fluoxetine, Prozac, Sarafem, Prozac Weekly
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: fluoxetine
BRAND NAME: Prozac, Sarafem, Prozac Weekly
DRUG CLASS AND MECHANISM: Fluoxetine is an oral drug that is used primarily for treating depression. It 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.
GENERIC AVAILABLE: Yes
PREPARATIONS: Capsules: 10, 20 and 40 mg. Capsules (delayed release): 90 mg. Tablets: 10, 20 and 60 mg. Oral suspension: 20 mg/5ml
STORAGE: Fluoxetine should be stored at room temperature 15 C to 30 C (59 F to 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, 90 mg once weekly 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 20-80 mg daily and panic disorder is managed with 10-60 mg daily.
The recommended regimen for premenstrual dysphoric disorder is 20 mg (maximum dose 80 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 treatment 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 such as linezolid [Zyvox] and intravenous methylene blue. 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 (possibly longer after long term use of fluoxetine or if large doses were used) after fluoxetine has been stopped. Similar reactions occur when fluoxetine is combined with other drugs, for example, tryptophan, St. John's wort, meperidine (Demerol), lithium (Lithobid, Eskalith), triptans (for example, sumatriptan [Imitrex)]), and tramadol (Ultram) that increase serotonin in the brain.
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