Interactions with prozac
Prozac Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing
Warnings:
Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.
Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.
Warnings:
Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.
Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech).
Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.
... Show More
Uses
Fluoxetine is used to treat depression, panic attacks, obsessive compulsive disorder, a certain eating disorder (bulimia), and a severe form of premenstrual syndrome (premenstrual dysphoric disorder).This medication may improve your mood, sleep, appetite, and energy level and may help restore your interest in daily living. It may decrease fear, anxiety, unwanted thoughts, and the number of panic attacks. It may also reduce the urge to perform repeated tasks (compulsions such as hand-washing, counting, and checking) that interfere with daily living. Fluoxetine may lessen premenstrual symptoms such as irritability, increased appetite, and depression. It may decrease binging and purging behaviors in bulimia.
How to use Prozac Capsule
Read the Medication Guide provided by your pharmacist before you start using fluoxetine and each time you get a refill.
If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth as directed by your doctor, usually once daily in the morning. If you are taking this medication twice a day, your doctor may direct you to take it in the morning and at noon.
If you are taking fluoxetine for premenstrual problems, your doctor may direct you to take it every day of the month or just for the 2 weeks before your period through the first full day of your period. To help you remember, mark your calendar.
If you are using the liquid form of this medication, measure the dose carefully using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.
The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Take this medication regularly to get the most benefit from it.
To help you remember, take it at the same time each day.
Keep taking this medication even if you feel well. Do not stop taking this medication without first consulting your doctor. Some conditions may become worse when the drug is abruptly stopped. Your dose may need to be gradually decreased.
You should see some improvement in 1 to 2 weeks. It may take 4 to 5 weeks before you feel the full benefit.
Tell your doctor if your condition does not improve or if it worsens.
Side Effects
See also Warning section.
Nausea, drowsiness, dizziness, anxiety, trouble sleeping, loss of appetite, tiredness, sweating, or yawning may occur. If any of these effects last or get worse, tell your doctor promptly.
Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including: unusual or severe mental/mood changes (such as agitation, unusual high energy/excitement, thoughts of suicide), easy bruising/bleeding, muscle weakness/spasm, shakiness (tremor), decreased interest in sex, changes in sexual ability, unusual weight loss.
Get medical help right away if you have any very serious side effects, including: bloody/black/tarry stools, vomit that looks like coffee grounds, seizures, signs of kidney problems (such as change in the amount of urine), eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night, blurred vision).
If you have diabetes, fluoxetine may affect your blood sugar levels. Monitor your blood sugar regularly and share the results with your doctor. Your doctor may need to adjust your medication, diet, and exercise when you start or stop fluoxetine.
This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.
Rarely, males may have a painful or prolonged erection lasting 4 or more hours. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Precautions
Before taking fluoxetine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies.
This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal or family history of bipolar/manic-depressive disorder, personal or family history of suicide attempts, liver problems, diabetes, low sodium in the blood (such as may occur while taking "water pills" - diuretics), severe dehydration, seizures, stomach/intestinal ulcers, personal or family history of glaucoma (angle-closure type).
This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).
The liquid form of this medication contains alcohol. Caution is advised if you have diabetes, alcohol dependence, or liver disease.
Some medications (such as metronidazole, disulfiram) can cause a serious reaction when combined with alcohol. Ask your doctor or pharmacist about using this product safely.
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
Children may be more sensitive to the side effects of this drug, especially weight loss. Monitor weight and height in children who are taking this drug.
Older adults may be more sensitive to the side effects of this drug, especially bleeding and loss of coordination. Loss of coordination can increase the risk of falling. Older adults may also be more likely to develop low sodium in the blood, especially if they are taking "water pills" (diuretics).
During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Also, babies born to mothers who have used this drug during the last 3 months of pregnancy may rarely develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying.
If you notice any of these symptoms in your newborn, tell the doctor promptly.
Since untreated mental/mood problems (such as depression, panic attacks, obsessive compulsive disorder) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss the benefits and risks of using this medication during pregnancy with your doctor.
This medication passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.
Interactions
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Fluoxetine can stay in your body for many weeks after your last dose and may interact with many other medications. Before using any medication, tell your doctor or pharmacist if you have taken fluoxetine in the previous 5 weeks.
Some products that may interact with this drug include: other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, "blood thinners" such as warfarin).
