinking, which was present in 29% of the sample at baseline, improved significantly in all 4 treatment groups.
Fluoxetine is available with a prescription generically and under the brand names Prozac and Sarafem. , 1985) in the nucleus accumbens and the prefrontal cortex (Waldmeier, P. ) administration produced a neurotoxic loss of 5-HT and 5-hydroxyindoleacetic acid (5-HIAA) in cortex, hippocampus and striatum and a reduction in cortical 3H -paroxetine binding 7 days later. It is approved for the treatment of Major Depressive Disorder (MDD), Obsessive Compulsive Disorder (OCD), Panic Disorder, Bulimia Nervosa and Premenstrual Dysphoric Disorder (PMDD).
3 the work which eventually led to the discovery of fluoxetine began at
Combined use of fluoxetine and MAO inhibitors is contraindicated (see Contraindications).
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(Back to top) Fluoxetine has the potential to interact with a variety of medications, check with your healthcare professional.
Do not take fluoxetine if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) during the last 2 weeks.
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Always read the manufacturer’s information leaflet, if possible, before beginning treatment.
The incidence of spontaneous adverse events resulted quite impressive, but the vast majority of depressed patients were proud to report their symptoms to physician in a controlled study environment.
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Fluoxetine (Prozac) is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), some eating disorders, and panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks). Therefore, before using this product, tell your doctor or pharmacist of all the products you use.
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Table 1). What did they find After four weeks of treatment, participants taking fluoxetine were significantly less likely to report each of the five symptoms than controls.
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As with other spontaneous reports, an immediate effect of the February, 1990 Teicher article was to open up a stream of similar reports. Keep your regular appointments with your doctor so your progress can be monitored. Warfarin (new subsection): Altered anti-coagulant effects, including increased bleeding, have been reported when fluoxetine is co-administered with warfarin. Elevation of blood levels of haloperidol and clozapine has been observed in patients receiving concomitant fluoxetine.
(Back to top) Fluoxetine has the potential to interact with a variety of medications, check with your healthcare professional.
Before taking fluoxetine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. Taking any of these drugs with fluoxetine may cause you to bruise or bleed easily. If you have any questions, consult your doctor or pharmacist. 7 times that seen in placebo-treated patients.
On February 28, 1991 a "Donahue" TV talk show presented a group of individuals who reported compulsively self-destructive and violent behaviors after taking Prozac. Fluoxetine has been reported once combination with Perphenazine for the treatment of psychotic depression, according to MEDLINE.
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SSRI. The pertinent literature was identified by performing a Medline® search in January of 1995 for the keywords fluoxetine with either violence or suicide appearing as MESH headings and/or as title/abstract text in articles published between 1988 and 1995. Drs Kaplan and Woodside have reported receiving research support from Eli Lilly and Co. Continue to take fluoxetine even if you feel well. If you experience dizziness or drowsiness, avoid these activities. Alternatively, excellent separation was seen over 12 minutes on a C18 column with high sensitivity (<0. Plasma concentrations of fluoxetine were higher than those predicted from single dose studies, presumably because fluoxetine's metabolism is not proportional to dose. Check below for an answer to your question. This risk is expected to increase with fluoxetine-induced inhibition of thioridazine metabolism (see
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Some of the less common side effects of Fluoxetine (Prozac, Sarafem) include:
Fluoxetine is used to treat major depressive disorder, bulimia nervosa (an eating disorder) obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD).
Depression is a common, life-disrupting, potentially lethal illness that can affect both sexes and all ages. When compared with normal metabolizers, the total sum at steady state of the plasma concentrations of the 4 active enantiomers was not significantly greater among poor metabolizers. The results of the survival analyses help clarify the reasons for premature termination and the impact of medication. Fluoxetine will pass through the mothers
34 study assess that the probability of achieving a clinical response, defined as HAMD-21 score reduction from baseline of at least 50%, was similar for both fluoxetine and placebo at the end of week 1.
Whether you are an average consumer or a pharma industry professional, you can now find out everything you need to know about fluoxetine, as well as take part in our open discussion forum by sharing your own knowledge and experiences with people who are using this medication. Accordingly, estimates of the incidence of untoward sexual experience and performance, cited in product labeling, are likely to underestimate their actual incidence.
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A fluoxetine and CBT combination is the most effective treatment for depressed adolescents, a study. Critical revision of the manuscript for important intellectual content: Attia, Olmsted, Carter, Pike, Devlin, Woodside, Rockert.
