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Fluoxetine
Aka: Fluoxetine, Prozac, Prozac Weekly, Sarafem
- Mechanism
- Selective Serotonin Reuptake Inhibitor (SSRI)
- Indications
- Major Depression (especially with Hypersomnia)
- Obsessive Compulsive Disorder
- Bulimia Nervosa
- Premenstrual Dysphoric Disorder (Premenstrual Syndrome)
- Background
- Tablets are generic with cost as low as $26 per month
- Preparations
- Capsules: 10, 20 and 40 mg
- Tablets (scored): 10 mg
- Oral solution: 20 mg/5 ml
- Long-acting Prozac Weekly preparation: 90 mg capsules
- Dosing
- Daily
- Start
- Children (age 7 to 18 years): 5-10 mg qd
- Adults: 20 mg PO qd
- Elderly: 10 mg qd
- Titrate
- Avoid increasing dose more often than monthly
- Maximum
- Children (age 7 to 18 years): 60 mg
- Adults: 80 mg PO qd
- Maximal dose often required in Bulimia and OCD
- Weekly
- Prozac Weekly 90 mg once weekly
- Equivalent to 20 mg qd
- Pharmacokinetics
- Half Life is Very Long! (7-9 days)
- Therapeutic Blood level 163-560 ng/ml
-
Drug Interactions
- See Serotonin Syndrome
- Stop for 5 weeks before starting MAO inhibitor
- Inhibits Cytochrome P450-3A and P450-2D6
- Highly protein bound
- Interacts with other protein bound medications
- Raises the following drug levels
- Warfarin (Coumadin) and increased INR
- Tricyclic Antidepressants
- Carbamazepine (Tegretol)
- Phenytoin (Dilantin)
- Adverse Effects: General
- Activating on the sedation to excitation continuum
- Most activation or aggravation of all SSRIs
- Anxiety or nervousness
- Akathisia
- Insomnia
- Consider Trazodone (Desyrel) at bedtime
- Avoid in the elderly
- Weight loss may occur
- Adverse Effects: Pregnancy
- Earlier safety data
- Major Fetal Structural abnormality
- No Change (5.5% versus 4% for Placebo)
- Minor Fetal Structural abnormality
- Significant Association (15.5% vs 6.5% for Placebo)
- Fluoxetine also associated with
- Preterm Labor
- NICU admissions
- Low birth weight
- References: Study of n=482
- Chambers (1996) N Engl J Med 335:1010-5 [PubMed]
- Safety data in 2015
- Fluoxetine has been well studied in pregnancy, but data in 2015 showed association with cardiac defects
- Berard (2015) Br J Clin Pharmacol +PMID:26613360 [PubMed]
- Resources
- Prozac Website (Lilly)
- http://www.prozac.com