Fluoxetine T300 26-27

Fluoxetine

Prozac, Sarafem

Fluoxetine Drug Class

SSRI Antidepressant

Fluoxetine Dosage Forms

Oral Capsule: 10 mg, 20 mg, 40 mg;

Oral Capsule, Delayed Release, Weekly: 90 mg;

Oral Tablet: 10 mg, 20 mg, 60 mg;

Oral Solution: 20 mg/5 mL

Fluoxetine Dosing By Indication

1. Bipolar major depression: Adults, 20 mg po daily, may titrate to 80 mg po daily; Children ≥8 y of age, 10-20 mg po daily, max 20 mg po daily

2. Major depressive disorder: Adults, 20 mg po daily, may titrate to 80 mg po daily; Children ≥8 y of age, 10-20 mg po daily, max 20 mg po daily

3. OCD: Adults, 10-20 mg po daily, may titrate to 80 mg po daily; Children ≥7 y of age, 10 mg po daily, may titrate to 60 mg po daily

4. Panic disorder: 5-10 mg po daily, may increase to 60 mg po daily

5. Premenstrual dysphoric disorder: 10 mg po daily or for 14 d prior to expected start of menses through the 1st full day of menses, may titrate to 20-30 mg po daily

6. Bulimia nervosa: Adults, 20 mg po daily, may titrate to 60 mg po daily

Fluoxetine Off Label Uses

1. Post-traumatic stress disorder, binge eating disorder: 10-80 mg po daily

2. Fibromyalgia, treatment refractory: 20-80 mg po daily

3. Social anxiety disorder, generalized anxiety disorder: 10-60 mg once daily

Fluoxetine MOA

This drug is a bicyclic antidepressant that is a selective and potent inhibitor of presynaptic reuptake of serotonin (an SSRI).

Fluoxetine Common Adverse Effects

Diarrhea, headache, insomnia, nausea, somnolence, tremor, xerostomia, decreased appetite

Fluoxetine Efficacy Monitoring Parameters

Improvement in symptoms of depression, generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder, panic disorder, OCD, premenstrual syndrome, bulimia.

Fluoxetine Safety Monitoring Parameters

Worsening of depression, suicidality, or unusual changes in behavior, especially at the initiation of therapy or with dosage increases or decreases; signs/symptoms of abnormal bleeding; ECG assessment for patients with risk factors for QTc prolongation. Monitor electrolytes (sodium) in patients at risk for SIADH. Obtain baseline SCr, LFTs, and as indicated. Assess for significant change in sleep patterns.

Fluoxetine Key Counseling Points

Take with or without food in the morning. Avoid activities requiring mental alertness or coordination until drug effects are realized. Symptomatic improvement may not be seen for several weeks, while adverse effects often present in the 1st wk of therapy. Report worsening depression, suicidal ideation, unusual changes in behavior, or unusual bleeding to HCP. Do not drink alcohol or use NSAIDs or aspirin while taking this drug.

Fluoxetine Clinical Pearls

Must be dispensed with medication guide. Weekly dosage form with more pharmacokinetic variability than daily dosing. If stable on 20 mg/d, can be converted to 90 mg weekly dose, starting 7 d after the last 20 mg dose. Available as a combination product with olanzapine for depressive episodes associated with bipolar I disorder. The coformulation with olanzapine should be administered at bedtime to avoid daytime drowsiness. When used for premenstrual dysphoric disorder, can be dosed continuously or intermittently (starting 14 d prior to onset of menstruation through the 1st day of menstruation and repeated each cycle). Due to long half-life, does not typically require taper-on discontinuation or conversion to another antidepressant. If intolerable withdrawal symptoms occur following a decrease in dose or therapy discontinuation, may need to resume the previous dose and taper at a more gradual rate.