Taking MAO inhibitors with his medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for 2 weeks before and at least 5 weeks after treatment with this medication. Ask your doctor when to start or stop taking this medication.
This medication can slow down the removal of other medications from your body, which may affect how they work.
Examples of affected drugs include pimozide, thioridazine, vinblastine, antiarrhythmics (such as propafenone, flecainide), tricyclic antidepressants (such as desipramine, imipramine), among others.
Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise.
The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including other SSRIs such as citalopram/paroxetine, SNRIs such as duloxetine/venlafaxine), tryptophan, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.
Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine).
Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
This medication may interfere with certain medical/laboratory tests (including brain scan for Parkinson's disease), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.
Does Prozac Capsule interact with other drugs you are taking?
Enter your medication into the WebMD interaction checker
Overdose
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: fast/irregular heartbeat, severe dizziness, fainting.
Do not share this medication with others.
Keep all regular medical and psychiatric appointments.
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
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Selected from data included with permission and copyrighted by First Databank, Inc.
This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.
Fluoxetine Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing
Warnings:
Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders.
These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.
Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.
Warnings:
Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.
Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech).
Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.
... Show More
Uses
This long-acting form of fluoxetine is used to treat depression in people who have been successfully treated with the form of fluoxetine that is taken daily. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI).SSRIs work by helping to restore the balance of certain natural substances in the brain (neurotransmitters such as serotonin). Fluoxetine may decrease anxiety, improve your mood, sleep, appetite, and energy level and may help restore your interest in daily living.
How to use Fluoxetine DR
Read the Medication Guide provided by your pharmacist before you start using fluoxetine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth as directed by your doctor, usually once a week with or without food. Swallow the capsule whole.
Do not crush or chew the contents of the capsule. Start taking this medication 7 days after your last dose of the form of fluoxetine that is taken daily.
The dosage is based on your medical condition and response to treatment. Use this medication regularly in order to get the most benefit from it. To help you remember, take it on the same day of the week. Mark a calendar to help you remember when you should take your next dose.
Keep taking this medication even if you feel well. Do not stop taking this medication without first consulting your doctor. Some conditions may become worse when the drug is abruptly stopped. Your dose may need to be gradually decreased.
Tell your doctor if your condition does not improve or if it worsens.
Side Effects
See also Warning section.
Nausea, drowsiness, dizziness, anxiety, trouble sleeping, loss of appetite, tiredness, sweating, or yawning may occur. If any of these effects last or get worse, tell your doctor promptly.
Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including: unusual or severe mental/mood changes (such as agitation, unusual high energy/excitement, thoughts of suicide), easy bruising/bleeding, muscle weakness/spasm, shakiness (tremor), decreased interest in sex, changes in sexual ability, unusual weight loss.
Get medical help right away if you have any very serious side effects, including: bloody/black/tarry stools, vomit that looks like coffee grounds, seizures, signs of kidney problems (such as change in the amount of urine), eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night, blurred vision).
If you have diabetes, fluoxetine may affect your blood sugar levels. Monitor your blood sugar regularly and share the results with your doctor.
Your doctor may need to adjust your medication, diet, and exercise when you start or stop fluoxetine.
This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.
Rarely, males may have a painful or prolonged erection lasting 4 or more hours. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Precautions
Before taking fluoxetine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal or family history of bipolar/manic-depressive disorder, personal or family history of suicide attempts, liver problems, diabetes, low sodium in the blood (such as may occur while taking "water pills" - diuretics), dehydration, seizures, stomach/intestinal ulcers, personal or family history of glaucoma (angle-closure type).
This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
Children may be more sensitive to the side effects of this drug, especially weight loss. Monitor weight and height in children who are taking this drug.
Older adults may be more sensitive to the side effects of this drug, especially bleeding and loss of coordination. Loss of coordination can increase the risk of falling. Older adults may also be more likely to develop low sodium in the blood, especially if they are taking "water pills" (diuretics).
During pregnancy, this medication should be used only when clearly needed.
It may harm an unborn baby. Also, babies born to mothers who have used this drug during the last 3 months of pregnancy may rarely develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying. If you notice any of these symptoms in your newborn, tell the doctor promptly.
Since untreated mental/mood problems (such as depression, post traumatic stress disorder) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss the benefits and risks of using this medication during pregnancy with your doctor.
