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NERVOUS SYSTEM › PSYCHOANALEPTICS › ANTIDEPRESSANTS › Selective serotonin reuptake inhibitors
fluoxetine
N06AB03
Forms & Strengths
- Capsule: 10 mg, 20 mg, 40 mg
- Tablet: 10 mg, 20 mg, 60 mg
- Oral Solution: 20 mg/5 mL
- Delayed-Release Capsule (Prozac Weekly): 90 mg
Adult Dosing
- Major Depressive Disorder: Initial 20 mg/day PO in the morning; may increase after several weeks; max 80 mg/day
- Obsessive-Compulsive Disorder: Initial 20 mg/day PO in the morning; range 20-60 mg/day; max 80 mg/day
- Bulimia Nervosa: 60 mg/day PO in the morning
- Panic Disorder: Initial 10 mg/day PO; increase to 20 mg/day after several days; max 60 mg/day
- Premenstrual Dysphoric Disorder: 20 mg/day PO continuously or starting 14 days prior to menstruation through first day of menses (max 80 mg/day)
Pediatric Dosing
- Major Depressive Disorder (Ages 8-17): Initial 10 mg/day PO; may increase to 20 mg/day after 1 week
- Obsessive-Compulsive Disorder (Ages 7-17): Initial 10 mg/day PO; may increase to 20 mg/day after 2 weeks (lower weight children may start at 10 mg/day)
Indications
- Major Depressive Disorder
- Obsessive-Compulsive Disorder
- Bulimia Nervosa
- Panic Disorder
- Premenstrual Dysphoric Disorder
- Acute treatment of depressive episodes associated with Bipolar I Disorder (in combination with olanzapine)
- Treatment-resistant depression (in combination with olanzapine)
Mechanism of Action
- Selective serotonin reuptake inhibitor (SSRI)
- Potently and selectively inhibits neuronal reuptake of serotonin (5-HT) in the central nervous system, enhancing serotonergic neurotransmission
Contraindications
- Hypersensitivity to fluoxetine
- Concurrent use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs
- Concurrent use with pimozide
- Concurrent use with thioridazine or within 5 weeks of discontinuing fluoxetine
Adverse Reactions
- Insomnia
- Nausea
- Diarrhea
- Anorexia and weight loss
- Sexual dysfunction (decreased libido, erectile dysfunction)
- Anxiety, nervousness, and restlessness
- Asthenia
- Tremor
- Rash
- QT prolongation (at higher doses)
- Serotonin syndrome
Drug Interactions
- MAOIs: Increased risk of severe, potentially fatal serotonin syndrome
- Pimozide or Thioridazine: Increased risk of QT prolongation and fatal cardiac arrhythmias due to CYP2D6 inhibition
- CYP2D6 substrates (e.g., tricyclic antidepressants, antipsychotics): Fluoxetine inhibits CYP2D6, increasing their plasma concentrations
- Serotonergic agents (e.g., triptans, tramadol, lithium, other SSRIs): Increased risk of serotonin syndrome
- Anticoagulants and antiplatelet agents (e.g., warfarin, NSAIDs): Increased risk of bleeding events
- CNS depressants (alcohol): Enhanced cognitive and motor impairment
Curated Content: Needs Vetting Before Put to Clinical Use