Pharm
Fluoxetine
search
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 Antidepressant
s
Carbamazepine
(
Tegretol
)
Phenytoin
(
Dilantin
)
Adverse Effects
Gene
ral
Activating on the sedation to excitation continuum
Most activation or aggravation of all
SSRI
s
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
Type your search phrase here