This medication passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.
Interactions
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions.
Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Fluoxetine can stay in your body for many weeks after your last dose and may interact with many other medications. Before using any medication, tell your doctor or pharmacist if you have taken fluoxetine in the previous 5 weeks.
Some products that may interact with this drug include: other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, "blood thinners" such as warfarin).
Taking MAO inhibitors with his medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication.
Most MAO inhibitors should also not be taken for 2 weeks before and at least 5 weeks after treatment with this medication. Ask your doctor when to start or stop taking this medication.
This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include pimozide, thioridazine, vinblastine, antiarrhythmics (such as propafenone, flecainide), tricyclic antidepressants (such as desipramine, imipramine), among others.
Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise.
The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including other SSRIs such as citalopram/paroxetine, SNRIs such as duloxetine/venlafaxine), tryptophan, among others.
The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.
Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine). Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
This medication may interfere with certain medical/laboratory tests (including brain scan for Parkinson's disease), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.
Does Fluoxetine DR interact with other drugs you are taking?
Enter your medication into the WebMD interaction checker
Overdose
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911.
Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: fast/irregular heartbeat, severe dizziness, fainting.
Do not share this medication with others.
Keep all regular medical and psychiatric appointments.
If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.
Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Images
Next
Related Links
Drug Survey
Are you currently using Fluoxetine DR?
This survey is being conducted by the WebMD marketing sciences department.
Free RX Coupon
Save up to 80% on your prescriptions.
Available coupons
Save up to 80% on your prescription with WebMDRx
Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.
| 💊 Ingredients of Prozac ® ✅ How to use Prozac ® Save Search for analogues Interaction Description of the active ingredients of the preparation Prozac ® (Prozac ® ) The scientific information provided is general and cannot be used to make decisions. 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
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
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. Clinical and pharmacological group: Antidepressant Pharmacotherapeutic group: Antidepressant Pharmacological actionAntidepressant, 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. 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
Dosage regimenThe 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 useGlaucoma, 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 lactationContraindicated in pregnancy and lactation. Use in hepatic impairmentUse with extreme caution in patients with hepatic impairment. Use in impaired renal function Contraindicated in severe renal impairment. Use in childrenThe safety of fluoxetine in children has not been established. Use in elderly patientsElderly patients require dosage adjustment. Special instructionsUse 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 InteractionsWhen 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 |
decisions about the use of a particular drug. 
20 mg: 14 or 28 pcs. 
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. 
2 
Use with extreme caution in patients with moderate and mild renal impairment. 
How we are treated: Prozac. From depression to bulimia
Medicine
16:00, December 14, 2017
Analysis of one of the popular antidepressants how it is customary to treat them and whether the antidepressant Prozac works, read in the new material of the heading “How we are treated”.
Prozac is on the list of the most important, safest and most effective (including from an economic point of view) drugs according to the World Health Organization. However, as we remember after the article with the analysis of Tamiflu, this does not guarantee its effectiveness.
Prozac is prescribed for the treatment of depression, obsessive-compulsive disorders, bulimia nervosa. If you know very well what it is, you can immediately skip to the “from what, from what” part.
When life is not nice
Depression is called depression, loss of interest in what used to make the patient happy. According to the international classification of diseases ICD-10, the main criteria by which such a diagnosis can be made include depressed mood for more than two weeks, loss of strength and consistently high fatigue (more than a month) and anhedonia (the inability to enjoy what used to bring joy). Doctors consider additional criteria for depression to be pessimism, low self-esteem, thoughts of death and suicide, appetite disturbances (weight loss or overeating), sleep problems, constant fears and anxieties, feelings of worthlessness and guilt, inability to concentrate, and a constant sweet taste in the mouth. These symptoms are unlikely to occur simultaneously (for example, fatigue and apathy may predominate in some cases, while anxiety and guilt may prevail in others), therefore, in order to diagnose depression, the patient's condition must meet at least two main criteria and three additional ones.
At the same time, according to the definition of the US National Institute of Mental Health, such a state should last quite a long time (more than two weeks).
