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How much prozac should i take


How and when to take fluoxetine

Dosage

The usual dose of fluoxetine for adults is 20mg a day. However, you may start at a lower dose and gradually be increased to a maximum dose of 60mg a day.

Some people might need to take a lower dose of fluoxetine. This includes people with liver problems, and older people.

The usual dose of fluoxetine for children is 10mg a day but this may be increased to 20mg a day.

How to take it

You’ll usually take fluoxetine once a day, with or without food.

You can take fluoxetine at any time, but it’s best to stick to the same time every day.

If you have trouble sleeping, try taking it in the morning.

How long to take it for

Once you're feeling better it's likely that you will continue to take fluoxetine for several more months.

Most doctors recommend that you take antidepressants for 6 months to a year after you no longer feel depressed. Stopping before that time can make depression come back.

If you forget to take it

If you occasionally forget to take a dose, just take your next dose the next day at the usual time. Never take 2 doses at the same time to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

Stopping fluoxetine

If you stop taking fluoxetine suddenly, you may get withdrawal symptoms such as:

  • feeling dizzy
  • feeling sick
  • numbness or tingling in the hands or feet
  • trouble sleeping
  • feeling agitated or anxious
  • headaches
  • shaking

Talk to your doctor if you want to stop. They will reduce your dose gradually to help you with any side effects.

If you take too much

The amount of fluoxetine that can lead to an overdose varies from person to person.

Taking too much can cause symptoms such as:

  • being sick (vomiting)
  • shaking
  • feeling sleepy
  • feeling agitated
  • feeling dizzy
  • racing heart
  • fits or seizures

Urgent advice: Contact 111 for advice now if:

  • you take more than your prescribed dose of fluoxetine

Go to 111.nhs.uk or call 111.

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the fluoxetine packet, or the leaflet inside it, plus any remaining medicine with you.

Page last reviewed: 10 February 2022
Next review due: 10 February 2025

Side effects, dosage, uses, and more

  1. Fluoxetine oral capsule is available as a brand-name drug and as a generic drug. Brand name: Prozac.
  2. Fluoxetine comes in four forms: capsule, delayed-release capsule, tablet, and solution. All forms are taken by mouth.
  3. Fluoxetine oral capsule is used to treat different types of depression, obsessive-compulsive disorder, some eating disorders, and panic attacks.

Other warnings

  • Serotonin syndrome warning: This drug can cause a life-threatening condition called serotonin syndrome. This syndrome happens when medications cause too much serotonin to build up in your body. Symptoms can include agitation, hallucinations (seeing or hearing something that isn’t there), problems with coordination, and a racing heart rate. They can also include overactive reflexes, fever, nausea, vomiting, or diarrhea. Call your doctor right away if you have any signs of this condition.
  • Mania warning: This drug may cause mania or hypomania. Symptoms include greatly increased energy, extreme irritability, talking more or faster than usual, racing thoughts, or severe trouble sleeping. If you have a history of mania or bipolar disorder, talk to your doctor before using this drug.
  • Low salt levels warning: This drug may cause you to have dangerously low salt levels in your blood. Symptoms include headache, weakness, confusion, trouble concentrating, memory problems, and feeling unsteady. Call your doctor right away if you have any symptoms of this condition.

Fluoxetine is a prescription drug. It comes as a capsule, delayed-release capsule, tablet, and solution. All forms are taken by mouth. (A delayed-release capsule is released into your body more slowly.)

Fluoxetine oral capsule is available as the brand-name drug Prozac. It’s also available as a generic drug. Generic drugs usually cost less than brand-name versions. In some cases, they may not be available in every strength or form as brand-name drugs.

Fluoxetine oral capsule may be used as part of a combination therapy. This means you may need to take it with other medications. For the treatment of depressive episodes related to bipolar I disorder and treatment-resistant depression, this drug must be used with olanzapine.

Why it’s used

Fluoxetine oral capsule is used to treat the following conditions:

  • Depression. This includes major depression.
  • Obsessive-compulsive disorder. This condition causes bothersome thoughts that won’t go away (obsessions) and the need to do certain actions over and over (compulsions).
  • Bulimia nervosa. This condition is an eating disorder marked by binge eating followed by extreme behaviors to avoid gaining weight (purging, fasting, or excessive exercise).
  • Panic attacks. These are sudden episodes of extreme fear and worry even though no threat exists.

How it works

Fluoxetine oral capsule belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Fluoxetine works by increasing the amount of serotonin (a natural substance) in your brain. Serotonin helps maintain mental health balance. An increase in serotonin helps to treat symptoms of depression, obsessive-compulsive disorder, bulimia nervosa, and panic attacks.

