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Fluoxetine hydrochloride
Fluoxetine hydrochloride (Prozac)
Fluoxetine hydrochloride
(flew-OX-eh-teen)
Pregnancy Category: B Apo-Fluoxetine Dom-Fluoxetine Novo-Fluoxetine Nu-Fluoxetine PMS-Fluoxetine Prozac STCC-Fluoxetine (Rx)

Classification: Antidepressant, miscellaneous

See Also: See also Selective Serotonin Reuptake Inhibitors.

Action/Kinetics: Metabolized in the liver to norfluoxetine, a metabolite with equal potency to fluoxetine. Norfluoxetine is further metabolized by the liver to inactive metabolites that are excreted by the kidneys. Time to peak plasma levels: 6-8 hr. Peak plasma concentrations: 15-55 ng/mL. t1/2, fluoxetine: 1-6 days; t1/2, norfluoxetine: 4-16 days. Time to steady state: 2-4 weeks. Active drug maintained in the body for weeks after withdrawal.

Uses: Depression in adults and geriatric (aged 65 and older) clients, obsessive-compulsive disorders (as defined in the DSM-IV), bulimia nervosa. Investigational: Many (see Dosage).

Special Concerns: A lower initial dose may be necessary in geriatric clients. Use in hospitalized clients, use for longer than 5-6 weeks for depression, or use for more than 13 weeks for obsessive-compulsive disorder has not been studied adequately.

Side Effects: A large number of side effects have been reported for this drug. Listed are those with a reported frequency of greater than 1%. CNS: Headache (most common), activation of mania or hypomania, insomnia, anxiety, nervousness, dizziness, fatigue, sedation, decreased libido, drowsiness, lightheadedness, decreased ability to concentrate, tremor, disturbances in sensation, agitation, abnormal dreams. Although less frequent than 1%, some clients may experience seizures or attempt suicide. GI: Nausea (most common), diarrhea, vomiting, constipation, dry mouth, dyspepsia, anorexia, abdominal pain, flatulence, alteration in taste, gastroenteritis, increased appetite. CV: Hot flashes, palpitations. GU: Sexual dysfunction, impotence, anorgasmia, frequent urination, UTI, dysmenorrhea. Respiratory: URTI, pharyngitis, cough, dyspnea, rhinitis, bronchitis, nasal congestion, sinusitis, sinus headache, yawn. Skin: Rash, pruritus, excessive sweating. Musculoskeletal: Muscle, joint, or back pain. Miscellaneous: Flu-like symptoms, asthenia, fever, chest pain, allergy, visual disturbances, blurred vision, weight loss, bacterial or viral infection, limb pain, chills.

Additional Drug Interactions: Alprazolam / Alprazolam levels and psychomotor performance Buspirone / Buspirone effects; worsening of obsessive-compulsive disorder Carbamazepine / Serum carbamazepine levels toxicity Clozapine / Serum clozapine levels Cyproheptadine / or Reversal of fluoxetine effect Dextromethorphan / Possibility of hallucinations Diazepam / Diazepam half-life excessive sedation or impaired psychomotor skills Digoxin / Area under the curve of digoxin; use together with caution Haloperidol / Serum haloperidol levels Lithium / Serum lithium levels possible neurotoxicity Phenytoin / Phenytoin levels

How Supplied: Capsule: 10 mg, 20 mg; Oral Solution: 20 mg/5 mL; Tablet: 10 mg

Dosage
•Capsules, Oral Solution, Tablets Antidepressant.
Adults, initial: 20 mg/day in the morning. If clinical improvement is not observed after several weeks, the dose may be increased to a maximum of 80 mg/day in two equally divided doses.
Obsessive-compulsive disorder.
Initial: 20 mg/day in the morning. If improvement is not significant after several weeks, the dose may be increased. Usual dosage range: 20-60 mg/day; the total daily dosage should not exceed 80 mg.
Treatment of bulimia nervosa.
60 mg/day given in the morning. May be necessary to titrate up to this dose over several days.
Alcoholism.
40-80 mg/day.
Anorexia nervosa, bipolar II affective disorder, trichotillomania.
20-80 mg/day.
Attention deficit hyperactivity disorder, schizophrenia.
20-60 mg/day.
Borderline personality disorder.
5-80 mg/day.
Cataplexy and narcolepsy, Tourette's syndrome.
20-40 mg/day.
Kleptomania.
60-80 mg/day.
Migraine, chronic daily headaches, tension headaches.
20 mg every other day to 40 mg/day.
Posttraumatic stress disorder.
10-80 mg/day.
Premenstrual syndrome, recurrent syncope.
20 mg/day.
Levodopa-induced dyskinesia.
40 mg/day.
Social phobia.
10-60 mg/day.