Fluoxetine hydrochloride is an antidepressant drug used medically in the treatment of depression, body dysmorphic disorder, obsessive-compulsive disorder, bulimia nervosa, anorexia nervosa, premenstrual dysphoric disorder, hypochondriasis and panic disorder. She began to show delusions of a persecutory type accompanied with congruent auditory hallucinations.
Gonzalez-Rothi RJ, Zander DS, and Ros PR, “Fluoxetine Hydrochloride (Prozac®)-Induced Pulmonary Disease,” Chest, 1995, 107(6):1763-5. Other symptoms of Fluoxetine overdose include: Coma, delirium, fainting, high fever, irregular heartbeat, low blood pressure, mania, rigid muscles, sweating, stupor. Minireview: Prozac (Fluoxetine, Lilly 110140), the first selective selective serotonin uptake inhibitor and an antidepressant drug: twenty years since its first publication. If you are taking this medication twice a day, your doctor may direct you to take it in the morning and at noon.
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Pediatric (children and adolescents) In the controlled clinical trial of fluoxetine supporting its effectiveness in the treatment of OCD, patients were administered fluoxetine doses in the range of 10 to 60 mg/day (see
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Because Prozac is excreted in human milk, nursing while on Prozac is not recommended. Do not stop taking except on your prescriber's advice. Disclaimer This drug information is for your information purposes only, it is not intended that this information covers all uses, directions, drug interactions, precautions, or adverse effects of your medication. Lets begin with a re-examination of the Teicher et. An open trial of fluoxetine in patients with anorexia nervosa. However, unusual excitement, restlessness, irritability, and trouble in sleeping may be especially likely to occur in children, who seem to be more sensitive than adults to the effects of fluoxetine.
Before taking any ‘over-the-counter’ medicines, check with your pharmacist which medicines are safe to take alongside fluoxetine. The full therapeutic effect may be delayed until 5 weeks of treatment or longer. Six patients died, 127 patients completely recovered, 1 patient experienced renal failure, and 22 patients had an unknown outcome. Reproductive Sciences 12: 356-364
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Since introduction, reports of death attributed to overdose of fluoxetine alone have been rare.
The half-life of concurrently administered diazepam may be prolonged in some patients. to understand if the use of fluoxetine is clinically effective and safe compared with previously available drugs
Symbyax (Olanzapine and fluoxetine) drug description - prescription drugs and medications at RxList
Fluoxetine inhibits the activity of CYP2D6, and may make individuals with normal CYP2D6 metabolic activity resemble a poor metabolizer. Because of limited information available about the treatment response of individuals with the restricting subtype of anorexia nervosa and of indications that such patients might respond more favorably to fluoxetine,
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Drug: Fluoxetine
Drugs metabolized by CYP3A4 In an in vivo interaction study involving coadministration of fluoxetine with single doses of terfenadine (a CYP3A4 substrate), no increase in plasma terfenadine concentrations occurred with concomitant fluoxetine.
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Some clinical data suggests a possible pharmacodynamic and/or pharmacokinetic interaction between SSRIs and antipsychotics. Also tell your doctor if you have recently had a heart attack and if you have or have ever had diabetes, seizures, or liver or heart disease.
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Impairment of fertility Two fertility studies conducted in adult rats at doses of up to 7. DOSAGE AND ADMINISTRATION: Bulimia Nervosa (new subsection): Initial Treatment information contains same cautions as in Depression and Obsessive-Compulsive Disorder subsections, namely that 1) a lower or less frequent dosage of Prozac should be used in patients with renal and/or hepatic impairment, and 2) a lower or less frequent dosage should also be considered for patients, such as the elderly (see Usage in the Elderly under PRECAUTIONS), with concurrent disease or on multiple medications. 05 using 2-sided tests was the criterion for significance for all analyses except the Cox proportional hazards regressions, for which, because of an interim analysis, a P value of . Studies comparing fluoxetine 20, 40, and 60 mg/day to placebo indicate that 20 mg/day is sufficient to obtain a satisfactory response in major depressive disorder in most cases.