Fluoxetine oral capsule doesn’t cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects of fluoxetine can include:

  • strange dreams
  • decreased sex drive and trouble having an orgasm
  • decreased appetite
  • anxiety and nervousness
  • weakness
  • diarrhea
  • dry mouth
  • indigestion
  • flu
  • erectile dysfunction (trouble getting or keeping an erection)
  • trouble sleeping
  • nausea
  • sore throat
  • rash
  • watery nasal discharge
  • sleepiness
  • sweating and hot flashes
  • tremors (uncontrollable rhythmic movement in one part of your body)
  • yawning
  • If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Serotonin syndrome. Symptoms can include:
    • agitation (feeling aggravated or restless)
    • hallucinations (seeing or hearing something that isn’t there)
    • problems with coordination
    • racing heart rate
    • overactive reflexes
    • fever
    • nausea
    • vomiting
    • diarrhea
  • Abnormal bleeding. Symptoms can include:
    • bruising or bleeding more easily than normal
  • Mania. Symptoms can include:
    • greatly increased energy
    • severe trouble sleeping
    • racing thoughts
    • reckless behavior
    • unusually grand ideas
    • excessive happiness or irritability
    • talking more or faster than normal
  • Seizures
  • Low salt levels in your blood. Symptoms can include:
    • headache
    • weakness
    • confusion
    • trouble concentrating
    • memory problems
    • feeling unsteady

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Fluoxetine oral capsule can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with fluoxetine are listed below.

Drugs you should not use with fluoxetine

Do not take these drugs with fluoxetine. Doing so can cause dangerous effects in your body. Examples of these drugs include:

  • Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid, phenelzine, and tranylcypromine. You shouldn’t take fluoxetine if you take an MAOI or if you’ve stopped taking an MAOI within the last two weeks. Don’t take an MAOI within five weeks of stopping fluoxetine. Taking these drugs too close together could cause serious and life-threatening side effects. Symptoms include high fever, constant muscle spasms that you can’t control, and stiff muscles. They also include fast changes in your heart rate and blood pressure, confusion, and unconsciousness.
  • Thioridazine. You shouldn’t take these drugs together. Don’t take thioridazine within five weeks of stopping fluoxetine. Taking these drugs together can cause serious heart rhythm problems. These problems can cause you to die suddenly.
  • Pimozide. You shouldn’t take these drugs together. Fluoxetine can cause the levels of pimozide to increase in your body. This raises your risk for heart rhythm problems.

Interactions that increase your risk of side effects

Increased side effects: Taking fluoxetine with certain medications raises your risk of side effects. This is because fluoxetine and these other medications can cause the same side effects. These drugs include serotonergic drugs, such as:

  • selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline
  • serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine and venlafaxine
  • tricyclic antidepressants (TCAs) such as amitriptyline and clomipramine
  • the opioids fentanyl and tramadol
  • the anxiolytic buspirone
  • triptans
  • lithium
  • tryptophan
  • St. John’s wort
  • amphetamines

Taking these drugs with fluoxetine may increase your risk of serotonin syndrome, which can be fatal. If you take any of these drugs, your doctor will start you on a lowered dosage of fluoxetine and monitor you for signs of serotonin syndrome. Symptoms can include agitation, sweating, muscle twitches, and confusion.

Increased side effects from other drugs: Taking fluoxetine with certain medications raises your risk of side effects from these drugs. Examples of these drugs include:

  • Benzodiazepines, such as triazolam and midazolam. Taking these drugs together may cause more sedation and drowsiness.
  • Warfarin. Taking these drugs together may cause an increase in bleeding. Your doctor will monitor you closely.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Taking these drugs together may cause an increase in bleeding. Your doctor will monitor you closely.
  • Aspirin. Taking these drugs together may cause an increase in bleeding. Your doctor will monitor you closely.
  • Drugs broken down by the enzyme CYPD2D6, such as aripiprazole, dextromethorphan, and risperidone. Taking these drugs with fluoxetine may increase your risk of serotonin syndrome, heart rhythm problems, and involuntary muscle movements.
  • Lithium. Your doctor should monitor your lithium blood levels if you need to take these drugs together.
  • Phenytoin. Taking these drugs together may cause confusion, dizziness, and fever. You may also have changes in your behavior. These changes include anger, irritability, or sadness. Your doctor should monitor the level of phenytoin in your body.
  • Carbamazepine. Taking these drugs together can cause blurred vision, vertigo, or tremors. Your doctor should monitor the level of carbamazepine in your body.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

This drug comes with several warnings.

Allergy warning

This medication can cause a severe allergic reaction. Symptoms can include:

  • hives
  • rash alone or with a fever and joint pain
  • trouble breathing
  • swelling of your throat or tongue

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Warnings for people with certain health conditions

For people with blood clotting disorders: This drug may cause you to bleed more easily. If you take another drug to thin your blood, it could cause dangerous bleeding.

For people with diabetes: This drug may cause low blood sugar levels. Once you stop taking this drug, it may cause your blood sugar levels to increase.

For people with bipolar I disorder: You shouldn’t take this drug alone to treat depression associated with bipolar I disorder. This drug may increase your risk of a mixed or manic episode.

For people with liver disease: If you have liver problems or a history of liver disease, your body may not be able to process this drug as well. This may increase the levels of this drug in your body and cause more side effects. Your doctor may lower your dose or have you take this drug less often.

