Overall, however, a causal relationship has not been established. Such complications can arise immediately upon delivery. Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying.
It should be noted that, in some cases, the clinical picture is consistent with serotonin syndrome [see Warnings and Precautions 5.
PPHN occurs in 1 - 2 per 1, live births in the general population and is associated with substantial neonatal morbidity and mortality. Other studies do not show a significant statistical association. Physicians should also note the results of a prospective longitudinal study of pregnant women with a history of major depression, who were either on antidepressants or had received antidepressants less than 12 weeks prior to their last menstrual period, and were in remission.
Women who discontinued antidepressant medication during pregnancy showed a significant increase in relapse of their major depression compared to those women who remained on antidepressant medication throughout pregnancy.
When treating a pregnant woman with PROZAC, the physician should carefully consider both the potential risks of taking an SSRI, along with the established benefits of treating depression with an antidepressant. The decision can only be made on a case by case basis [see Dosage and Administration 2. Animal Data — In embryo-fetal development studies in rats and rabbits, there was no evidence of teratogenicity following administration of fluoxetine at doses up to However, because fluoxetine crosses the placenta and because of the possibility that fluoxetine may have adverse effects on the newborn, fluoxetine should be used during labor and delivery only if the potential benefit justifies the potential risk to the fetus.
In one breast-milk sample, the concentration of fluoxetine plus norfluoxetine was The concentration in the mother's plasma was No adverse effects on the infant were reported. In another case, an infant nursed by a mother on PROZAC developed crying, sleep disturbance, vomiting, and watery stools.
As with other SSRIs, decreased weight gain has been observed in association with the use of fluoxetine in children and adolescent patients. In addition, fluoxetine treatment was associated with a decrease in alkaline phosphatase levels.
The safety of fluoxetine treatment for pediatric patients has not been systematically assessed for chronic treatment longer than several months in duration. In particular, there are no studies that directly evaluate the longer-term effects of fluoxetine on the growth, development and maturation of children and adolescent patients. Therefore, height and weight should be monitored periodically in pediatric patients receiving fluoxetine. Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, warfarin, and other anti-coagulants may add to this risk.
Case reports and epidemiological studies case-control and cohort design have demonstrated an association between use of drugs that interfere with serotonin reuptake and the occurrence of gastrointestinal bleeding.
Angle-Closure Glaucoma Angle-Closure Glaucoma The pupillary dilation that occurs following use of many antidepressant drugs including Prozac may trigger an angle closure attack in a patient with anatomically narrow angles who does not have a patent iridectomy.
In many cases, this hyponatremia appears to be the result of the syndrome of inappropriate antidiuretic hormone secretion SIADH. Also, patients taking diuretics or who are otherwise volume depleted may be at greater risk [see Use In Specific Populations].
Discontinuation of PROZAC should be considered in patients with symptomatic hyponatremia and appropriate medical intervention should be instituted. Signs and symptoms of hyponatremia include headache, difficulty concentrating , memory impairment, confusion , weakness , and unsteadiness , which may lead to falls. PROZAC should be used with caution in patients with congenital long QT syndrome ; a previous history of QT prolongation; a family history of long QT syndrome or sudden cardiac death; and other conditions that predispose to QT prolongation and ventricular arrhythmia.
Such conditions include concomitant use of drugs that prolong the QT interval; hypokalemia or hypomagnesemia ; recent myocardial infarction , uncompensated heart failure , bradyarrhythmias, and other significant arrhythmias; and conditions that predispose to increased fluoxetine exposure overdose, hepatic impairment, use of CYP2D6 inhibitors, CYP2D6 poor metabolizer status, or use of other highly protein-bound drugs.
Avoid the concomitant use of drugs known to prolong the QT interval. These include specific antipsychotics e. Consider discontinuing PROZAC and obtaining a cardiac evaluation if patients develop signs or symptoms consistent with ventricular arrhythmia. Caution is advisable in using PROZAC in patients with diseases or conditions that could affect metabolism or hemodynamic responses.
Cardiovascular Fluoxetine has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease. However, the electrocardiograms of patients who received PROZAC in double-blind trials were retrospectively evaluated; no conduction abnormalities that resulted in heart block were observed.
