Fluoxetine

How it works

     * Fluoxetine is a medicine that may be used to treat several
       conditions associated with mood. Experts aren't sure exactly how it
       works but believe its effects are due to its ability to block the
       reuptake of serotonin by nerves. This results in an increase in
       serotonin concentrations in the nerve synapse (the space between
       two nerves).
     * The activity of fluoxetine against other neurotransmitters appears
       much less than some other antidepressants.
     * Fluoxetine belongs to a group of medicines called Selective
       Serotonin Reuptake Inhibitors (SSRIs).

Upsides

     * May be used in the treatment depression and to help maintain relief
       from depression in adults and children aged 8 to 18 years.
     * May be helpful for the relief of symptoms of obsessive-compulsive
       disorder (OCD) in adults and children aged 7 to 17 years.
     * May be useful in the treatment of the eating disorder, bulimia
       nervosa, to relieve moderate-to-severe symptoms such as
       binge-eating and vomiting.
     * Has been used to treat panic disorder in adults, with or without
       agoraphobia (an extreme avoidance of situations that could cause
       panic).
     * May also be used in the treatment of premenstrual dysphoric
       disorder (PMDD) - a condition characterized by severe depressive
       symptoms, irritability, and tension prior to menstruation.
     * Less likely to cause weight gain than some other antidepressants;
       may cause weight loss.
     * Less likely to cause sedation than some other antidepressants; may
       cause insomnia (sleeplessness).
     * Generic fluoxetine is available.

Downsides

   If you are between the ages of 18 and 60, take no other medication or
   have no other medical conditions, side effects you are more likely to
   experience include:
     * Anxiety, a lack of energy, drowsiness or insomnia, diarrhea,
       indigestion, increased sweating, nausea, tremor, headache, weight
       loss or a decreased appetite, dry mouth, a rash, restlessness and a
       decreased libido are the more commonly reported side effects.
     * As with other antidepressants, fluoxetine may increase the risk of
       suicidal thoughts or behavior; the risk is higher in children and
       young adults aged less than 24. Monitor for worsening mood.
     * Fluoxetine may cause drowsiness or impair your judgment and affect
       your ability to drive or operate machinery. Avoid these tasks if
       fluoxetine has this effect on you.
     * Interaction or overdosage may cause serotonin syndrome (symptoms
       include mental status changes [such as agitation, hallucinations,
       coma, delirium], fast heart rate, dizziness, flushing, muscle
       tremor or rigidity and stomach symptoms [such as nausea, vomiting,
       diarrhea]). Another serious syndrome, called Neuroleptic Malignant
       Syndrome, has also been reported; symptoms include high body
       temperature, muscle rigidity, and mental disturbances. Discontinue
       fluoxetine immediately and seek urgent medical advice if this
       syndrome occurs.
     * May increase the risk of bleeding, especially if used with other
       drugs that also increase bleeding risk.
     * May precipitate a manic episode in people with undiagnosed bipolar
       disorder.
     * May cause a lowering of total body sodium (hyponatremia); elderly
       people or people taking diuretics or already dehydrated are more at
       risk.
     * May cause a discontinuation syndrome if abruptly stopped. Symptoms
       include irritability, low mood, dizziness, electric shock
       sensations, headache or confusion. The dosage of fluoxetine should
       be tapered down slowly on withdrawal.
     * Rarely causes seizures.
     * Few studies have evaluated the use of fluoxetine long-term.
     * Seek medical advice if a rash develops while taking fluoxetine.
       Discontinue if a severe allergic reaction to fluoxetine occurs and
       seek urgent medical advice.
     * May interact with a number of other drugs including other
       antidepressants, tramadol, bupropion, diuretics, St John's Wort,
       and drugs that prolong the QT interval (such as pimozide or
       thioridazine).
     * May not be suitable for some people including those with glaucoma,
       bleeding disorders, a history of seizures, liver or kidney disease,
       the elderly, or certain heart conditions. People with diabetes may
       need the dosage of their medication adjusted.

   Notes: In general, seniors or children, people with certain medical
   conditions (such as liver or kidney problems, heart disease, diabetes,
   seizures) or people who take other medications are more at risk of
   developing a wider range of side effects. For a complete list of all
   side effects, [84]click here.

Bottom Line

   Fluoxetine may be used for the treatment of depression and other mood
   disorders. It is more likely to cause insomnia than drowsiness.

Tips

     * May be taken with or without food. Morning dosages may decrease the
       risk of insomnia.
     * Take fluoxetine exactly as directed by your doctor. Do not stop
       suddenly without your doctor's advice. Fluoxetine is best tapered
       down slowly on discontinuation.
     * Be alert for worsening mood and suicide-related thoughts or
       behaviors. Seek medical advice if changes are apparent.
     * Do not drive or operate machinery if fluoxetine impairs your
       judgment or makes you sleepy.
     * Seek urgent medical advice if symptoms consistent with serotonin
       syndrome (such as agitation, hallucinations, fast heart rate,
       dizziness, flushing, nausea, diarrhea) or Neuroleptic Malignant
       Syndrome (including high body temperature, muscle rigidity, or
       mental disturbances) develop.
     * Talk to your doctor immediately if you develop a rash or seek
       urgent medical advice with severe allergy-type symptoms such as
       swelling of the face or throat, or shortness of breath.
     * Do not take any other medicines, including those bought
       over-the-counter, without first consulting a doctor or pharmacist
       and asking if the medicine is safe to take with fluoxetine.
     * If you have diabetes, you may need to monitor your blood sugar
       levels more regularly on initiation of fluoxetine and with any
       dosage change. Talk to your doctor if your blood sugar levels are
       not as well controlled as they use to be.
     * Talk with your doctor if you experience any:

     * Unusual bruising or increased bleeding while taking fluoxetine
     * Persistent headaches, confusion, weakness, or unsteadiness
       resulting in falls
     * An increase, irregularity, or slowing of your heart rate or
       shortness of breath
     * Eye pain or swelling or visual disturbances
     * Seizures
     * Manic behavior such as recklessness, racing thoughts, increased
       energy, severe difficulty in sleeping.

Response and Effectiveness

     * Peak plasma concentrations occur within six to eight hours of a
       single dose. A reduction in depressive or other symptoms may be
       noticed within two to four weeks; however, it may take up to six to
       eight weeks for the full effects of fluoxetine on mood are seen.
     * Because fluoxetine persists for a long time in the body, it may
       several weeks before dosage increases are reflected as an
       improvement in mood, or a reduction in side effects is seen with
       dosage decreases.

References