For people with closed-angle glaucoma (a sudden buildup of pressure inside your eye): Fluoxetine may cause a glaucoma attack. If you have closed-angle glaucoma, talk with your doctor before taking this drug.

For people with epilepsy or other conditions that cause seizures: This drug can increase your risk of seizures. If you’ve had seizures in the past, talk with your doctor before taking this drug. Tell them if you have increased seizures after starting the treatment.

For people with heart rhythm problems: This drug can cause your heart to beat abnormally. Sometimes, this has led to an unsafe abnormal heartbeat called torsades de pointes. You have a higher risk if you’ve ever had heart problems. Call your doctor right away if you have a fast or irregular heartbeat. Anyone who loses consciousness requires urgent medical care.

Warnings for other groups

For pregnant women: Talk to your doctor if you’re pregnant or plan to become pregnant. Research in animals has shown adverse effects to the fetus when the mother takes the drug. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus. This drug should only be used if the potential benefit justifies the potential risk.

For women who are breastfeeding: This drug may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: Seniors may have a higher risk of side effects from this drug. Because of this risk, your doctor may lower your dosage or have you take the medication less often.

Bulimia nervosa and panic disorder: This drug hasn’t been studied in children for these conditions. It shouldn’t be used in people younger than 18 years.

Major depressive disorder: This drug shouldn’t be used in children younger than 8 years for this condition.

Obsessive-compulsive disorder: This drug shouldn’t be used in children younger than 7 years for this condition.

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Dosage for bulimia nervosa

Generic: Fluoxetine

  • Form: oral capsule
  • Strengths: 10 mg, 20 mg, 40 mg

Brand: Prozac

  • Form: oral capsule
  • Strengths: 10 mg, 20 mg, 40 mg

Adult dosage (ages 18 to 64 years)

Typical dosage: 60 mg per day taken in the morning.

Child dosage (ages 0 to 17 years)

This drug hasn’t been studied in children for this condition. It shouldn’t be used in people younger than 18 years.

Senior dosage (ages 65 years and older)

Seniors may have a higher risk of side effects from this drug. Because of this risk, your doctor may lower your dosage or reduce how often you take the drug.

Dosage for major depressive disorder

Generic: Fluoxetine

  • Form: oral capsule
  • Strengths: 10 mg, 20 mg, 40 mg
  • Form: oral delayed-release capsule
  • Strength: 90 mg

Brand: Prozac

  • Form: oral capsule
  • Strengths: 10 mg, 20 mg, 40 mg

Adult dosage (ages 18 to 64 years)

  • Typical dosage: 20–80 mg per day.
  • Maximum dosage: 80 mg per day.
  • Initial dosage: 20 mg per day taken in the morning.
  • Alternative dosage: You may be a candidate for taking this drug once per week. In this case, your doctor will stop your daily dose of the immediate-release capsules and switch you over to the delayed-release capsules. You’ll take 90 mg once per week. You’ll start taking it seven days after your last daily dose of fluoxetine.

Child dosage (ages 8 to 17 years)

  • Typical dosage: 10–20 mg per day.
  • Initial dosage: After your child takes 10 mg per day for one week, your doctor may increase their dosage to 20 mg per day.

Child dosage (ages 0–7 years)

This drug shouldn’t be used in children younger than 8 years for this condition.

Senior dosage (ages 65 years and older)

Seniors may have a higher risk of side effects from this drug. Because of this risk, your doctor may lower your dose or reduce how often you take the drug.

Dosage for obsessive-compulsive disorder

Generic: Fluoxetine

  • Form: oral capsule
  • Strengths: 10 mg, 20 mg, 40 mg

Brand: Prozac

  • Form: oral capsule
  • Strengths: 10 mg, 20 mg, 40 mg

Adult dosage (ages 18 to 64 years)

  • Typical dosage: 20–60 mg per day.
  • Maximum dosage: 80 mg per day.
  • Initial dosage: 20 mg per day taken in the morning.

Child dosage (ages 13 to 17 years, and higher weight children)

  • Typical dosage: 20–60 mg per day.
  • Initial dosage: 10 mg per day. After two weeks, your doctor will likely increase your child’s dosage to 20 mg per day.

Child dosage (ages 7 to 12, and lower weight children)

  • Typical dosage: 20–30 mg per day.
  • Initial dosage: 10 mg per day.

Child dosage (ages 0 to 6 years)

This drug shouldn’t be used in children younger than 7 years for this condition.

Senior dosage (ages 65 years and older)

Seniors may have a higher risk of side effects from this drug. Because of this risk, your doctor may lower your dosage or reduce how often you take the drug.

Dosage for panic disorder

Generic: Fluoxetine

  • Form: oral capsule
  • Strengths: 10 mg, 20 mg, 40 mg

Brand: Prozac

  • Form: oral capsule
  • Strengths: 10 mg, 20 mg, 40 mg

Adult dosage (ages 18 to 64 years)

  • Typical dosage: 20–60 mg per day.
  • Initial dosage: 10 mg per day. After one week, your doctor will likely increase your dosage to 20 mg per day.