Hypoglycemia has occurred during therapy with PROZAC, and hyperglycemia has developed following discontinuation of the drug. Patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that the drug treatment does not affect them adversely. Long Elimination Half-Life Because of the long elimination half-lives of the parent drug and its major active metabolite, changes in dose will not be fully reflected in plasma for several weeks, affecting both strategies for titration to final dose and withdrawal from treatment.
While these reactions are generally self-limiting, there have been reports of serious discontinuation symptoms.
A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered.
Subsequently, the physician may continue decreasing the dose but at a more gradual rate. Plasma fluoxetine and norfluoxetine concentration decrease gradually at the conclusion of therapy which may minimize the risk of discontinuation symptoms with this drug. Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking PROZAC as monotherapy or in combination with olanzapine.
General Information Healthcare providers should instruct their patients to read the Medication Guide before starting therapy with PROZAC and to reread it each time the prescription is renewed. Healthcare providers should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with PROZAC and should counsel them in its appropriate use.
Healthcare providers should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. Patients should be advised of the following issues and asked to alert their healthcare provider if these occur while taking PROZAC.
Suicidal Thoughts And Behaviors In Children, Adolescents, And Young Adults Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia psychomotor restlessness , hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down.
For the treatment of panic disorder in adults, the initial Prozac dosage is 10 mg per day. According to the prescribing information, the dosage should be increased to 20 mg daily after one week of treatment. The usual recommended Prozac dosage is 20 mg per day administered in the morning. During clinical trials, patients were administered dosages ranging from 10 to 60 mg.
A dosage of 20 mg was most frequently administered to patients during clinical trials. For all indications of Prozac, it may require four weeks of treatment or longer before patients experience improvements in symptoms.
It is essential for patients to continue with treatment exactly as directed to achieve desired therapeutic outcomes. What is the difference between generic and brand Prozac? In most patients, there is no significant difference between generic and brand Prozac fluoxetine.
There is currently a generic equivalent available for Prozac, known as fluoxetine. Food and Drug Administration FDA requires that generic medications be bioequivalent to the brand-name medication and, therefore, exert the same pharmacologic effects in the body. Generic medications are considered, by the FDA, to be therapeutically identical to the brand-name counterparts in dose, strength, route of administration, safety, efficacy and indication for use.
Generic medications will appear differently and may have different inactive ingredients, however, the labeling and directions for use remain the same. For most medications, generic equivalents are a lower-cost alternative to the more expensive brand-name medication, and the majority of patients observe no changes in therapeutic effect.
However, some patients may experience a change in therapeutic effect and, subsequently, must continue treatment with the brand-name medication. Generic Prozac, fluoxetine, is a selective serotonin reuptake inhibitor SSRI antidepressant which is approved for the treatment of major depressive disorder, obsessive-compulsive disorder OCD , panic disorder and bulimia nervosa.
Frequently reported side effects for generic Prozac are similar those observed in patients being treated with the brand-name medication and may include abnormal dreams, abnormal ejaculation, anorexia, anxiety, asthenia, diarrhea, dry mouth, dyspepsia, flu syndrome, impotence, insomnia, decreased libido, nausea, nervousness, pharyngitis, rash, sinusitis, somnolence, sweating, tremor, vasodilatation and yawn.
The warnings and precautions associated with Prozac are also possible with the generic fluoxetine. According to the prescribing information for Prozac, warnings and precautions, possible with treatment, include clinical worsening of depression and suicide risk, serotonin syndrome or neuroleptic malignant syndrome-like reactions, allergic reactions and rash, activation of mania or hypomania, seizures, altered appetite and weight, abnormal bleeding, hyponatremia, possibility of anxiety and insomnia, potential for cognitive and motor impairment and long half-life affecting changes in dosage.
Fluoxetine, generic Prozac, should be administered exactly the same as the brand-name medication. Fluoxetine is typically taken once daily and administered in the morning.
Is Prozac for insomnia? Prozac fluoxetine is not indicated for insomnia treatment by the U. Prozac is approved by the FDA for the treatment of several other medical conditions including depression, obsessive-compulsive disorder, bulimia nervosa and panic disorder. During clinical trials, one of the most commonly observed adverse reactions in patients being treated with Prozac, for any indication, was insomnia. Patients should be advised to take Prozac exactly as directed by their health care provider.
