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Pharmacologic class:乐动体育开户 Selective serotonin reuptake inhibitor
Therapeutic class:乐动体育开户 Antidepressant
Pregnancy risk category B
Selectively inhibits serotonin reuptake in CNS; has little to no effect on norepinephrine and dopamine reuptake
Capsules:乐动体育开户 10 mg, 15 mg, 20 mg, 40 mg
Capsules (delayed-release): 90 mg
Oral solution: 20 mg/5 ml
Tablets: 10 mg, 15 mg, 20 mg
Indications and dosages
➣ Major depressive disorder (MDD)
Adults: 20 mg/day P.O. in morning. After several weeks, may increase by 20 mg/day at weekly intervals. Give dosages above 20 mg/day in two divided doses (morning and noon); don't exceed 80 mg/day. Patients stabilized on 20 mg/day may be switched to 90-mg/week delayed-release capsules (Prozac Weekly) 7 days after last 20-mg dose.
Children ages 8 to 18: Initially, 10 to 20 mg/day P.O. After 1 week at 10 mg daily, dosage should be increased to 20 mg/day. However, because of higher plasma levels in lower-weight children, starting and target dose in this group may be 10 mg/day. Dosage increase to 20 mg/day may be considered after several weeks if insufficient clinical improvement occurs.
➣乐动体育开户 Obsessive-compulsive disorder (OCD)
Adults: Initially, 20 mg/day P.O. in morning. After several weeks, may increase dosage. Give doses above 20 mg/day once daily (morning) or in two divided doses b.i.d. (morning and noon). Dosage range of 20 to 60 mg/day is recommended; however, dosages of up to 80 mg/day have been well tolerated. Don't exceed 80 mg/day.
Children ages 7 to 17:乐动体育开户 Initially, 10 mg/day P.O. in morning in adolescents and higher-weight children; after 2 weeks, may increase dosage to 20 mg/day. Additional dosage increases may be considered after several more weeks if insufficient clinical improvement occurs. Dosage range of 20 to 60 mg/day is recommended. Initially, 10 mg/day P.O. in lower-weight children; may increase dosage after several more weeks if insufficient clinical improvement occurs. Dosage range of 20 to 30 mg/day is recommended. Experience with daily doses greater than 20 mg is very minimal; there is no experience with doses greater than 60 mg.
➣乐动体育开户 Acute treatment of depressive episodes associated with bipolar I disorder
Adults: Initially, 20 mg fluoxetine P.O. with 5 mg olanzapine P.O. daily; dosage range of fluoxetine is 20 to 50 mg; olanzapine, 5 to 12.5 mg. Safety of fluoxetine doses above 75 mg and olanzapine doses above 18 mg haven't been established
➣乐动体育开户 Bulimia nervosa
Adults:乐动体育开户 60 mg/day P.O.; may be titrated upward over several days
➣乐动体育开户 Panic disorder
Adults:乐动体育开户 10 mg/day P.O. for 1 week; then, if needed, increase to 20 mg/day. Dosage increases of up to 60 mg/day may be considered after several weeks if patient doesn't respond to lower dosage.
➣ Premenstrual dysphoric disorder
Adults:乐动体育开户 20 mg/day (Sarafem) P.O., not to exceed 80 mg/day
• Hepatic impairment
乐动体育开户• Concurrent disease or multiple concomitant medications
• Pregnant women during third trimester
• Elderly patients
乐动体育开户• Diabetic peripheral neuropathy
• Bipolar II disorder
乐动体育开户• Borderline personality disorder
• Posttraumatic stress disorder
乐动体育开户• Social phobia
• Hypersensitivity to drug
乐动体育开户• MAO inhibitor use within past 14 days
• Concurrent use of thioridazine or within 5 weeks of discontinuing fluoxetine
• Concurrent use of pimozide
乐动体育开户Use cautiously in:
• hepatic or renal impairment, diabetes mellitus, cardiovascular disease, concomitant illness, acute narrow-angle glaucoma
乐动体育开户• history of seizures, serotonin syndrome or neuroleptic malignant syndrome, clinical worsening and suicidal thinking and behavior, activation of mania or hypomania
• hyponatremia in association with syndrome of inappropriate antidiuretic hormone secretion
• concurrent use of NSAIDs, aspirin, warfarin, or other drugs that affect coagulation
• concurrent use of tryptophan (use not recommended)
• pregnant patients (third trimester)
乐动体育开户• breastfeeding patients (use not recommended)
乐动体育开户• children younger than age 7 (in OCD use), younger than age 8 (in MDD use), younger than age 18 for all other uses (safety and efficacy not established).