Child dosage (ages 0 to 17 years)

This drug hasn’t been studied in children for this condition. It shouldn’t be used in people younger than 18 years.

Senior dosage (ages 65 years and older)

Seniors may have a higher risk of side effects from this drug. Because of this risk, your doctor may lower your dosage or reduce how often you take the drug.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

Fluoxetine oral capsule is used for short- and long-term treatment of bulimia nervosa, major depression, and obsessive-compulsive disorder. It’s also used for short-term treatment of panic attacks.

This drug comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: If you don’t take this drug, the symptoms of your condition may not improve.

Don’t stop taking this drug without talking to your doctor first. Stopping this drug too quickly may cause serious symptoms. These can include:

  • anxiety
  • irritability
  • mood swings
  • restlessness
  • changes in your sleep habits
  • headache
  • sweating
  • nausea
  • dizziness

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • tiredness
  • vomiting
  • fast heart rate
  • nausea
  • dizziness
  • agitation
  • tremors

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: The symptoms of your condition should improve. However, you might not feel better right when you start taking this drug. It can take 1–4 weeks to start working.

Keep these considerations in mind if your doctor prescribes fluoxetine for you.

General

  • You can take this drug with or without food.
  • Take this drug at the time(s) recommended by your doctor.
  • Don’t open the oral capsules or oral delayed-release capsules.

Storage

  • Store this drug at room temperature. Keep it between 59°F and 86°F (15°C and 30°C).
  • Keep this drug away from light.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t harm your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These health issues include:

  • Mental health and behavioral problems. You and your doctor should watch for any unusual changes in your behavior and mood. This drug can cause new mental health and behavior problems. It may also worsen problems you already have.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Prozac instructions for use: indications, contraindications, side effects - description of Prozac Capsules (694)

💊 Ingredients of Prozac ®

✅ How to use Prozac ®


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Description of the active ingredients of the preparation Prozac ® (Prozac ® )

The scientific information provided is general and cannot be used to make decisions. decisions about the use of a particular drug.

Update date: 2020.06.09

Marketing authorization holder:

ELI LILLY VOSTOK, S.A. (Switzerland)

Made:


PATHEON FRANCE, S.A.S. (France)

ATX code: N06AB03 (Fluoxetine)

Active substance: fluoxetine (fluoxetine)

Rec.INN WHO registered

Dosage form


Prozac ®

Caps. 20 mg: 14 or 28 pcs.

reg. No.: P N014206/01 dated 17.03.08 - Indefinitely

Release form, packaging and composition Prozac

®

Capsules hard gelatin capsules, size #3, opaque, green/cream, imprinted with the LILLY logo and the identification code "3105"; the contents of the capsules are white powder.0008

1 caps.
fluoxetine (as hydrochloride) 20 mg

Excipients : starch, dimethicone.

Composition of the capsule shell: patented blue dye (patent blue V dye), iron oxide yellow dye, titanium dioxide, gelatin, food ink (for identification printing).

14 pcs. - blisters (1) - packs of cardboard.
14 pcs. - blisters (2) - packs of cardboard.

Clinical and pharmacological group: Antidepressant

Pharmacotherapeutic group: Antidepressant

Pharmacological action

Antidepressant, propylamine derivative. The mechanism of action is associated with selective blockade of neuronal reuptake of serotonin in the CNS. Fluoxetine is a weak antagonist of cholino-, adreno- and histamine receptors. Unlike most antidepressants, fluoxetine does not appear to cause a decrease in the functional activity of postsynaptic β-adrenergic receptors. Helps improve mood, reduces feelings of fear and tension, eliminates dysphoria. Does not cause sedation. When taken in average therapeutic doses, it practically does not affect the functions of the cardiovascular and other systems.

Pharmacokinetics

Absorbed from the gastrointestinal tract. Weakly metabolized during the "first pass" through the liver. Eating does not affect the degree of absorption, although it may slow down its rate. C max in plasma is achieved after 6-8 hours. C ss in plasma is achieved only after continuous administration for several weeks. Protein binding 94.5%. Easily penetrates through the BBB. It is metabolized in the liver by demethylation to form the main active metabolite of norfluoxetine.

T 1/2 fluoxetine is 2-3 days, norfluoxetine is 7-9 days. Excreted by the kidneys 80% and through the intestines - about 15%.

Indications of the active substances of the drug Prozac

®

Depression of various origins, obsessive-compulsive disorders, bulimic neurosis.

Open list of ICD-10 codes

F31 Bipolar affective disorder
F32 Depressive episode
F33 Recurrent depressive disorder
F41. 2 Mixed anxiety and depressive disorder
F42 Obsessive-compulsive disorder
F50.2 Bulimia nervosa

Dosage regimen

The method of administration and dosing regimen of a particular drug depends on its form of release and other factors. The optimal dosage regimen is determined by the doctor. Compliance of the dosage form of a particular drug with indications for use and dosing regimen should be strictly observed.

