Mental Health Book

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FluoxetineAka: Prozac, Prozac Weekly, Sarafem

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  1. Mechanism
    1. Selective Serotonin Reuptake Inhibitor (SSRI)
  2. Indications
    1. Major Depression (especially with Hypersomnia)
    2. Obsessive Compulsive Disorder
    3. Bulimia Nervosa
    4. Premenstrual Dysphoric Disorder (Premenstrual Syndrome)
  3. Background
    1. Tablets are generic with cost as low as $26 per month
  4. Preparations
    1. Capsules: 10, 20 and 40 mg
    2. Tablets (scored): 10 mg
    3. Oral solution: 20 mg/5 ml
    4. Long-acting Prozac Weekly preparation: 90 mg capsules
  5. Dosing
    1. Daily
      1. Start
        1. Children (age 7 to 18 years): 5-10 mg qd
        2. Adults: 20 mg PO qd
        3. Elderly: 10 mg qd
      2. Titrate
        1. Avoid increasing dose more often than monthly
      3. Maximum
        1. Children (age 7 to 18 years): 60 mg
        2. Adults: 80 mg PO qd
        3. Maximal dose often required in Bulimia and OCD
    2. Weekly
      1. Prozac Weekly 90 mg once weekly
        1. Equivalent to 20 mg qd
  6. Pharmacokinetics
    1. Half Life is Very Long! (7-9 days)
    2. Therapeutic Blood level 163-560 ng/ml
  7. Drug Interactions
    1. See Serotonin Syndrome
    2. Stop for 5 weeks before starting MAO inhibitor
    3. Inhibits Cytochrome P450-3A and P450-2D6
    4. Highly protein bound
      1. Interacts with other protein bound medications
    5. Raises the following drug levels
      1. Warfarin (Coumadin) and increased INR
      2. Tricyclic Antidepressants
      3. Carbamazepine (Tegretol)
      4. Phenytoin (Dilantin)
  8. Adverse Effects: General
    1. Activating on the Sedation to excitation continuum
      1. Most activation or aggravation of all SSRIs
    2. Anxiety or nervousness
    3. Akathisia
    4. Insomnia
      1. Consider Trazodone (Desyrel) at bedtime
    5. Avoid in the elderly
    6. Weight loss may occur
  9. Adverse Effects: Pregnancy
    1. Major Fetal Structural abnormality
      1. No Change (5.5% versus 4% for Placebo)
    2. Minor Fetal Structural abnormality
      1. Significant Association (15.5% vs 6.5% for Placebo)
    3. Fluoxetine also associated with
      1. Preterm Labor
      2. NICU admissions
      3. Low birth weight
    4. References: Study of n=482
      1. Chambers (1996) N Engl J Med 335:1010
  10. Resources
    1. Prozac Website (Lilly)
      1. http://www.prozac.com

Fluoxetine (C0016365)

Definition (MSH)The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants.
Definition (CSP)N-methyl-gamma-(4-(trifluoromethyl) -phenoxy)-benzenepropanamine; used in the treatment of depression; action thought to be linked to its inhibition of CNS neuronal uptake of serotonin.
Definition (NCI)A drug used to treat depression. It belongs to the family of drugs called antidepressants.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD005473
EnglishFLUOX, Fluoxetin, Fluoxetine, FLUOXETINE PREPARATION
Spanishfluoxetina
Parent ConceptsPropylamines (C0033504), Antidepressive Agents (C0003289), Serotonin Uptake Inhibitors (C0162758), phenylalkoxyalkylamine (C0597213), [CN609] ANTIDEPRESSANTS, OTHER (C0973506), Selective serotonin re-uptake inhibitor (C0360105), Drug allergen (C1320237)
SourcesAOD, CSP, LNC, MSH, MTHSPL, NCI, NDFRT, PDQ, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Prozac (C0162373)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD005473
EnglishProzac
SourcesCSP, MSH, NCI, PDQ, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


Prozac Weekly (C0939456)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishProzac Weekly
SourcesRXNORM
Derived from the NIH UMLS (Unified Medical Language System)


Sarafem (C1692877)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD005473
EnglishSarafem
SourcesMSH, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)



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