Medications and Drugs
Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: fluoxetine
BRAND NAME: Prozac, Sarafem
DRUG CLASS AND MECHANISM: Fluoxetine is an oral drug that is used for
treating depression. It is in a class of drugs called selective serotonin
reuptake inhibitors (SSRIs), a class that also contains 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.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Capsules: 10, 20, and 40 mg. Capsules (delayed release): 90 mg.
Tablets: 10, 15, and 20 mg. Oral suspension: 20mg/5ml
STORAGE: Fluoxetine should be stored at room temperature 15-30°C (59-86°F).
PRESCRIBED FOR: Fluoxetine is used for treating depression, bulimia,
obsessive-compulsive disorder (OCD),
panic disorder, and
premenstrual dysphoric
disorder (PMDD). It also is used in combination with olanzapine
(Zyprexa) for treatment of resistant depression and treatment of depression
associated with bipolar disorder.
DOSING: 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, once weekly dosing may be effective in
some patients.
Bulimia is treated with 60 mg of fluoxetine daily. Long-term treatment for up
to 52 weeks has been shown to be beneficial in maintaining remission.
Obsessive-compulsive disorder in adults and children is treated with 20-60 mg
daily and panic disorder is managed with 10-60 mg daily. The recommended regimen
for PMDD is 20 mg administered every day of the menstrual cycle or daily for 14
days prior to the onset of menstruation through the first day of menses.
The recommended treatment for resistant depression is 20-50 mg of
fluoxetine and 5-20 mg olanzapine once daily in the evening while the
recommended treatment for depression associated with bipolar disorder is 20-50
mg fluoxetine and 5-12.5 mg olanzapine once daily in the evening
DRUG INTERACTIONS: Fluoxetine should not be taken with any of the monoamine
oxidase inhibitor (MAOI) class of antidepressants [for example, isocarboxazid
(Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline
(Eldepryl), and procarbazine (Matulane)] or other drugs that inhibit monoamine
oxidase [for example, linezolid (Zyvox)]. Such combinations may lead to confusion,
high
blood pressure, tremor, hyperactivity, coma, and death.
Fluoxetine should not be administered for at least 14 days after stopping
MAOIs. Because fluoxetine is active in the body for several weeks, MAOIs
should not be administered
for at least 5 weeks after fluoxetine has been stopped. Similar reactions occur
when fluoxetine is combined with other drugs, for example,
tryptophan, St.
John's wort, meperidine (Demerol),
and tramadol (Ultram) that increase serotonin in the brain.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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