Initial dose - 20 mg 1 time / day in the morning; if necessary, the dose can be increased after 3-4 weeks. The frequency of admission is 2-3 times / day.

The maximum daily oral dose of for adults is 80 mg.

Side effects

From the side of the central nervous system: possible anxiety, tremor, nervousness, drowsiness, headache, sleep disturbances.

From the digestive system: possible diarrhea, nausea.

From the side of metabolism: may increase sweating, hypoglycemia, hyponatremia (especially in elderly patients and with hypovolemia).

From the reproductive system: decreased libido.

Allergic reactions: possible skin rash, itching.

Other: joint and muscle pain, shortness of breath, fever.

Contraindications for use

Glaucoma, bladder atony, severe renal dysfunction, benign prostatic hyperplasia, simultaneous administration of MAO inhibitors, convulsive syndrome of various origins, epilepsy, pregnancy, lactation, hypersensitivity to fluoxetine.

Use in pregnancy and lactation

Contraindicated in pregnancy and lactation.

Use in hepatic impairment

Use with extreme caution in patients with hepatic impairment.

Use in impaired renal function

Contraindicated in severe renal impairment. Use with extreme caution in patients with moderate and mild renal impairment.

Use in children

The safety of fluoxetine in children has not been established.

Use in elderly patients

Elderly patients require dosage adjustment.

Special instructions

Use with extreme caution in patients with impaired liver and kidney function, with a history of epileptic seizures, cardiovascular diseases.

In patients with diabetes mellitus, changes in blood glucose levels are possible, which requires correction of the dosing regimen of hypoglycemic drugs. When used in debilitated patients while taking fluoxetine, the likelihood of developing epileptic seizures increases.

With the simultaneous use of fluoxetine and electroconvulsive therapy, the development of prolonged epileptic seizures is possible.

Fluoxetine can be used no earlier than 14 days after discontinuation of MAO inhibitors. The period after the abolition of fluoxetine before the start of therapy with MAO inhibitors should be at least 5 weeks.

Elderly patients require dosage adjustment.

The safety of fluoxetine in children has not been established.

Do not drink alcohol during treatment.

Influence on the ability to drive vehicles and mechanisms

During the period of treatment, one should refrain from potentially hazardous activities that require increased attention and rapid psychomotor reactions.

Drug Interactions

When used simultaneously with drugs that have a depressant effect on the central nervous system, with ethanol, a significant increase in the inhibitory effect on the central nervous system, as well as an increase in the likelihood of convulsions, is possible.

With simultaneous use with MAO inhibitors, furazolidone, procarbazine, tryptophan, serotonin syndrome may develop (confusion, hypomania, restlessness, agitation, convulsions, dysarthria, hypertensive crisis, chills, tremor, nausea, vomiting, diarrhea).

With simultaneous use, fluoxetine inhibits the metabolism of tricyclic and tetracyclic antidepressants, trazodone, carbamazepine, diazepam, metoprolol, terfenadine, phenytoin, which leads to an increase in their concentration in blood serum, an increase in their therapeutic and side effects.

With simultaneous use, inhibition of the biotransformation of drugs metabolized with the participation of the CYP2D6 isoenzyme is possible.

When used simultaneously with hypoglycemic agents, their effect may be enhanced.

There have been reports of increased effects of warfarin when co-administered with fluoxetine.

When used simultaneously with haloperidol, fluphenazine, maprotiline, metoclopramide, perphenazine, periciazine, pimozide, risperidone, sulpiride, trifluoperazine, cases of extrapyramidal symptoms and dystonia have been described; with dextromethorphan - a case of the development of hallucinations is described; with digoxin - a case of increasing the concentration of digoxin in the blood plasma.

When used simultaneously with lithium salts, an increase or decrease in the concentration of lithium in the blood plasma is possible.

With simultaneous use, it is possible to increase the concentration of imipramine or desipramine in the blood plasma by 2-10 times (may persist for 3 weeks after fluoxetine is discontinued).

When used simultaneously with propofol, a case is described in which spontaneous movements were observed; with phenylpropanolamine - a case is described in which dizziness, weight loss, hyperactivity were observed.

Co-administration may enhance the effects of flecainide, mexiletine, propafenone, thioridazine, zuclopenthixol.


Keep

What you need to know about antidepressants

Ekaterina Kushnir

treats anxiety disorder

I have generalized anxiety disorder.

For a long time I coped without pills and other help, but one day I got tired of constant anxiety and began to interfere with my normal life. As a result, I turned to a private psychiatrist.

The doctor prescribed an antidepressant from the SSRI group - these are selective serotonin reuptake inhibitors. Such drugs are the first thing prescribed in the treatment of depression and a number of other conditions, including my illness.

The doctor immediately warned me about some peculiarities associated with taking the drug. Some of them I then felt on myself. I think everyone who plans to be treated with antidepressants should know about them.