Severe depression (clinical) includes a complex set of symptoms called major depressive disorder and may sometimes not be accompanied by low mood at all. However, because of her, the patient is physically unable to live and work normally, and the comments of those around him in the spirit of “he just can’t pull himself together” or “enough to turn sour that he spread snot” sound like a mockery. Such phrases stigmatize depression, blaming a person for his condition, while he himself will not be able to cope and needs treatment. To diagnose major depressive disorder, there is a whole questionnaire of major depression compiled by the World Health Organization. Also, depressive disorders include other conditions accompanied by depression, such as dysthymia (daily low mood and mild symptoms of depression for two years or more).
The causes of depression can be very different: somatic (due to diseases of the body), psychological (after strong dramatic experiences, such as the death of a relative) and iatrogenic (as a side effect of certain drugs). As strange as it would be to provide first aid to a victim of an electric shock without removing the wire from him, it is difficult to cure the symptoms of depression without eliminating its cause or changing the lifestyle that led the patient to such a state. If the patient lacks some essential substances (for example, tryptophan), it is important to make up for their lack, and not just fight the depressed mood with drugs. If he has some kind of psychological trauma, the help of a psychotherapist will be required. And for a person whose depression is provoked by hormonal disorders, neurological diseases, heart disease, diabetes, or even cancer (and this happens), it is more important to cure the disease itself, and symptomatic treatment of depression will be a secondary goal.
When you can't stop
Obsessive-compulsive disorder, or OCD (also called obsessive-compulsive disorder), consists of two mandatory components: obsessions (obsessive anxious or frightening thoughts) and compulsions (compulsive actions). A classic example is cleanliness-related OCD, where a person is afraid of contamination or contamination by microorganisms. Such thoughts and fears are called obsessions. In order to protect themselves from them, a person will worry too much about cleanliness, such as constantly washing their hands. Any contact with a non-sterile, according to the patient, object, plunges such a person into horror. And if you can’t wash your hands again, he will experience real suffering.
You can learn how to understand medicines on your own in the author's online course "How We Are Treated" by the editor of Indicator.Ru Ekaterina Mishchenko: https://clck.ru/Pnmtk
This "protective" behavior is called compulsion. The desire for cleanliness can be understood if a person is in conditions of complete unsanitary conditions or, on the contrary, wants to maintain sterile conditions somewhere in the operating room.
But if the action loses its true meaning and becomes a mandatory ritual, it becomes a compulsion.
However, OCD can manifest itself not only as a fear of pollution, but also as excessive superstition, fear of losing a necessary object, sexual or religious obsessive thoughts and related actions. Their reasons may lie in several areas: biological and psychological. The first includes diseases and features of the nervous system, lack of neurotransmitters (biologically active substances that ensure the transmission of a nerve impulse from one neuron to another, for example, dopamine or serotonin), genetic predisposition (mutations in the hSERT gene encoding the serotonin carrier protein and located on 17 -th chromosome).
There is also an infectious theory of the development of OCD, associated with the fact that in children it sometimes occurs after infection with streptococcus. This theory is called PANDAS - an abbreviation for the English Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections, which translates as "Children's autoimmune neuropsychiatric disorders associated with streptococcal infections.
" The cause of this syndrome may be an attack of its own antibodies produced against streptococcus on the patient's nerve cells. However, this theory has not yet been confirmed.
Another group of explanations for the development of OCD is psychological. They go back to the theories of the beginning of the last century (from Freud to Pavlov). Mayakovsky's father died of blood poisoning after being injected with a binder, so it is believed that the poet also showed a pathological love for cleanliness. But you don't have to be a futurist poet to experience the full benefits of OCD: even dogs and cats suffer from it. Only in them this is expressed in the endless licking of wool and attempts to catch their tail.
The Yale-Brown scale is used to diagnose obsessive-compulsive disorder. In the fight against OCD, the method of psychological persuasion can be useful: patients are patiently explained that if they skip the “ritual” once, nothing terrible will happen. But drugs are also used in treatment.
When you are how you eat
Bulimia nervosa (third indication for Prozac) is a binge eating disorder. The main signs of bulimia are uncontrolled eating in large quantities, obsession with excess weight (calorie counting, attempts to induce vomiting after eating, fasting, use of laxatives), low self-esteem, low blood pressure. Other symptoms are sudden changes in body weight, kidney problems and dehydration, enlarged salivary glands, heartburn after eating, and inflammation of the esophagus. Due to provoking vomiting, hydrochloric acid from the stomach constantly enters the oral cavity of patients, which can lead to grinding of tooth enamel and ulcers on the mucous membrane. According to the DSM-5 classification of diseases, uncontrolled consumption of large amounts of food and the simultaneous use of various drastic measures for weight loss is the main criterion for diagnosing bulimia nervosa.
