about Fluoxetine class, uses, side effects contraindications
Fluoxetine
Short Description
Fluoxetine is an antidepressant that belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs), which work by inhibiting the reuptake of serotonin by nerve cells, thus increasing its level in the brain.
Category
Chemical class: Phenylpropylamine derivative
Therapeutic class: Antibulimic, antidepressant, antiobsessive-compulsive
Pregnancy category: C
Indications
To treat depression ,,(PROZAC)
Adults. Initial: 20 mg daily in the morning. Dosage increased every 4 to 8 wk as needed. Dosage greater than 20 mg daily given b.i.d. morning and noon. Maximum: 80 mg daily. Children and adolescents. Initial: 10 mg daily. Increased after 1 wk to 20 mg daily.
DOSAGE ADJUSTMENT For lower-weight children, dosage increased to 20 mg daily only if improvement insufficient after several wk. DELAYED-RELEASE (PROZAC WEEKLY)
Adults.90 mg/wk, beginning 7 days after last 20-mg daily dose. To treat obsessive-compulsive disorder ,,(PROZAC)
Adults.Initial: 20 mg daily in the morning. Dosage increased every 4 to 8 wk as needed. Dosage greater than 20 mg daily given b.i.d. morning and noon. Maximum: 80 mg daily. Children and adolescents. Initial: 10 mg daily. Dosage increased after 2 wk to 20 mg daily. Subsequent dosage increased, as needed, at intervals of at least several wk. Maintenance: 20 to 60 mg daily.
DOSAGE ADJUSTMENT For lower-weight children, dosage should be increased above 10 mg daily only if clinical improvement remains insufficient after several wk. Maintenance dosage for such patients should not exceed 30 mg daily. To treat moderate to severe bulimia nervosa ,,(PROZAC)
Adults.60 mg daily in the morning. Some patients may be prescribed a lower dose, which is titrated to 60 mg daily as tolerated. To treat panic disorder with or without agoraphobia ,,(PROZAC)
Adults.Initial: 10 mg daily. Dosage increased in 1 wk to 20 mg daily, as needed. Maximum: 60 mg daily. To treat premenstrual dysmorphic disorder (SARAFEM)
Adults.20 mg daily. Dosage increased as needed. Maximum: 80 mg daily.
DOSAGE ADJUSTMENT Dose or frequency reduced for patients with hepatic impairfluoxetine hydrochloride 448 ment or concurrent illness, those who take multiple medications, and for elderly patients. Route Onset Peak Duration P.O.* 1–6 wk Unknown Unknown
Mechanism of Action
Selectively inhibits reuptake of the neurotransmitter serotonin by CNS neurons and increases the amount of serotonin available in nerve synapses. An elevated serotonin level may result in elevated mood and, consequently, reduced depression.
Contraindications
Hypersensitivity to selective serotonin reuptake inhibitors or their components, use within 14 days of MAO inhibitor therapy
Interactions
alprazolam, diazepam: Possibly prolonged half-life of these aspirin, NSAIDs,
warfarin: Increased anticoagulant activity and risk of bleeding astemizole: Increased risk of serious arrhythmias buspirone: Decreased buspirone effects clozapine, fluphenazine, haloperidol, maprotiline, trazodone: Increased risk of adverse effects CYP2D6-metabolized , such as antiarrhythmics (especially flecainide, propafenone), selected antidepressants (tricyclics), antipyschotics (phenothiazines and most atypicals), thioridazine, and vinblastine: Increased plasma levels of these and increased risk of serious
Side Efect
linezolid, lithium, serotonergics (such as amphetamines and other psychostimulants, antidepressants, and dopamine agonists), St. John’s wort, tramadol, triptans: Increased risk of serotonin syndrome
MAO inhibitors: Possibly severe and lifethreatening adverse effects
phenytoin: Increased blood phenytoin level and risk of toxicity pimozide: Possibly bradycardia sumatriptan: Increased risk of weakness, hyperreflexia, and difficulty with coordination tryptophan: Increased risk of central and peripheral toxicity
Side Efect
CNS: Anxiety, chills, dream disturbances, drowsiness, fatigue, fever, headache, hypomania, insomnia, mania, nervousness, neuroleptic malignant syndrome, restlessness, seizures, serotonin syndrome, somnolence, suicidal ideation, tremor, vertigo, weakness, yawning
CV: Hypotension, palpitations
EENT: Abnormal vision, dry mouth, pharyngitis, sinusitis
ENDO: Galactorrhea, gynecomastia, hypoglycemia, syndrome of inappropriate antidiuretic hormone secretion (SIADH)
GI: Anorexia, diarrhea, indigestion, nausea
GU: Decreased libido, ejaculation disorders, impotence
HEME: Altered platelet function, unusual bleeding
MS: Arthralgia, myalgia
RESP: Dyspnea
SKIN: Diaphoresis, pruritus, rash, urticaria
Other: Flulike symptoms, hyponatremia, weight loss
Cautions
Use fluoxetine cautiously in patients with a history of seizures.
