fluoxetine (Prozac, Sarafem, Prozac Weekly)

Fluoxetine is an oral drug that is used primarily for treating depression. Fluoxetine is also used to treat depression, bulimia, obsessive-compulsive disorder (OCD), panic disorder, and premenstrual dysphoric disorder (PMDD). It is also prescribed in combination with olanzapine (Zyprexa) to treat resistant depression and depression associated with bipolar disorder.

Fluoxetine is in a class of drugs called selective serotonin reuptake inhibitors (SSRIs), a class that includes citalopram (Celexa), paroxetine (Paxil) and sertraline (Zoloft). Fluoxetine affects neurotransmitters, the chemicals that nerves within the brain use to communicate with each other. Neurotransmitters are manufactured and released by nerves and then travel and attach to nearby nerves. Thus, neurotransmitters can be thought of as the communication system of the brain. Serotonin is one neurotransmitter that is released by nerves in the brain. The serotonin either travels across the space between nerves and attaches to receptors on the surface of nearby nerves or it attaches to receptors on the surface of the nerve that produced it, to be taken up by the nerve and released again (a process referred to as re-uptake). Many experts believe that an imbalance among neurotransmitters is the cause of depression. Fluoxetine works by preventing the reuptake of one neurotransmitter, serotonin, by nerve cells after it has been released. Since uptake is an important mechanism for removing released neurotransmitters and terminating their actions on adjacent nerves, the reduced uptake caused by fluoxetine increases free serotonin that stimulates nerve cells in the brain. The FDA approved Fluoxetine in December 1987.

What brand names are available for fluoxetine?

Prozac, Sarafem, Prozac Weekly

Is fluoxetine available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for fluoxetine?

Yes

Fluoxetine, as with most antidepressants, can cause nausea, headaches, anxiety, insomnia, drowsiness, and loss of appetite. Fluoxetine has been implicated in serious skin rashes and vasculitis (inflammation of small blood vessels). Increased blood pressure can occur, and blood pressure should be monitored. Seizures have been reported as has sexual dysfunction. Some patients may experience withdrawal reactions upon stopping fluoxetine. Symptoms of withdrawal include anxiety, nausea, nervousness, and insomnia. The dose of fluoxetine should be gradually reduced when therapy is discontinued. Fluoxetine and other antidepressants have been associated with angle closure attacks in people with narrow angle glaucoma.

Antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of fluoxetine or any other antidepressant in a child or adolescent must balance this risk of suicide with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

Depression in adults is treated with 20-80 mg of fluoxetine daily. The recommended dose for treating depression in children is 10-20 mg daily. After 13 weeks of daily administration, 90 mg once weekly may be effective in some patients.

Taking fluoxetine with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxant, or medicine for anxiety, depression, or seizures.

Many drugs can interact with fluoxetine. Tell your doctor about all your current medicines and any you start or stop using, especially:

• any other antidepressant
• St. John's wort
• tryptophan (sometimes called L-tryptophan)
• a blood thinner -- warfarin (Coumadin, Jantoven)
• medicine to treat anxiety, mood disorders, thought disorders, or mental illness -- amitriptyline, buspirone, desipramine, lithium, nortriptyline, and many others
• medicine to treat ADHD or narcolepsy -- Adderall, Concerta, Ritalin, Vyvanse, Zenzedi, and others
• migraine headache medicine -- rizatriptan, sumatriptan, zolmitriptan
• narcotic pain medicine -- fentanyl, oxycodone, hydrocodone, and others

Taking monoamine oxidase inhibitors (MAOIs) with fluoxetine may cause a serious (possibly fatal) drug interaction. Avoid taking MAOIs (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with fluoxetine. Most MAOIs should also not be taken for 2 weeks before and at least 5 weeks after treatment with fluoxetine. Ask your doctor when to start or stop taking this medication.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including other SSRIs such as citalopram/paroxetine, SNRIs such as duloxetine/venlafaxine), tryptophan, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Many drugs besides fluoxetine may affect the heart rhythm (QT prolongation), including pimozide and thioridazine, among others. Aspirin can increase the risk of bleeding when used with fluoxetine. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81 to 325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (such as codeine).

Check the labels on all your medicines (such as allergy or cough-and-cold products), because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

Fluoxetine is excreted in breast milk. Therefore, use of fluoxetine while nursing is not recommended.

What preparations of fluoxetine are available?

Capsules: 10, 20 and 40 mg. Capsules (delayed release): 90 mg. Tablets: 10, 20 and 60 mg. Oral suspension: 20 mg/5ml

How should I keep fluoxetine stored?

Fluoxetine should be stored at room temperature 15 C to 30 C (59 F to 86 F).