Fluoxetine

Indications
 Oral
Depression
Adult: 20-40 mg daily. Max: 80 mg daily.
Child: 8-18 yr: 10-20 mg daily; initiate at 10 mg daily for lower-wt children, may increase to 20 mg/day after 1 wk if necessary.
Elderly: Initially, 10 mg daily, may increase by 10-20 mg every few wk as tolerated.
Max Dosage:
Hepatic impairment: Dose adjustments may be needed.
Oral
Bulimia nervosa
Adult: 60 mg daily.
Hepatic impairment: Dose adjustments may be needed.
Oral
Obsessive compulsive disorder
Adult: Initially, 20 mg daily increased up to 60 mg daily after several wk if unresponsive. Max: 80 mg daily.
Child: 7-18 yr: Initially, 10 mg daily; may increase to 20 mg daily after 2 wk in adolescents and higher-wt children. Usual range: 10-60 mg daily.
Hepatic impairment: Dose adjustments may be needed.
Oral
Premenstrual dysphoric disorder
Adult: 20 mg daily continuously. Alternatively, 20 mg daily, to be started 14 days before onset of menstruation and continue until 1st day of menses. May repeat with each cycle, if needed.
Hepatic impairment: Dose adjustments may be needed.
Oral
Panic disorder
Adult: Initial dose: 10 mg daily, may increase to 20 mg daily after a wk. May increase to 60 mg daily after a few wk, if needed.
Hepatic impairment: Dose adjustments may be needed.
Contraindications
 Severe renal or hepatic failure; hypersensitivity; lactation; concomitant MAOIs or within 2 wk of MAOI withdrawal.
Warnings / Precautions
 Unstable epilepsy, liver and renal impairment, cardiac disease, diabetes, electroconvulsive therapy, bleeding disorders, closed-angle glaucoma; pregnancy. May impair performace of skilled tasks; withdraw gradually. Close monitoring of clinical worsening and behavioural changes during the 1st few mth of treatment or when there are dose changes.
Adverse Reactions
 Nervousness, insomnia, anxiety, headache, tremor, drowsiness, dry mouth, nausea, vomiting, sweating, diarrhoea. Seizures, mania, hypomania or mixed manic states reported. Hyponatraemia; elevation of hepatic enzymes.
Potentially Fatal: Rarely, systemic events possibly related to vasculitis have been reported in patients with rash but may be serious involving lungs, kidney and liver.
Overdose Reactions
 Symptoms include abnormal accommodation, abnormal gait, confusion, unresponsiveness, nervousness, pulmonary dysfunction, vertigo, tremor, increased BP, impotence, movement disorder and hypomania. Treatment is supportive, activated charcoal may be used to remove unabsorbed drug.
Drug Interactions
 May cause transient shift in plasma conc of tightly protein bound drugs e.g. warfarin and digoxin, resulting in adverse effects. T1/2 of diazepam is prolonged. Avoid concurrent use with clopidogrel.
Potentially Fatal: Serious reactions when combined with MAOIs; at least 14 days should elapse after MAOIs withdrawal before starting fluoxetine treatment or at least 5 wk should elapse after fluoxetine treatment before starting MAOIs therapy. Two-fold increase in plasma levels of other antidepressants when combined with fluoxetine. Monitor lithium levels when combined.
See Below for More fluoxetine Drug Interactions
Mechanism of Actions
 Fluoxetine is a potent and highly selective inhibitor of serotonin (5-HT) re-uptake. No affinity for adrenoceptors or histamine, GABA-B, or muscarinic receptors.
Absorption: Oral admin: Readily absorbed from the GI tract; peak plasma concentrations after 6-8 hr.
Distribution: Widely distributed; enters breast milk. Protein-binding: 95%.
Metabolism: Extensively hepatic by demethylation to norfluoxetine.
Excretion: Urine. Elimination half-life: 1-3 days (fluoxetine), 4-16 days (norfluoxetine).
Administration
 May be taken with or without food.
Storage Conditions
 Oral: Store at 15-30°C.
ATC Classification
 N06AB03 - fluoxetine ; Belongs to the class of selective serotonin reuptake inhibitors. Used in the management of depression.
Storage
 Oral: Store at 15-30°C.
Available As
  • Fluoxetine 10 mg
  • Fluoxetine Hcl 10 mg
  • Fluoxetine 100 mg
  • Fluoxetine 20 mg
  • Fluoxetine Hcl 20 mg
  • Fluoxetine Hcl USP 20 mg
  • Fluoxetine Hcl BP 20 mg
  • Fluoxetine 40 mg
  • Fluoxetine 60 mg
  • Fluoxetine 90 mg

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