WARNING Avoid giving fluoxetine within 14 days of an MAO inhibitor or starting MAO inhibitor therapy within 5 weeks of discontinuing fluoxetine. In patients taking fluoxetine for depression (especially children, adolescents, and young adults), watch closely for suicidal tendencies, particularly when therapy starts and dosage changes, because depression may worsen temporarily during those times. Monitor patient closely for evidence of GI bleeding, especially if patient takes another drug known to increase the risk, such as aspirin, an NSAID, or warfarin. Monitor patient—especially an elderly patient—for hypoosmolarity of serum and urine and for hyponatremia (headache, difficulty concentrating, memory impairment, weakness, unsteadiness), which may indicate fluoxetine-induced SIADH. To discontinue, expect to taper drug, as ordered, to minimnize Side Efect
. fluoxetine hydrochloride 449 E F * Capsules, oral solution, and tablets. For depression and bulimia; 5 wk for obsessive-compulsive disorder.
WARNING Monitor patient for possible serotonin syndrome, characterized by agitation, chills, confusion, diaphoresis, diarrhea, fever, hyperactive reflexes, poor coordination, restlessness, shaking, talking or acting with uncontrolled excitement, tremor, and twitching, especially if patient is receiving another drug that raises serotonin level (such as dopamine agonist, MAO inhibitor, tryptophan, amphetamine, and other antidepressant or psychostimulant). In its most severe form, serotonin syndrome can resemble neuroleptic malignant syndrome, which includes a high fever, muscle rigidity, autonomic instability, and possible fluctuations in vital signs and mental status. Monitor patient with diabetes mellitus for altered blood glucose level because drug may cause hypoglycemia during therapy and hyperglycemia when it stops. Expect to adjust dosage of antidiabetic drug, as prescribed. Expect patient to be reevaluated periodically to determine continued need for therapy. When stopping fluoxetine therapy, expect to taper drug to minimize adverse reactions. PATIENT SAFTY
WARNING Tell patient that drug increases risk of serotonin syndrome, a rare but serious complication, especially when taken with certain other . Teach patient to recognize its signs and symptoms, and advise her to notify prescriber immediately if they occur. Urge family or caregiver to watch patient closely for suicidal tendencies, especially when therapy starts or dosage changes and particularly if patient is a child, teenager, or young adult. Caution patient to avoid hazardous activities until CNS effects of drug are known. Caution against stopping fluoxetine abruptly because serious adverse effects may result. Advise patient to consult prescriber before taking OTC or prescription , if a rash or hives develop, or if she becomes or intends to become pregnant during therapy. Inform patient that drug may take several weeks to achieve full effects.
