Fluoxetine
Fluoxetine
Definition
Fluoxetine is an antidepressant of the type known as selective serotonin reuptake inhibitors (SSRI). It is sold in the United States under the brand names Prozac and Sarafem.
Purpose
Fluoxetine is used to treat depression, premenstrual syndrome , bulimia, and obsessive-compulsive disorder.
Description
Serotonin is a neurotransmitter—a brain chemical that carries nerve impulses from one nerve cell to another. Researchers think that depression and certain other
mental disorders may be caused, in part, because there is not enough serotonin being released and transmitted in the brain. Like the other SSRI antidepressants, fluvoxamine (Luvox), sertraline (Zoloft), and paroxetine (Paxil) , fluoxetine increases the level of brain serotonin (also known as 5-HT). Increased serotonin levels in the brain may be beneficial in patients with obsessive-compulsive disorder, alcoholism, certain types of headaches, post-traumatic stress disorder (PTSD), premenstrual tension and mood swings, and panic disorder.
Fluoxetine was the first of the class of antidepressants called SSRIs to be approved for use in the United States. In 2000, fluoxetine was approved by the Food and Drug Administration (FDA) for use in treating premenstrual dysphoric disorder.
The benefits of fluoxetine develop slowly over a period of several weeks. Patients should be aware of this and continue to take the drug as directed, even if they feel no immediate improvement.
Fluoxetine (marketed as Prozac) is available in 10-, 20-, and 40-mg capsules, 10-mg tablets, and in a liquid solution with 20 mg of active drug per 5 ml. Prozac Weekly capsules are a time-release formula containing 90 mg of active drug. Sarafem is available in 10- and 20-mg capsules.
Recommended dosage
Fluoxetine therapy in adults is started as a single 20-mg dose, initially taken in the morning. Depending on the patient’s response after four to six weeks of therapy, this dose can be increased up to a total of 80 mg per day. Doses over 20 mg per day can be given as equally divided morning and afternoon doses.
Precautions
Patients taking fluoxetine should be monitored closely for insomnia, anxiety , mania, significant weight loss, seizures , and thoughts of suicide.
Caution should also be exercised when prescribing fluoxetine to patients with impaired liver or kidney function, the elderly (over age 60) children, individuals with known manic-depressive disorder or a history of seizures, people with diabetes, and individuals expressing ideas of committing suicide.
Individuals should not take monoamine oxidase inhibitors (MAOIs) during fluoxetine therapy, for two weeks prior to beginning fluoxetine therapy, and for five weeks after stopping fluoxetine therapy.
Care should be taken to weigh the risks and benefits of this drug in women who are, or wish to become, pregnant, as well as in breast-feeding mothers.
People with diabetes should monitor their blood or urine sugar more carefully, since fluoxetine can affect blood sugar.
Until an individual understands the effects that fluoxetine may have, he or she should avoid driving, operating dangerous machinery, or participating in hazardous activities. Alcohol should not be used while taking fluoxetine.
Side effects
More common side effects include decreased sexual drive, restlessness, difficulty sitting still, skin rash, hives, and itching.
Less common side effects include fever and/or chills, and pain in joints or muscles.
Rare side effects include pain or enlargement of breasts and/or abnormal milk production in women, seizures, fast heart rate, irregular heartbeats, red or purple spots on the skin, low blood sugar and its symptoms (anxiety, chills, cold sweats, confusion, difficulty concentrating, drowsiness, excess hunger, rapid heart rate, headache, shakiness or unsteadiness, severe fatigue ), low blood sodium and its symptoms (including confusion, seizures, drowsiness, dry mouth, severe thirst, decreased energy), serotonin syndrome (usually at least three of the following: diarrhea, fever, sweatiness, mood or behavior changes, overactive reflexes, fast heart rate, restlessness, shivering or shaking), excitability, agitation, irritability, pressured talking, difficulty breathing, and odd body or facial movements.
KEY TERMS
Bulimia —An eating disorder characterized by binges in which large amounts of food are consumed, followed by forced vomiting.
Obsessive-compulsive disorder —Disorder in which the affected individual has an obsession (such as a fear of contamination, or thoughts he or she does not like to have and cannot control) and feels compelled to perform a certain act to neutralize the obsession (such as repeated hand washing).
Premenstrual syndrome —A severe change in mood that occurs in women immediately prior to, and during, their menstrual period.
Interactions
Fluoxetine interacts with a long list of other medications. People starting this drug should review the other medications they are taking with their physician and pharmacist for possible interactions. Patients should always inform all of their health-care providers, including dentists, that they are taking fluoxetine.
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.
The following drugs may increase the risk of serotonin syndrome: dexfenfluramine, fenfluramine, and tryptophan.
When buspirone is taken with fluoxetine, the therapeutic effect of buspirone may be impaired.
Low blood sodium may occur when fluoxetine is taken along with diuretics.
Increased risk of mania and high blood pressure occurs when selegiline is taken along with fluoxetine.
Severe, fatal reactions have occurred when fluoxetine is given along with MAOIs.