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Fluoxetine should be given with caution to patients suffering from anorexia nervosa and only if the expected benefits (e. A neonate whose mother had been taking fluoxetine during most of her pregnancy sufferred tachypnoea, emesis, continuous crying, irritability, tremor and increased muscle tone; the symptoms resolved within 96 hours (Spencer, 1993). Click on a drug in the list below to view prices and information. (3) Over the past five years fluoxetine has been the subject of, at times, intense debate with the accusants ranging from skeptical psychiatrists to The Church of Scientology. Furthermore, these fluoxetine treated patients demonstrated significantly greater remission and response rates, mean changes on HAMD-17 total score, anxiety/somatization, retardation and cognitive disturbance factor score, than placebo treated patients (p 0,01). tell your doctor if you have or have ever had, or anyone in your family has or has ever had, depression, bipolar disorder (mood that changes from depressed to abnormally excited), or mania (frenzied, abnormally excited mood), or you have, or anyone in your family has, thought about or attempted suicide. Dextromethorphan is a commonly used cough medication and may interact with fluoxetine. As they are well tolerated, even in the presence of comorbid medical illness, and easier to manage, SSRIs enhance compliance. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy.
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Before taking fluoxetine make sure your doctor or pharmacist knows:
Fluoxetine may increase the effect of anti-blood-clotting medicines (anticoagulants) such as warfarin, and this may increase the risk of bleeding. Its peak onset is in the early adult years. Chewing sugarless gum or sucking hard candy, and drinking plenty of water will help.
HMG-CoA reductase inhibitors: Fluoxetine may inhibit the metabolism of lovastatin and simvastatin resulting in myositis and rhabdomyolysis; these combinations are best avoided. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. Patients should be urged to inquire with the prescribing physician before taking any new medication, including over the counter medication and herbal remedies.
If you are taking fluoxetine for depression, it may take 4 weeks or longer before you begin to feel better. Example inhibitors include chlorpromazine, delavirdine, miconazole, paroxetine, pergolide, quinidine, quinine, ritonavir, and ropinirole. Consequently, concentrations of S-norfluoxetine at steady state were lower. SSRIs bind with significantly less affinity to histamine, acetylcholine, and norepinephrine receptors than tricyclic antidepressant drugs. Previous episodes were treated with the combination of Amitriptyline and Thioproperazine. 4% for TCAs; fluoxetine did not differ statistically from any comparator group.
The antidepressant, antiobsessive-compulsive, and antibulemic actions of fluoxetine are presumed to be linked to its inhibition of CNS neuronal uptake of serotonin.
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Drug: fluoxetine; Drug: sertraline; Drug: citalopram; Drug: escitalopram; Drug: bupropion; Drug: mirtazapine; Drug: venlafaxine; Drug: lithium; Behavioral: Cognitive Behavioral Therapy
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One other patient who reportedly took up to 3000 mg of fluoxetine experienced 2 grand mal seizures that remitted spontaneously without specific treatment. Check with you pharmacist when taking with other medications. Average steady-state concentrations of once-daily dosing were highest in children ages 6 to 13 (fluoxetine 171 ng/mL; norfluoxetine 195 ng/mL), followed by adolescents ages 13 to 18 (fluoxetine 86 ng/mL; norfluoxetine 113 ng/mL); concentrations were considered to be within the ranges reported in adults (fluoxetine 91-302 ng/mL; norfluoxetine 72-258 ng/mL). Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first. Concomitant use of Prozac and pimozide is contraindicated (see
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Black B and Uhde TW, “Treatment of Elective Mutism With Fluoxetine: A Double Blind, Placebo-Controlled Study,” J Am Acad Child Adolesc Psychiatry, 1994, 33(7):1000-6. Patients who have concomitant systemic illnesses or who are receiving other drugs concomitantly should be under careful observation at all dosage levels. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you. Paroxetine has also been evaluated in combination with neuroleptics (Zotepine or Haloperidol) with a good response without side effects (Wolfersdorf, M. A direct comparison between that study and the current one is confounded by a number of differences.
Store fluoxetine at room temperature away from moisture and heat. Fluoxetine also inhibits enzymes known as CYP2C9(6) and CYP2C19,(3) and could interfere with the elimination of many medications including warfarin (an anticoagulant) and phenytoin (a seizure medication). (Fluoxetine should only be prescribed by a specialist and should be used in combination with psychological therapy. It is important to continue taking this medication as prescribed even if you feel well. The differential diagnosis includes neuroleptic malignant syndrome, acute with non-specific monoamine oxidase inhibitors or strychnine, acute sepsis, or severe metabolic disturbances.
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CYP1A2 substrates: Fluoxetine may increase the levels/effects of CYP1A2 substrates. However, given the long half-life and nonlinear disposition of the drug, a single-dose study is not adequate to rule out the possibility of altered pharmacokinetics in the elderly, particularly if they have systemic illness or are receiving multiple drugs for concomitant diseases. Dr Attia has reported receiving research support from Eli Lilly and Co and Pfizer Inc.