At the same time, it should be taken into account that most of the negative effects of therapy are temporary and not dangerous, and if they do not go away, one medicine can be replaced with another. Antidepressants help many people with mental disorders and other illnesses get rid of their symptoms and return to a full life, so you definitely should not be afraid of them. The main thing is to take such drugs when they are really needed: as prescribed by a competent doctor and under his control.

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Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

Fact No. 1

Antidepressants may make symptoms worse at first

Antidepressants can increase anxiety in anxiety disorders, as well as cause irritability and agitation - the so-called causeless motor agitation, the inability to sit still. It's not dangerous, but rather unpleasant. This condition is sometimes referred to as initial anxiety, that is, the anxiety of starting therapy. Up to 65% of people face it.

Antidepressant-induced anxiety syndrome - a systematic review in the British Journal of Psychiatry

There is also evidence that some classes of antidepressants, including SSRIs, may increase suicidal ideation in depression in young people aged 18 to 24 years. These data are not very reliable, and in older people, the risk of suicide no longer increases and even decreases.

Without treatment, depression is more likely to lead to suicidal thoughts, and in case of anxiety, you just need to prepare for such an effect, then it will be easier to survive the attacks.

The doctor told me that in the first two or three weeks there may be an increase in anxiety, but I did not take it too seriously.

Everything was fine the first week. After about seven days, I became nervous and irritable. And then I woke up at night and after a while I felt an incomprehensible fear. My heartbeat increased, my head was spinning, my throat was constricted. Because of this, I felt a real panic - I spent the rest of the night fighting terrible thoughts, in the morning I got up completely broken.

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I have never had such panic attacks before medication - my anxiety was background, general. I got scared and wrote to the doctor, who reassured me and said that it was not dangerous and would pass soon.

After that, I already expected these panic attacks, immediately tried to relax, calm down, remember that this was just a temporary effect of the drugs. And they ended faster, and then they completely disappeared.

My letter to a psychiatrist. I was scared: I expected an increase in background anxiety, but not panic attacks. I even thought about giving up the medicine

Fact No. 2

The effect of antidepressant treatment will not be immediate

Increase the dose of antidepressants gradually to reduce side effects. They usually start with the minimum, and then bring it up to the working one. For example, for SSRIs with the active ingredient "sertraline", the working dose is from 100 mg per day. I started taking such a drug with 25 mg, and then gradually, in several steps, under the supervision of a doctor, raised the dose to 100 mg.

SSRI dosage - NHS

What doses of antidepressants will be optimal - an article in The Lancet

The process of reaching a working dose can take from two weeks to a month or more. It depends on the drug and its tolerance. I turned out to be sensitive to the medicine, it was hard for me to survive every increase in dosage: anxiety increased again, there were other side effects that then stopped. However, this is not the case for everyone, sometimes the process goes faster.

The full therapeutic effect, that is, the disappearance or a strong improvement in the symptoms of the disease, occurs some time after reaching the working dosage. As a rule, this is a week or two, although some positive changes may be earlier. For some people, this process stretches for a longer period: 6-12 weeks. Minimum initial doses of drugs usually do not work.

It is better to get ready for the fact that the symptoms of the disease will not disappear in the first weeks of treatment. And remember - this does not always mean that the drug needs to be changed, sometimes you just need to wait or further increase the dosage under the supervision of a doctor.

Fact No. 3

Antidepressants are usually taken in combination with other drugs

Another way to mitigate the side effects of antidepressants is to prescribe an additional drug along with them: for example, from the group of tranquilizers. Such drugs may have their own side effects, they should not be taken for a long time. Unlike antidepressants, some of them can be addictive. They are usually appointed for a month, but this period may be shorter or longer.

Antidepressants together with benzodiazepines work better for depression - BMJ magazine

My doctor prescribed a rather mild drug for me. However, he did not suit me. At first, it caused increased drowsiness: during the period of increased anxiety, it went away for a while, but then returned - even with half a pill I turned off and could sleep all day. And if I drank at night, I woke up with difficulty in the morning. The psychiatrist prescribed another medicine, but I could not buy it: the drug was not available in any pharmacy nearby.

As a result, I simply endured all the side effects of therapy - they were unpleasant, but tolerable. When discussing with the doctor, she called this option acceptable if the side effects of the second medicine only worsen the situation.

My prescriptions for drugs. I never used one, because there was no such medicine in pharmacies

Fact No. 4

Side effects are not always, but they are

Modern antidepressants, including SSRIs, are mild and have almost no side effects. Older drugs - tricyclic antidepressants and monoamine oxidase inhibitors - cause more side effects. Doctors usually use them when milder first-line drugs don't work or when they can't be prescribed.

Side effects of antidepressants - the National Health Service of the UK

Side effects of various antidepressants - Uptodate

Side effects of antidepressants and their impact on the treatment of a large depressive disorder - the journal NATURE

STRICTIC STRICTIC OF STROTONONIA

. effects of antidepressants - advice from the Mayo Clinic staff

Choosing an SSRI drug does not guarantee the absence of side effects - many people tolerate treatment easily, but sometimes a change in drug may be necessary.

