Prozac (fluoxetine)
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DESCRIPTION
Fluoxetine belongs to a class of drugs known as selective inhibitors of serotonin reuptake (SSRIs), also known as antidepressants, which can alter the levels of brain chemicals and are used for mental depression and panic disorder. Depression often accompanies other symptoms of MS and antidepressants may be included in treatment regimens. Before the depression is diagnosed, physicians should rule out poor sleep patterns, medical conditions, and other possible side effects of drugs. Patients should be encouraged to exercise regularly, take medication with antidepressants.
Fluoxetine is one of many antidepressants prescribed for depression and fatigue in MS. It is generally well tolerated, however, must be taken in the morning to avoid sleep disturbances. Other common side effects include dry mouth and dizziness.
ORIGINAL USES (LABEL)
Major depressive disorder, obsessive compulsive disorder, bulimia nervosa, panic disorder, premenstrual dysphoric disorder.
Newly discovered uses (off-label)
Attention deficit / hyperactivity disorder (ADHD), alcoholism (cravings and dependence), Alzheimer’s disease, anorexia nervosa, bipolar disorder, childhood anxiety, chronic fatigue syndrome, fibromyalgia, impulsive aggressive disorder, prevention of migraine, stroke (motor control), multiple sclerosis, narcolepsy, nocturnal enuresis, premature ejaculation, post-traumatic stress disorder (PTSD), Raynaud’s syndrome, schizoaffective disorder, social phobia, prevention of tension headache , vasovagal syncope.
POSSIBLE SIDE EFFECTS
Abnormal thinking, anxiety, dizziness, headache, decreased libido, manic reaction, nervousness, somnolence, sweating, abdominal pain, anorexia, constipation, diarrhea, dry mouth, stomach pain, nausea, vomiting, urinary frequency , rhinitis, abnormal vision, fever, flu syndrome, pain, weight loss, low sodium levels, changes in blood glucose levels, abnormal dreams, rash, sexual dysfunction, sinusitis.
PRECAUTIONS
Use may be associated with the development of suicidal thinking and behavior (see special information).
Do not use if you have been taking an MAO inhibitor (eg phenelzine, tranylcypromine, isocarboxazid) within the last 14 days. When used with MAO-Is fever, high blood pressure, increased heart rate, confusion, convulsions and death have been reported.
Decrease the dose gradually after discontinuation of therapy.
Notify your doctor if you have a history of mania, seizures, and alcoholism.
Be careful if you have liver dysfunction, or renal failure, or are elderly.
Concomitant use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of bleeding.
DRUG INTERACTIONS
MAO inhibitors (eg phenelzine, isocarboxazid, or linezolid), selegiline, warfarin, cimetidine, linezolid, cyproheptadine, metoclopramide, sibutramine, tramadol, phenytoin, L-tryptophan, tricyclic antidepressants (eg nortriptyline, amitriptyline, imipramine, etc.) benzodiazepines (including diazepam, flurazepam, etc), beta blockers, buspirone, carbamazepine, clozapine, cyclosporine, haloperidol, lithium, olanzapine, phenothiazines, propafenone, ritonavir, trazodone.
FOOD INTERACTIONS
Can occur with or without food. Avoid alcohol.
INTERACTIONS HERBS
Valerian, St. John, the same, kava kava.
Pregnancy and lactation PRECAUTIONS
FDA Pregnancy Risk Category C. excreted in breast milk. It is not recommended during lactation.
SPECIAL INFORMATION
Therapeutic response may take 4-6 weeks.
It can cause insomnia, administered in the morning; sedative antidepressants in small doses (ie trazadone 50 mg), often managed by SA simultaneously.
In a case study of Canada, a 41-years with multiple sclerosis (MS) and a history of 12 months of severe depression (not suicidal) had previously been treated with doxepin hydrochloride with limited effect. Doxepin hydrochloride and was suspended for this exchange of nidicine. Six weeks after initiation of fluoxetine, reported improved mood, less hostility, less emotional lability, and better concentration at work. A side effect is fatigue, which resolved when the government passed the night. His sensory problems, including numbness, has also improved.
In a trial of Prozac and amitriptyline in patients with MS, the drug has a greater effect on cognitive disturbances (another symptom of MS) than amitriptyline.
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What is Prozac?
This drug inhibits the reuptake of serotonin in the neuron and therefore increases levels of serotonin in the body and brain.
NAME
Prozac Weekly, Sarafem, Prozac
GENERIC NAME
Fluoxetine
CHEMISTRY CLASS
Trifluoro propylamine derivative.
NURSING MOTHERS
Antidepressants (selective inhibitors of serotonin reuptake)
Use FORMS
Capsules – Oral 10 mg, 20 mg.
DOSAGE
Adults
Major depressive disorder, obsessive-compulsive disorder, premenstrual dysphoric disorder: 20 mg PO QAM, increase after 4-6 weeks prn, max 80 mg / day, doses> 20 mg dose can be divided into morning and noon, for intermittantly premenstrual dysphoric disorder can also be used from 14 days before the expected start of menstruation and continuing until 1 full day of menses and repeating with each new cycle.
Bulimia nervosa: 60 mg PO QAM, may be advisable to assess target dose over several days in some patients.
Maintenance therapy in depression: PO 20 mg or 90 mg QD qwk after 7 days after the last daily dose of 20 mg.
Child (8-18 years)
Major depressive disorder: 10-20 mg PO q AM.
Obsessive-compulsive disorder: 10 mg PO q AM; may gradually increase after 2 weeks. Dose range of 20-60 mg is recommended for adolescents and higher weight children.