Follow your doctor's instructions carefully.
Even if it is not superior to other drugs in terms of efficacy, its better tolerability may justify its use as a first line antidepressant in bulimia nervosa. 39)
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You should know that your mental health may change in unexpected ways when you take fluoxetine or other antidepressants even if you are an adult over age 24. The observed decreases were not clinically significant. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms. The data were limited by the fact that these clinical trials lasted only from five to six weeks, but the emergence of new SI during early treatment, should have been captured in this rather narrow window. A thorough medical history should be understood prior to prescribing this medication. It should not be construed as containing specific instructions for any particular patient. No statistically significant relationships were found between number of residual symptoms and selected Axis I comorbid conditions or total number of Axis II disorders.
Drugs that interfere with hemostasis (NSAIDs, aspirin, warfarin, etc. Serotonergic neurotransmitters are thought to play a role in the pathogenesis of irritable bowel syndrome. When switching patients to a TCA, the TCA dosage may have to be reduced and plasma TCA concentrations may need to be monitored temporarily when fluoxetine is coadministered or hs recently been discontinued. All the laboratory investigations excluded relevant general medical conditions.
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The detailed information of fluoxetine use, precautions and fluoxetine side effects is placed on our online pharmacy. They should be carefully monitored and encouraged to report any distressing feelings, thoughts about suicide or self-harm, irritability, mood changes or other unusual change in behaviour that they may experience while taking the medicine. In terms of epinephrine, it is not known what effect vasoconstrictors in the local anesthetic regimen will have in patients with a known history of congenital prolonged QT interval or in patients taking any medication that prolongs the QT interval. Ask your pharmacist about using those products safely. Also, do not take fluoxetine if you are taking thioridazine (Mellaril). 6%) had no subthreshold or threshold SCID-P major depressive disorder symptoms, while 28 (25. The interaction between fluoxetine and other highly protein-bound drugs has not been fully evaluated, but may be important (see
Pediatric pharmacokinetics (children and adolescents) Fluoxetine pharmacokinetics were evaluated in 21 pediatric patients (10 children ages 6 to 13, 11 adolescents ages 13 to 18) diagnosed with major depressive disorder or obsessive-compulsive disorder (OCD). Adverse effects similar to those observed in rats treated with fluoxetine during the juvenile period have not been reported after administration of fluoxetine to adult animals.
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Among pediatric patients (ages 3 months to 17 years), there were 156 cases of overdose involving fluoxetine alone or in combination with other drugs. A 17-year-old patient assigned to fluoxetine made a suicide attempt during the study; there were no other unexpected adverse events. Caution should be exercised when taking this medicine certain antibiotics, such as erythromycin, clarithromycin, or azithromycin. 1 Cardiovascular Sinus tachycardia, bradycardia (Feder, 1991), hypotension, mild hypertension, ECG changes especially QT interval prolongation and ventricular dysrhythmias. Using these medicines together can cause very serious heart problems.
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Combined use of fluoxetine and MAO inhibitors is contraindicated (see Contraindications).
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Case of a patient with Fluoxetine & Selegiline induced Fatal Serotonin Syndrome
When taken with fluoxetine, blood levels of the following drugs may increase: benzodiazepines, beta blockers, carbamazepine, dextromethorphan, haloperidol, atorvastatin, lovastatin, simvastatin, phenytoin, and tricyclic antidepressants.
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The Pulvule, tablet, oral solution, and Prozac Weekly capsule dosage forms of fluoxetine are bioequivalent. There are no commonly-available immunoassay kits for drug testing (including those for tricyclic antidepressants) which respond to fluoxetine.
Bipolar disorder (mood disorder with alternating episodes of mania and depression) or risk of—May make condition worse. Adverse events were recorded by clinical investigators using descriptive terminology of their own choosing. Your doctor may advise you to keep taking fluoxetine for several months.
Emslie GJ, Rush AJ, Weinberg WA, et al, “A Double-Blind, Randomized, Placebo-Controlled Trial of Fluoxetine in Children and Adolescents With Depression,” Arch Gen Psychiatry, 1997, 54(11):1031-7.
Olanzapine Fluoxetine (marketed as Symbyax) Information
Fluoxetine (Prozac) comes as a capsule, a tablet, a delayed-release (long-acting) capsule, and a solution (liquid) to take by mouth. Prozac Weekly capsules are a time-release formula containing 90 mg of active drug. Emergence of motor nervousness or restlessness was assessed using the ESRS scale for akathisia. Studies at clinically relevant doses in man have demonstrated that fluoxetine blocks the uptake of serotonin into human platelets. , phenothiazines and most atypicals), and antiarrhythmics (e.