For the first couple of weeks of taking it, there is a risk that you will not feel well - it's worth thinking about. It may be worth scheduling the start of therapy on vacation.

I work remotely, and it was easier for me: the first pill was taken on Saturday, I slept through the weekend. Then she continued to work, but refused any additional loads: housework, part-time jobs, training and everything else.

It was hard to work: I wanted to sleep, then I began to worry and get distracted. I also had diarrhea, nausea, headaches, tremors, i.e. hand trembling, hot flashes, sweating, palpitations. At night, panic attacks began, in the morning I had difficulty getting up because I was in pain and dizzy.

There are mixed data on how common side effects of antidepressants are. If we summarize them, then the numbers look something like this:

  • nausea - about 25% feel it;
  • diarrhea - it happens in 15% of people, and 5%, on the contrary, will have constipation;
  • sweating and a feeling of heat occur in about 20% of people;
  • sexual dysfunction, decreased libido may occur in 80% of cases;
  • insomnia - in 11% of cases;
  • headache and dizziness - in about 10-11% of cases;
  • weight gain - not all drugs have this effect. Some, on the contrary, can reduce weight. On my medicine, I lost 2 kilograms in the first month, despite the fact that I quit training due to poor health. True, then they returned back.

It can be seen that most side effects occur in less than half of the cases. In addition, in most cases they pass in the first weeks and are not dangerous.

Side effects not listed above are very rare. I was "lucky", and I faced one such - a decrease in visual acuity. Once in the morning I noticed that I see worse without glasses. A little later, I realized that something was wrong with the glasses.

I wrote to the doctor, she replied that this happens, as a rule, is not dangerous and passes, but it is better to visit an ophthalmologist. I went to the ophthalmologist, everything was fine with my eyes, there was nothing terrible, but my vision really worsened - it was not a subjective feeling. On the right eye, it was -0.5 diopters, it became -0.75, and on the left eye it was -1. 5, and it became -3.5.

I was offered to try changing the drug, but I decided to wait. Vision was then restored. I have not yet gone to the doctor to have it measured, but according to subjective feelings, it is at the same level as before: I am comfortable again in my glasses.

Side effects should not be tolerated - if something greatly worries, scares or interferes with life, it is better to tell the doctor right away. The psychiatrist will be able to determine whether the side effect of the drug is dangerous and whether it is worth continuing to take it. There are several antidepressants of the SSRI group, in addition, there are groups of drugs with a slightly different mechanism of action. As a rule, doctors manage to find a medicine that gives a good effect without side effects.

If there is no danger, the doctor can adjust the dose or increase it more gradually - this often helps to cope with unpleasant effects.

I wrote to the doctor again when my visual acuity decreased

Fact No. 5

Antidepressants need to be taken long term

Antidepressants are not drugs that you can stop drinking as soon as you get better. They are taken for a long time: usually from several months, less often several years.

Anxiety Therapy - UpToDate

For example, for generalized anxiety disorder, the duration of treatment is at least a year. Moreover, the date is not counted from the very beginning, but from the moment when a lasting effect appeared from the pills. In fact, they will have to be drunk for about 1.5 years - it depends on how long it takes to reach the working dosage of the medicine.

The cost of a package of the most famous antidepressant "Zoloft" is about 700 R, enough for about a month. That is, a course of therapy will cost about 10,000 R - maybe more or less, depending on which drug is selected.

Psychotherapy review - UpToDate

Another drug of the same group already costs more than 2000 R per pack. Source: rigla.ru

The cost of an appointment with a good psychiatrist in Moscow is 3000-5000 R. At first, you will need to visit him about once every 1-1.5 months, then less often.

You can apply to the psycho-neurological dispensary at the place of residence under compulsory medical insurance - it's free. At the same time, they will not put you on psychiatric registration: it was canceled in 1993. People with disorders that do not threaten their lives or those around them are on consultative and diagnostic care. If you stop going to the doctor, he will not find out what happened: a person seeks help at will.

Psychotherapy, usually cognitive-behavioral, is also commonly prescribed to enhance and consolidate the effect of antidepressants. In many cases, it improves the effectiveness of drugs, including depression and generalized anxiety disorder. An appointment with a psychotherapist in Moscow costs an average of 5000 R. For treatment, you will need about 10 sessions or more.

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How psychotherapy works

Fact No. 6

Antidepressants should not be stopped abruptly

Antidepressants do not develop dependence. However, if you abruptly stop drinking them, there will be a withdrawal syndrome. This is felt as electric current discharges while moving or turning the head, headaches, dizziness, insomnia. Many people experience symptoms similar to the flu or an intestinal virus: low fever, diarrhea, general malaise, chills. Often there is anxiety, there are intrusive images.

Withdrawal symptoms after taking serotonin reuptake inhibitors - Journal of Clinical Psychiatry

How difficult it is to stop taking antidepressants - American Psychological Association

Stopping antidepressants in adults - UpToDate

treatment, they should be canceled only under the supervision of a doctor.

