HEALTHY LIFESTYLE




Fluoxetine
Fluoxetine.JPG

Fluoxetine

CLINICAL USE

SSRI antidepressant:Depressive illness Bulimia nervosa Obsessive compulsive disorder

DOSE IN NORMAL RENAL FUNCTION

20–60 mg daily depending on indication

PHARMACOKINETICS

  • Molecular weight                           :345.8 (as hydrochloride)
  • %Protein binding                           :94.5
  • %Excreted unchanged in urine     :
  • <10           :
  • Volume of distribution (L/kg)       :20–40
  • half-life – normal/ESRD (hrs)      :Acute dosing: 24–72/UnchangedChronic dosing: 4–6 days/Increased

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function
  • <10           : Use low dose, or on alternate days and increase according to response

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Not dialysed. Dose as in GFR <10 mL/min
  • HD                     :Not dialysed. Dose as in GFR <10 mL/min
  • HDF/high flux   :Not dialysed. Dose as in GFR <10 mL/min
  • CAV/VVHD      :Not dialysed. Dose as in GFR=
  • 10 to 20     : mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs
  • Analgesics: increased risk of bleeding with aspirin and NSAIDs; risk of CNS toxicity increased with tramadol
  • Anti-arrhythmics: increased flecainide concentration
  • Anticoagulants: effect of coumarins possibly enhanced
  • Antidepressants: avoid concomitant use with MAOIs and moclobemide, increased risk of toxicity; avoid concomitant use with St John’s wort; possibly enhanced serotonergic effects with duloxetine; can increase tricyclics antidepressant concentration; increased agitation and nausea with tryptophan
  • Anti-epileptics: antagonism (lowered convulsive threshold); concentration of carbamazepine and phenytoin increased
  • Antimalarials: avoid concomitant use with artemether/lumefantrine
  • Antipsychotics: concentration of haloperidol, clozapine, risperidone, sertindole and zotepine increased; possibly inhibit aripiprazole metabolism – reduce aripiprazole dose
  • Antivirals: concentration possibly increased by ritonavir
  • Ciclosporin: may increase ciclosporin concentration
  • Dopaminergics: increased risk of hypertension and CNS excitation with selegiline – avoid concomitant use; increased risk of CNS toxicity with rasagiline – avoid concomitant use5HT 1 agonist: increased risk of CNS toxicity with sumatriptan; possibly increased risk of serotonergic effects with frovatriptan
  • Lithium: increased risk of CNS effects (lithium toxicity reported)
  • Sibutramine: increased risk of CNS toxicity – avoid concomitant use

    ADMINISTRATION

    Reconstition

    Route

    Oral

    Rate of Administration

    Comments

    OTHER INFORMATION

    Accumulation may occur in patients with severe renal failure during chronic treatment (metabolites are excreted renally)
  • other drugs