Fluoxetine is excreted into breast milk. 8, 1-8, and 3-20 times, respectively, pediatric exposure at the MRD.
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Fluoxetine (Prozac) is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), some eating disorders, and panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks). Therefore, before using this product, tell your doctor or pharmacist of all the products you use.
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benzodiazepines such as diazepam or alprazolam.
Because of the long elimination half-lives of fluoxetine and its major active metabolite norfluoxetine, changes in dose will not be fully reflected in plasma for several weeks, affecting both strategies for titration to final dose and withdrawal from treatment (see Pharmacology and Dosage).
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There is a risk of negative drug interactions associated with Fluoxetine. Strober M, Freeman R, DeAntonio M, Lampert C, Diamond J. tell your doctor if you are being treated with electroshock therapy (procedure in which small electric shocks are administered to the brain to treat certain mental illnesses), if you have recently had a heart attack and if you have or have ever had diabetes, seizures, or liver or heart disease. Thus, fluoxetine may be administered with or without food.
4%) met DSM-IV criteria for binge-purge subtype.
(20) Additional negative reports included Dominguez and Goldstein's(21) case report of suicidal and homicidal ideation emerging during a placebo period and Wheadon et. "Differential brain activation in exclusively homosexual and heterosexual men produced by the selective serotonin reuptake inhibitor, fluoxetine. Fluoxetine in the treatment of premenstrual dysphoric disorder. Current studies show that the overall increased effectiveness of fluoxetine in treating depression compensates for its higher cost, compared with older drugs, by reducing the need for physician contact because of increased compliance and less need of titration, and by reducing premature patient discontinuation, thereby yielding fewer relapses, less recurrence, and less reutilization of mental health services.
Since it may be difficult to distinguish between certain common symptoms of MS and some side effects of fluoxetine, be sure to consult your health care professional if an abrupt change of this type occurs. Levels in fetal tissue are approximately half the corresponding maternal concentrations. John's Wort are of comparable efficacy to synthetic antidepressants in their normally prescribed dosages. From a pharmacokinetic perspective, it may be better to separate the first 90-mg weekly dose and the last 20-mg once-daily dose by 1 week (see
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Data, based on a group of 9087 patients, who were included in 87 different randomized clinical trials, confirms that fluoxetine is safe and effective in the treatment of depression from the first week of therapy. In receptor binding studies, fluoxetine was shown to have only weak affinity for various receptor systems, namely opiate, serotonergic 5HT(1), dopaminergic, beta-adrenergic, alpha(2)-adrenergic, histaminergic, alpha(1)-adrenergic, muscarinic, and serotonergic 5HT(2) receptors. They are rare with fluoxetine, because it remains in your blood for a few weeks after you stop taking it, and its blood level naturally decreases slowly over time. Be sure to read this information carefully each time. A single case report has suggested possible additive effects of pimozide and fluoxetine leading to bradycardia. com Fluoxetine (Prozac)
Fluoxetine HCl is a selective serotonin reuptake inhibitor (SSRI) used to treat depression, panic disorder, obsessive-compulsive disorder (OCD), or bulimia. The response rates are close to 80%; however, other authors recommend it only when there is no response to the antidepressant - antipsychotic combination or to Amoxapine (Glassman, A.
Objective: To determine the efficacy of fluoxetine, pill placebo, and Social Effectiveness Therapy for Children (SET-C) for children and adolescents with social phobia. Fluoxetine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). Upon the appearance of rash or of other allergic phenomena for which an alternative etiology cannot be identified, fluoxetine should be discontinued.
Drug: cisplatin; Drug: fluoxetine; Drug: gemcitabine hydrochloride; Procedure: chemotherapy; Procedure: psychosocial assessment and care
SSRI's Fluoxetine (Prozac) & fluvoxamine (Luvox) induced hyperglycemia. SSRIs also effectively treat anxious depression, dysthymia and atypical depression. Eur J Clin Pharmacol 1996; 51(1):73-78 Alfaro CL, Lam YW, Simpson J, Ereshefsky L. This weight loss is usually small, but if a large weight loss occurs, it may be harmful in some patients.
coagulation monitoring when fluoxetine is initiated or stopped. Program staff not involved in the study prepared medication and placebo, which were contained in identical bottles. If fluoxetine is administered to patients with liver disease, a lower or less frequent dose should be used (see