Antidepressant withdrawal occurs as gradually as the start of treatment. The dosage is slowly reduced, usually at this time again a cover-up drug is prescribed to alleviate side effects. As a rule, this is the same medicine that was at the beginning of the intake.

Withdrawal is usually harmless and resolves within the first weeks of stopping the drug. Sometimes even within a few days - it still depends on which medicine was prescribed. If severely disturbing symptoms appear during the withdrawal period, you should consult a doctor.

Fact No. 7

If you need to change the drug, everything will start over

It is far from always possible to immediately find the right antidepressant - sometimes the side effects do not go away and you need to take a new one.

Changing antidepressants in adults - UpToDate

Serotonin syndrome - MSD

Most often, it is started again with a small dosage, this delays the process of obtaining the effect of treatment. The new drug may also have side effects - the same or different. We will have to wait again until they pass.

You won't be able to change the drug on your own, since all antidepressants are sold only by prescription - and that's good. Switching from one drug to another can be dangerous if you do not know the characteristics of different groups of drugs.

For example, taking SSRIs is possible only some time after the withdrawal of antidepressants from the group of monoamine oxidase inhibitors - due to the risk of developing serotonin syndrome. This is a potentially fatal condition, accompanied by a change in mental state, high fever, increased muscle tone and other symptoms.

If the drug is changed correctly, there will be no dangerous negative effects, so consultation with a doctor is required.

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Fact No. 8

Among antidepressants there are original drugs and generics

Preparations may be original or generic. Originals are medicines first released by some pharmaceutical company that have passed all clinical trials and checks. Generics are drugs with the same active ingredient from another pharmaceutical company, that is, copied from the original drug.

Theoretically, the effect of generic drugs should not differ from the effect of original drugs. However, this is possible, since generics may contain other additional substances or the manufacturer may use other raw materials.

Due to my anxiety, I did not read anything in detail about specific drugs before I bought my first antidepressant in a pharmacy so as not to be scared and not think about taking it. I also didn’t think to ask the doctor about this question.

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As a result, I first bought a generic because it was in stock. Then it turned out that, after all, according to the experience of my psychiatrist, the original drug often gives fewer side effects and is better tolerated. As a result, I changed the generic to the original drug - and, indeed, the side effects softened.

In my subjective opinion, which is supported by some data, in the case of antidepressants and other psychotropic drugs, you should always choose the original medicine. Moreover, the cost of originals and generics is not always very different.

Originals and generics of some SSRIs

Active ingredient Original Original cost Generics Cost of generics
Sertraline Zoloft About 700 R, 100 mg tablets "Serenata", "Sirlift" 500-600 R, tablets 100 mg
Escitalopram "Cipralex" 3000 R, 10 mg tablets "Selektra", "Elycea" 500-1300 R, tablets 10 mg
Fluoxetine Prozac About 350 R, 20 mg tablets Profluzak, Fluoxetine 100-200 R, tablets 20 mg

SERTRIN

Original

Zoloft

Original cost

about 700 r, tablets 100 mg

Generiki

“Serenata”, “Cerelift”

Cost of

500-600 r. , tablets 100 mg

Escitalopram

Original

Cipralex

Original price

3000 r, tablets 10 mg

Generics

“Chektra”, “Elice”

Cost of generics

500-1300 r, tablets 10 mg

Fluoxetine

“Przak”

9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000

000 9000

000

000

000

000

000

000

000

000

000

000

000 9000

000 original

About 350 R, tablets 20 mg

Generics

Profluzak, Fluoxetine

Cost of generics

100—200 R, tablets 20 mg

one remained unclaimed

Fact No. 9

Do not take alcohol along with antidepressants

Drinking alcohol while taking antidepressants can exacerbate unpleasant side effects. Also, alcohol is a depressant, that is, it has the opposite effect, and its intake can adversely affect the results of treatment.

Why you shouldn't mix antidepressants and alcohol - Mayo Clinic

Alcohol is strictly forbidden to drink with some groups of antidepressants, for example, tricyclic antidepressants and monoamine oxidase inhibitors: combination with the latter, for example, can lead to an uncontrolled increase in pressure. MAO inhibitors in general require a special diet - it is unlikely that a doctor will prescribe such drugs as the first antidepressants, but if necessary, he will issue a list of what is allowed and prohibited.

With other antidepressants, moderate use may not be dangerous and even pass without consequences, but doctors still recommend abstaining in order not to increase side effects and improve the result of treatment.

The main thing is not to temporarily stop taking the drug in order to drink. This can lead to the development of a withdrawal syndrome.

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How I Treated Generalized Anxiety Disorder under CHI

Fact No. 10

Antidepressants are incompatible with certain drugs and have contraindications

It is important to tell your doctor what medications you are taking and what chronic illnesses you have. For example, SSRIs may not be suitable for epilepsy and bleeding disorders, and tricyclic antidepressants are usually not prescribed for those who have recently had a heart attack, suffer from glaucoma, or porphyria.

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