Video about bulimia on the educational medical resource Open Osmosis (USA)
The causes of bulimia can be either biological (incorrect levels of hormones or neurotransmitters, including serotonin) or social. The importance of the latter is highlighted, for example, in a high-profile study among teenage girls in Fiji, which showed a sharp increase in cases of intentional bowel cleansing for weight loss in just three years (from 1995 to 1998) after television appeared in the province. Perhaps the desire to be like models from the screens and covers really pushes for such behavior.
Bulimia can often be associated with other psychiatric disorders (depression, anxiety disorders, sleep disorders). According to a study by the New York State Psychiatric Institute and Columbia University, 70% of people with bulimia have ever experienced depression, compared with just over 25% in the general population.
Bulimia itself is not very common, and it can be more difficult to diagnose than the same anorexia, because changes in body weight in bulimia are less sharp and noticeable.
For diagnosis, the food attitude test, developed by the Clark Institute of Psychiatry at the University of Toronto, and other tests based on it, are used. But (as with the tests for OCD and depression above), its result only indicates the likelihood that the patient has developed a disorder, but does not allow for a definitive diagnosis, especially for oneself.
From what, from what
What is a medicine that is prescribed for three types of disorders at once? The active ingredient in Prozac is fluoxetine. The patent for Prozac expired back in 2001, so many generics are available in pharmacies - cheaper copies that use the same active ingredient, but are not as well studied and may differ slightly from the original. These drugs include Fluoxetine, Prodel, Profluzak, Fluval.
Fluoxetine, discovered and marketed by Eli Lilly and Company, belongs to a group of antidepressants called selective serotonin reuptake inhibitors. This group is considered third-generation antidepressants, fairly well tolerated and without significant side effects.
Fluoxetine is readily absorbed into the blood, can bind to plasma proteins and accumulate in body tissues. It also penetrates the blood-brain barrier, which protects the nervous system and brain from many substances circulating in the blood. There, in the nervous system, it works in the synaptic cleft we have already mentioned, preventing the excess serotonin ejected from the synapse from returning to the neurotransmitter. Because of this, serotonin is longer present in the synaptic cleft and can bind to receptors. How exactly fluoxetine achieves this effect is not clear even to manufacturers, but it is known that it has little effect on the work of other neurotransmitters. However, at high doses, fluoxetine increases adrenaline and dopamine levels, as studies in rat brain tissue show.
Fluoxetine and its metabolite, norfluoxetine, can interfere with each other's actions. Because of this, according to scientists from the Institute of Research Medicine in Barcelona, a constant concentration of fluoxetine in the blood is achieved only after four weeks of taking the drug.
Similarly, the effects of taking the medicine do not disappear immediately. Associated with this is the difficulty in selecting the required dose for a particular patient.
Serotonin itself, which is absolutely incorrectly called the “hormone of happiness” (hormones are produced in one organ of the body, but perform their function in another, serotonin in this context simply conducts nerve impulses in the parts of the brain responsible for good mood, and is produced there well), in fact, it performs much more functions. Yes, it affects mood, sleep, and appetite, so some cases of depression, bulimia nervosa, and OCD may be caused by insufficient production of this neurotransmitter and corrected with serotonin reuptake inhibitors. But in addition, platelets can actively capture it and affect blood clotting. Serotonin is also involved in the processes of memorization and learning. At the same time, not only vertebrate animals can produce it: according to a study by Chinese and American scientists, the pain from an insect bite is largely due to the presence of serotonin in the poison, and the dysentery amoeba, according to an article in Science, can cause diarrhea by releasing serotonin in our intestines.
The lists (not) included
But all these are only mechanisms, and besides, they have not been studied to the smallest detail. To understand how this works in real people and how often it helps, let's turn to clinical trials. However, anyone who enters the combination “fluoxetine depression double blind randomized controlled” into the PubMed scientific article database and filters clinical trial (clinical trial) will see more than 558 articles, up to work comparing the effectiveness of Prozac and homeopathy.
