Mental Health Book

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Fluoxetine

Aka: Fluoxetine, Prozac, Prozac Weekly, Sarafem
  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. Earlier safety data
      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 335:1010-5 [PubMed]
    2. Safety data in 2015
      1. Fluoxetine has been well studied in pregnancy, but data in 2015 showed association with cardiac defects
      2. Berard (2015) Br J Clin Pharmacol +PMID:26613360 [PubMed]
  10. Resources
    1. Prozac Website (Lilly)
      1. http://www.prozac.com
Medication Costs
fluoxetine (on 5/17/2017 at Medicaid.Gov Pharmacy Drug pricing)
FLUOXETINE 20 MG/5 ML SOLUTION Generic $0.04 per ml
FLUOXETINE DR 90 MG CAPSULE Generic $29.71 each
FLUOXETINE HCL 10 MG CAPSULE Generic $0.03 each
FLUOXETINE HCL 10 MG TABLET Generic $0.82 each
FLUOXETINE HCL 20 MG CAPSULE Generic $0.03 each
FLUOXETINE HCL 20 MG TABLET Generic $1.39 each
FLUOXETINE HCL 40 MG CAPSULE Generic $0.14 each
FLUOXETINE HCL 60 MG TABLET Generic $8.56 each
prozac (on 5/18/2016 at Medicaid.Gov Pharmacy Drug pricing)
PROZAC 10 MG PULVULE Generic $0.03 each
PROZAC 20 MG PULVULE Generic $0.03 each
PROZAC 40 MG PULVULE Generic $0.14 each
PROZAC WEEKLY 90 MG CAPSULE Generic $29.71 each
sarafem (on 1/1/2017 at Medicaid.Gov Pharmacy Drug pricing)
SARAFEM 10 MG TABLET Generic $0.82 each
SARAFEM 20 MG TABLET Generic $1.39 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Fluoxetine (C0016365)

Definition (CHV) antidepressant drug sold under the brand name Prozac
Definition (CHV) antidepressant drug sold under the brand name Prozac
Definition (NCI_NCI-GLOSS) A drug used to treat depression. It belongs to the family of drugs called antidepressants.
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.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D005473
SnomedCT 372767007, 53640004
LNC LP14381-5, MTHU003396
English Fluoxetin, Fluoxetine, N-Methyl-gamma-(4-(trifluoromethyl)phenoxy)benzenepropanamine, Benzenepropanamine, N-methyl-gamma-(4-(trifluoromethyl)phenoxy)-, (+-)-, N-methyl-gamma-(4-(trifluoromethyl) -phenoxy)-benzenepropanamine, Fluoxetine [Chemical/Ingredient], fluoxetin, FLUOXETINE, FLUoxetine, fluoxetine, Fluoxetine (product), Fluoxetine (substance), FLUOX
Swedish Fluoxetin
Czech fluoxetin
Finnish Fluoksetiini
Russian FLUOKSETIN, ФЛУОКСЕТИН
Japanese フルオロキセチン, フルオキセチン
Italian N-Metil-gamma4-(trifluorometil)fenossi)benzenepropanamina, Fluossetina
Polish Fluoksetyna
Spanish fluoxetina (producto), fluoxetina (sustancia), fluoxetina, Fluoxetina
French Fluoxétine
German Fluoxetin
Portuguese Fluoxetina
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Prozac (C0162373)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D005473
English PROzac, Prozac
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Prozac Weekly (C0939456)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
English Prozac Weekly, prozac weekly, weekly prozac, PROzac Weekly
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Sarafem (C1692877)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D005473
English Sarafem, sarafem
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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