Resources
BOOKS
Preston, John D., John H. O’Neal, and Mary C. Talaga. Handbook of Clinical Psychopharmacology for Therapists, 4th ed. Oakland, CA: New Harbinger Publications, 2004.
PERIODICALS
Anderson, Shawanda W., and Marvin B. Booker. “Cognitive Behavioral Therapy Versus Psychosurgery for Refractory Obsessive-Compulsive Disorder.” Journal of Neuropsychiatry and Clinical Neurosciences 18.1 (Winter 2006): 129.
Denninger, John W., and others. “Somatic Symptoms in Outpatients With Major Depressive Disorder Treated With Fluoxetine.” Psychosomatics: Journal of Consultation Liaison Psychiatry 47.4 (Jul.-Aug.) 2006: 348–52.
Fava, Maurizio, and others. “Eszopiclone Co-Administered with Fluoxetine in Patients with Insomnia Coexisting with Major Depressive Disorder.” Biological Psychiatry 59.11 (June 2006): 1052–60.
Hammad, Tarek A., Thomas Laughren, and Judith Racoosin. “Suicidality in Pediatric Patients Treated with Antidepressant Drugs.” Archives of General Psychiatry 63.3 (Mar. 2006): 332–39.
Kratochvil, Christopher J., and others. “Selecting an Anti-depressant for the Treatment of Pediatric Depression.” Journal of the American Academy of Child and Adolescent Psychiatry 45.3 (Mar. 2006): 371–73.
Lam, Raymond W., and others. “The Can-SAD Study: A Randomized Controlled Trial of the Effectiveness of Light Therapy and Fluoxetine in Patients With Winter Seasonal Affective Disorder.” American Journal of Psychiatry 163.5 (May 2006): 805–12.
Martenyi, Ferenc, and Victoria Soldatenkova. “Fluoxetine in the Acute Treatment and Relapse Prevention of Combat-Related Post-Traumatic Stress Disorder: Analysis of the Veteran Group of a Placebo-Controlled, Randomized Clinical Trial.” European Neuropsychopharmacology 16.5 (July 2006): 340–49.
McGrath, Patrick J., and others. “Predictors of Relapse in a Prospective Study of Fluoxetine Treatment of Major Depression.” American Journal of Psychiatry 163.9 (Sept. 2006): 1542–48.
Moreno, Carmen, Ansley M. Roche, and Laurence L. Greenhill. “Pharmacotherapy of Child and Adolescent Depression.” Child and Adolescent Psychiatric Clinics of North America 15.4 (Oct. 2006): 977–98.
Mowla, Arash, Ahmad Ghanizadeh, and Azadeh Pani. “A Comparison of the Effects of Fluoxetine and Nortriptyline on the Symptoms of Major Depressive Disorder.” Journal of Clinical Psychopharmacology 26.2 (Apr. 2006): 209–11.
Mulder, Roger T., and others. “Six Months of Treatment for Depression: Outcome and Predictors of the Course of Illness.” American Journal of Psychiatry 163.1 (Jan. 2006): 95-100.
Nemeroff, Charles B., and Michael E. Thase. “A Double-Blind, Placebo-Controlled Comparison of Venlafaxine and Fluoxetine Treatment in Depressed Outpatients.” Journal of Psychiatric Research 41.3-4 (Apr.-June 2007): 351–59.
Pinto-Meza, Alejandra, and others. “Gender Differences in Response to Antidepressant Treatment Prescribed in Primary Care. Does Menopause Make a Difference?” Journal of Affective Disorders 93.1-3 (July 2006): 53–60.
Pollack, Mark H., and others. “Olanzapine Augmentation of Fluoxetine for Refractory Generalized Anxiety Disorder: A Placebo Controlled Study.” Biological Psychiatry 59.3 (Feb. 2006): 211–15.
Schreiber, Shaul, and Chaim G. Pick. “From Selective to Highly Selective SSRIs: A Comparison of the Antinociceptive Properties of Fluoxetine, Fluvoxamine, Citalopram and Escitalopram.” European Neuropsychopharmacology 16.6 (Aug. 2006): 464–68.
Serrano-Blanco, A., and others. “Effectiveness and Cost-Effectiveness of Antidepressant Treatment in Primary Health Care: A Six-Month Randomised Study Comparing Fluoxetine to Imipramine.” Journal of Affective Disorders 91.2-3 (Apr. 2006): 153–63.
Taravosh-Lahn, Kereshmeh Christel Bastida, and Yvon Delville. “Differential Responsiveness to Fluoxetine During Puberty.” Behavioral Neuroscience 120.5 (Oct. 2006): 1084–92.
Taylor, Bonnie P., and others. “Psychomotor Slowing as a Predictor of Fluoxetine Nonresponse in Depressed Outpatients.” American Journal of Psychiatry 163.1 (Jan. 2006): 73–78.
Tiihonen, Jari, and others. “Antidepressants and the Risk of Suicide, Attempted Suicide, and Overall Mortality in a Nationwide Cohort.” Archives of General Psychiatry 63.12 (Dec. 2006): 1358–67.