Trade Name & Company Name
effect of Fluoxetine in Pregnancy, Fetal Health
and Breast feeding
Pregnancy
. Depression is common during and after pregnancy, but typically goes unrecognized. Pregnancy
is not a reason a priori to discontinue psychotropic drugs. A fluoxetine dose of 20-40mg/d 409 results in relatively low trough fluoxetine-norfluoxetine concentrations during Pregnancy
(range, 317-850nmol/L) and the mean norfluoxetine/fluoxetine metabolic ratio is 2.4higher during late Pregnancy
compared to 2mo postpartum. This suggests increased clearance, which can be explained at least in part by increased demethylation of fluoxetine by CYP2D6 and is consistent with the observation that many pregnant women require an increase in their dose to maintain clinical efficacy. Fluoxetine is effective treatment for postpartum depression, and is as effective as a course of cognitive-behavioral counseling in the short term. Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. Fluoxetine crosses the human placenta, achieving F:M ratios approximating 0.9. This is significantly higher than the ratios achieved with either sertraline or paroxetine and similar to citalopram. Maternal doses predict the umbilical cord concentration. Prospectively ascertained Pregnancy
outcomes after SSRIs, mainly fluoxetine, conflict on the potential for a modest teratogenic effect. There are differences in birth weight and acute neonatal outcome between treated and untreated pregnancies. In one study of 20 pregnancies, there was a 4-fold difference in the serotonergic symptom score of newborns during the first 4d of life between treated and control groups. The exposed infants had significantly lower cord blood 5-hydroxyindoleacetic acid (5- HIAA) levels. There was an inverse correlation between the serotonergic symptom score and the umbilical vein 5-HIAA concentrations in the exposed infants. The long-term implications of these findings are unclear. Exposure throughout gestation does not adversely affect cognition, language development, or the temperament of preschool and early school-age children. In sheep, fluoxetine has transient effects on fetal behavioral and acid-base status. Rodent studies too are reassuring from the standpoint of structural birth defects, though the rates of IUGR and stillbirth are higher in rats treated with multiples of the MRHD. Prolonged prenatal SSRI exposure in rats is associated with reduced behavioral pain responses and increased parasympathetic cardiac modulation in recovery following an acute neonatal noxious event. However, a recent rodent study found that maternal exposure to fluoxetine has transient effects on fetal behavioral and acid-base status during Pregnancy
and lactation that result in enduring behavioral alterations in the pups throughout life. Others conclude that the behavioral affects are not permanent. Breastfeeding
Maternal serum and peak breast milk concentrations of fluoxetine and its active metabolite, norfluoxetine, predict nursing infant serum norfluoxetine concentrations. The mean estimated infant exposure from the breast milk of women taking 20-40mg/d to fluoxetine-norfluoxetine is 2.4% and 3.8% of the maternal weight-adjusted daily dose at 2w and 2mo of age, respectively. Neonatal serum concentrations are typically low in women taking 20mg/d or less. Thus, Breastfeeding is not contraindicated.
the follwing drugs will increse Fluoxetine by inhepiting cyp450
abiraterone ; amiodarone ; amiodarone ; bupropion ; capecitabine ; celecoxib ; ceritinib ; chlorpromazine ; cimetidine ; cinacalcet ; citalopram ; clemastine ; clobazam ; clomipramine ; cocaine ; diphenhydramine ; doxepin ; duloxetine ; efavirenz ; escitalopram ; fenofibrate ; fluconazole ; fluoxetine ; fluvastatin ; fluvoxamine ; halofantrine ; haloperidol ; hydroxyzine ; isoniazid ; levomepromazine ; lorcaserin ; methadone ; metoclopramide ; metronidazole ; midodrine ; moclobemide ; panobinostat ; paroxetine ; perphenazine ; phenylbutazone ; promethazine ; quercetin ; quinidine ; ritonavir ; rolapitant ; sertraline ; sulfamethoxazole ; sulfaphenazole ; terbinafine (oral) ; ticlopidine ; tripelennamine ; vemurafenib ; voriconazole ; zafirlukast ;
the follwing drugs will decrease Fluoxetine by inhancing cyp450
carbamazepine ; dabrafenib ; enzalutamide ; letermovir ; nevirapine ; phenobarbital ; rifampin ; secobarbital ;
trad drugs based on Fluoxetine
| Gen name | Trade name | Catagory name |
| fluoxetine | Prozac | Selective serotonin reuptake inhibitors |
| fluoxetine | Prozac Weekly | Selective serotonin reuptake inhibitors |
| fluoxetine | Rapiflux | Selective serotonin reuptake inhibitors |
| fluoxetine | Sarafem | Selective serotonin reuptake inhibitors |
| fluoxetine | Selfemra | Selective serotonin reuptake inhibitors |
| fluoxetine / olanzapine | Symbyax | Psychotherapeutic combinations |
| Fluoxetine | ANXETIN | |
| Fluoxetine | EVOREX 20MG CAP | |
| Fluoxetine | FLOZAK | |
| Fluoxetine | FLUOXETIN HEXAL 20MG CAPSULES | |
| Fluoxetine | FLUTIN 20MG CAPSULE | |
| Fluoxetine | FLUTIN 20MG-5ML SYRUP | |
| Fluoxetine | FLUZYN 20MG CAPSULES | |
| Fluoxetine | OXETINE 20MG FC TABLETS | |
| Fluoxetine | SALIPAX 20 | |
other drugs from same cataogory