☞乐动体育开户 Be aware that drug should be discontinued 5 weeks before MAO inhibitor or thioridazine therapy begins.
• Give before 2 P.M. to prevent nighttime insomnia.
• Be aware that drug should be gradually reduced rather than abruptly stopped whenever possible.
CNS: anxiety, drowsiness, headache, insomnia, abnormal dreams, dizziness, fatigue, nervousness, hypomania, mania, weakness, tremor, seizures, suicidal ideation
CV: chest pain, palpitations, prolonged QTc interval
EENT:乐动体育开户 visual disturbances, stuffy nose, sinusitis, pharyngitis
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, dry mouth, anorexia
GU:乐动体育开户 urinary frequency, sexual dysfunction, dysmenorrhea
Metabolic: hypouricemia, hypocalcemia, hyponatremia, hyperglycemia, hypoglycemia
Musculoskeletal: joint, back, or muscle pain
Respiratory: cough, upper respiratory tract infection, dyspnea, respiratory distress
Skin:乐动体育开户 diaphoresis, pruritus, erythema nodosum, flushing, rash
Other: abnormal taste, weight loss, fever, flulike symptoms, hot flashes, serotonin syndrome, neuroleptic malignant syndrome (NMS), allergic reactions, hypersensitivity reactions
Drug-drug. Adrenergics:乐动体育开户 increased sensitivity to adrenergics, increased risk of serotonin syndrome
Alprazolam: decreased metabolism and increased effects of alprazolam
Antihistamines, opioids, other antidepressants, sedative-hypnotics:乐动体育开户 additive CNS depression
Aspirin, NSAIDs, warfarin, other drugs that affect coagulation:乐动体育开户 increased risk of GI or other bleeding
Buspirone: potentiation of fluoxetine effects, increased risk of seizures
Carbamazepine, clozapine, digoxin, haloperidol, lithium, phenytoin, warfarin: increased blood levels of these drugs, greater risk of adverse reactions
CYP450-2D6 inducers:乐动体育开户 increased effects of these drugs
Cyproheptadine: decrease in or reversal of fluoxetine effects
Digoxin, warfarin, other highly protein-bound drugs:乐动体育开户 increased risk of adverse reactions to either drug
Efavirenz, ritonavir, saquinavir, other CYP450 inhibitors:乐动体育开户 serotonergics, triptans: increased risk of serotonin syndrome
MAO inhibitors:乐动体育开户 confusion, agitation, seizures, hypertension, and hyperpyrexia (serotonin syndrome)
Pimozide:乐动体育开户 increased risk of drug interaction or QTc-interval prolongation
Thioridazine:乐动体育开户 increased risk of QTc-interval prolongation or potential for elevated thioridazine plasma level
Other antidepressants, phenothiazines, risperidone, tryptophan: increased risk of adverse reactions
Ritonavir:乐动体育开户 increased ritonavir blood level
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, blood urea nitrogen, creatine kinase, electrolytes, glucose:乐动体育开户 increased levels
Sodium: decreased level
Drug-herbs. St. John's wort:乐动体育开户 increased risk of serotonin syndrome
Drug-behaviors. Alcohol use:乐动体育开户 additive CNS depression
☞ Monitor patient for signs and symptoms of depression. Assess for suicidal ideation.
☞ Evaluate neurologic status, watching especially for seizures.
☞乐动体育开户 Monitor cardiovascular status, particularly for prolonged QTc interval.
乐动体育开户• Assess weight regularly. Watch for signs of eating disorders.
☞ Monitor patient for signs and symptoms of allergic reactions, serotonin syndrome, or NMS-like reactions. Discontinue drug immediately and initiate supportive treatment if these reactions occur.
乐动体育开户• Encourage patient to establish effective bedtime routine to minimize sleep disorders.
乐动体育开户• Tell patient drug may take 4 weeks or longer to be fully effective.
☞乐动体育开户 Instruct patient to contact prescriber if he develops worsening depression or has suicidal thoughts.
☞乐动体育开户 Instruct patient to immediately stop drug and report signs and symptoms of allergic reactions (rash), serotonin syndrome, or neuroleptic malignant syndrome-like reactions.
乐动体育开户• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Tell female patient to inform prescriber if she is pregnant or breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.