Vasa, Roma A., Anthony R. Carlino, and Daniel S. Pine. “Pharmacotherapy of Depressed Children and Adolescents: Current Issues and Potential Directions.” Biological Psychiatry 59.11 (June 2006): 1021–28.
Rosalyn Carson-DeWitt, MD
Ruth A. Wienclaw, PhD
Fluoxetine
Fluoxetine
Definition
Fluoxetine is an antidepressant of the type known as selective serotonin reuptake inhibitors (SSRI). It is sold in the United States under the brand names Prozac and Sarafem.
Purpose
Fluoxetine is used to treat depression, premenstrual syndrome, bulimia, and obsessive-compulsive disorder .
Description
Serotonin is a neurotransmitter —a brain chemical that carries nerve impulses from one nerve cell to another. Researchers think that depression and certain other mental disorders may be caused, in part, because there is not enough serotonin being released and transmitted in the brain. Like the other SSRI antidepressants, fluvoxamine (Luvox), sertraline (Zoloft), and paroxetine (Paxil), fluoxetine increases the level of brain serotonin (also known as 5-HT). Increased serotonin levels in the brain may be beneficial in patients with obsessive-compulsive dirder, alcoholism, certain types of headaches, post-traumatic stress disorder (PTSD), pre-menstrual tension and mood swings, and panic disorder .
Fluoxetine was the first of the class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) to be approved for use in the United States. In 2000, fluoxetine was approved by the FDA for use in treating premenstrual dysphoric disorder.
The benefits of fluoxetine develop slowly over a period of several weeks. Patients should be aware of this and continue to take the drug as directed, even if they feel no immediate improvement.
Fluoxetine (marketed as Prozac) is available in 10-, 20-, and 40-mg capsules, 10-mg tablets, and in a liquid solution with 20 mg of active drug per 5 ml. Prozac Weekly capsules are a time-release formula containing 90 mg of active drug. Sarafem is available in 10- and 20-mg capsules.
Recommended dosage
Fluoxetine therapy in adults is started as a single 20-mg dose, initially taken in the morning. Depending on the patient's response after four to six weeks of therapy, this dose can be increased up to a total of 80 mg per day. Doses over 20 mg per day can be given as equally divided morning and afternoon doses.
Precautions
Patients taking fluoxetine should be monitored closely for insomnia , anxiety, mania, significant weight loss, seizures , and thoughts of suicide .
Caution should also be exercised when prescribing fluoxetine to patients with impaired liver or kidney function, the elderly (over age 60) children, individuals with known manic-depressive disorder or a history of seizures, people with diabetes, and individuals expressing ideas of committing suicide.
Individuals should not take MAO inhibitors during fluoxetine therapy, for two weeks prior to beginning fluoxetine therapy, and for five weeks after stopping fluoxetine therapy.
Care should be taken to weigh the risks and benefit of this drug in women who are, or wish to become, pregnant, as well as in breast-feeding mothers.
People with diabetes should monitor their blood or urine sugar more carefully, since fluoxetine can affect blood sugar.
Until an individual understands the effects that fluoxetine may have, he or she should avoid driving, operating dangerous machinery, or participating in hazardous activities. Alcohol should not be used while taking fluoxetine.
Side effects
More common side effects include decrease sexual drive, restlessness, difficulty sitting still, skin rash, hives, and itching.
Less common side effects include fever and/or chills, and pain in joints or muscles.
Rare side effects include pain or enlargement of breasts and/or abnormal milk production in women, seizures, fast heart rate, irregular heartbeats, red or purple spots on the skin, low blood sugar and its symptoms (anxiety, chills, cold sweats, confusion, difficulty concentrating, drowsiness, excess hunger, rapid heart rate, headache, shakiness or unsteadiness, severe fatigue ), low blood sodium and its symptoms (including confusion, seizures, drowsiness, dry mouth, severe thirst, decreased energy), serotonin syndrome (usually at least three of the following: diarrhea, fever, sweatiness, mood or behavior changes, overactive reflexes, fast heart rate, restlessness, shivering or shaking), excitability, agitation, irritability, pressured talking, difficulty breathing, and odd body or facial movements.
Interactions
Fluoxetine interacts with a long list of other medications. People starting this drug should review the other medications they are taking with their physician and pharmacist for possible interactions. Patients should always inform all of their health care providers, including dentists, that they are taking fluoxetine.
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.
The following drugs may increase the risk of serotonin syndrome: dexfenfluramine, fenfluramine, and tryptophan.
When buspirone is taken with fluoxetine, the therapeutic effect of buspirone may be impaired.
Low blood sodium may occur when fluoxetine is taken along with diuretics.
Increased risk of mania and high blood pressure occurs when selegiline is taken along with fluoxetine.
Severe, fatal reactions have occurred when fluoxetine is given along with MAO inhibitors.
Resources
BOOKS
Ellsworth, Allan J. Mosby's Medical Drug Reference. St. Louis, MO: Mosby Inc., 1999.
Mosby's Drug Consult. St. Louis, MO: Mosby, Inc., 2002.
Rosalyn Carson-DeWitt, M.D.