Double-blind, randomized, placebo-controlled method is a method of clinical drug research in which subjects are not privy to important details of the study being conducted. “Double-blind” means that neither the subjects nor the experimenters know who is being treated with what, “randomized” means that the distribution into groups is random, and placebo is used to show that the effect of the drug is not based on autosuggestion and that this medicine helps better than a tablet without active substance.
This method prevents subjective distortion of the results. Sometimes the control group is given another drug with already proven efficacy, rather than a placebo, to show that the drug not only treats better than nothing, but also outperforms analogues.
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No living person can analyze them within an adequate period of time. And even Cochrane reviews can be found as many as 36 (that's really a lot), although not all of them consider the action of fluoxetine for its direct indications (depression, bulimia and obsessive-compulsive disorder).
The Cochrane Library is a database of the Cochrane Collaboration, an international non-profit organization involved in the development of World Health Organization guidelines. The name of the organization comes from the name of its founder, the 20th-century Scottish medical scientist Archibald Cochrane, who championed the need for evidence-based medicine and the conduct of competent clinical trials and wrote the book Efficiency and Efficiency: Random Reflections on Public Health.
Medical scientists and pharmacists consider the Cochrane Database one of the most authoritative sources of such information: the publications included in it have been selected according to the standards of evidence-based medicine and report the results of randomized, double-blind, placebo-controlled clinical trials.
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One of them is dedicated to antidepressants used against bulimia nervosa. Although in general the authors note that there is little data on this topic, fluoxetine (for which there were only five randomized double-blind controlled trials in 2003) is recognized as a leader in this direction. However, the authors refuse to recommend this medicine in the conclusion, arguing that not all clinical trial data have been published and are available for consideration.
A 2008 review reviewing the benefits of serotonin reuptake inhibitors (including fluoxetine) in obsessive-compulsive disorder, concluded that they worked better than placebo, and the side effects associated with them were much more significant, among which nausea was most common , insomnia and headache.
According to a 2013 review, the usefulness of this same group of drugs in autism and related OCD is unclear, and the data are insufficient to conclude.
The most popular subject of fluoxetine reviews was fighting depression. But the authors of most of them note the lack of data (for example, in this 2013 review). In a broad inclusion criteria review of 1177 randomized controlled trials of fluoxetine for depression in adults, the authors conclude that it is about as effective as other antidepressants but less toxic. However, they warn against hasty decisions, since most of the studies were conducted on small groups of people (100 or less) and were funded by the manufacturer, which is more profitable to publish only positive results, hiding information about failures. Data on postpartum depression are also found to be insufficient and inconsistent. The same issues are highlighted by a review of articles on the effectiveness of antidepressants against dementia-related senile depression.
Indicator.Ru concludes: one of the best stimulant antidepressants is still not perfect
A large number of studies confirm the effectiveness of fluoxetine, a key component of Prozac. But part of the reviews of the Cochrane Collaboration note that not all trial data have been published by manufacturers. And this accusation is not an empty phrase: according to Eli Lilly's internal documents, manufacturers during trials often attributed suicide cases to worsening depression or overdosing on the drug.
As a result, following numerous reports of suicide by patients prescribed this drug, the US Food and Drug Administration (FDA) has issued a warning label to the drug's packaging.
This does not mean that the harm from the drug always outweighs its benefits, but such dishonest behavior of manufacturers does not allow us to assess the risks more accurately. Given the difficulty with the selection of an individual dose and the slow effect, adjusting the dosage is really not easy.
Prozac is also classified as a serotonin reuptake inhibitor, but if the cause of your condition is something else, you need to pay more attention to finding and eliminating them than fighting depression. As we wrote above, somatic diseases (for example, cirrhosis of the liver, cancer or diabetes), and even a lack of vitamins, can also cause depression. In addition, depression or another disorder may be the result of psychological trauma that will be difficult to deal with without psychotherapy.
All this suggests that the drug should be used under the supervision of a doctor (most likely, it will not be sold without a prescription), and that its action alone may not be enough for a complete recovery. And don't forget that serotonin is involved in many other processes in the body. Therefore, you should not use the drug in violation of the functions of the liver and kidneys, an increased risk of thrombosis, and not only during pregnancy and lactation. With manic states and suicidal moods, it is also better to abandon the drug.