If patients experience unpleasant or bothersome adverse reactions, such as insomnia, they are also advised not to change their dosing regimen or discontinue treatment without consulting with their health care provider. Prozac fluoxetine is an antidepressant categorized as a selective serotonin reuptake inhibitor SSRI.
Prozac is approved, by the U. Food and Drug Administration FDA for the acute and maintenance treatment of major depressive disorder in adult and pediatric patients aged 8 to 18 years, the acute and maintenance treatment of obsessive-compulsive disorder in adult and pediatric patients aged 7 to 17 years, the acute and maintenance treatment of bulimia nervosa in adult patients and the acute treatment of panic disorder, with or without agoraphobia in adult patients.
Prozac is typically administered in the morning and the recommended dosage depends on indication for use. Prozac is available in a capsule formulation in 10 mg, 20 mg and 40 mg strengths. Prozac is also available in a capsule formulation for weekly administration in 90 mg strength.
At least five weeks should be allowed after discontinuation of Prozac treatment prior to initiation of treatment with an MAOI because of the long half-life of Prozac. Prozac is also contraindicated in patients being treated with pimozide and thioridazine because of dangerous drug interactions.
Do not use thioridazine within five weeks of discontinuing Prozac treatment. There are several warnings and precautions associated with Prozac treatment that patients should discuss in detail with their health care provider and understand fully prior to initiation of treatment.
According to the prescribing information, the warnings and precautions, possible with Prozac treatment, include clinical worsening of depression and suicide risk, serotonin syndrome or neuroleptic malignant syndrome-like reactions, allergic reactions and rash, activation of mania or hypomania, seizures, altered appetite and weight, abnormal bleeding, hyponatremia, possibility of anxiety and insomnia, potential for cognitive and motor impairment and long half-life affecting changes in dosage.
Prozac is extensively metabolized broken down in the liver by the cytochrome P system and, therefore, has the potential to interact with several medications. It is essential for patients to inform their health care provider of all medications they are currently taking, including prescription medications, over the counter products and dietary or herbal supplements.
Treatment with Prozac, for all indications, may require four weeks of treatment or longer before patients experience improvements in symptoms. What are the benefits and risks of Prozac? There are several benefits and risks of Prozac fluoxetine. For most patients, the benefits outweigh the risks of treatment with Prozac.
However, there are still various risks a patient should be aware of prior to initiation of therapy. The benefits of Prozac extend across many medical conditions. Prozac, a selective serotonin reuptake inhibitor SSRI antidepressant, is a proven effective treatment option and has demonstrated benefits in patients with major depressive disorder, obsessive-compulsive disorder, panic disorder and bulimia.
In addition, Prozac has proven benefits for major depressive disorder and obsessive-compulsive disorder in the pediatric population as well. There are no drug treatments that are not without risk, including Prozac. One of the risks of Prozac treatment is the commonly occurring side effects. The most commonly reported side effects in patients treated with Prozac include abnormal dreams, abnormal ejaculation, anorexia, anxiety, asthenia, diarrhea, dry mouth, dyspepsia, flu syndrome, impotence, insomnia, decreased libido, nausea, nervousness, pharyngitis, rash, sinusitis, somnolence, sweating, tremor, vasodilatation and yawn.
Other risks of Prozac include several warnings and precautions which may occur with treatment. There is a risk of clinical worsening of depression symptoms and risk of suicide in both the adult and pediatric population. Clinical trials revealed that antidepressant drugs increase the risk of suicidality in children, adolescents and young adults ages 18 to 24 with major depressive disorder and other psychiatric disorders.
According to the prescribing information, all patients being treated with antidepressants, including Prozac, for any indication should be closely monitored and observed for clinical worsening, suicidality and unusual changes in behavior, especially during the first few months of therapy or during times of dosage adjustments.
Patients should be monitored for the following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathesia, hypomania and mania. These symptoms have been reported in adults and the pediatric population being treated with antidepressants for major depressive disorder, in addition to other psychiatric and nonpsychiatric indications. It is important to advise patients taking Prozac to be aware of the risk for serotonin syndrome or neuroleptic malignant syndrome NMS -like reactions that may occur with SSRIs alone or with the concomitant use of Prozac and other serotonergic medications, such as the triptans medications used to treat migraine headaches , tramadol, serotonin-norepinephrine reuptake inhibitors SNRIs , such as Cymbalta duloxetine , Effexor venlafaxine or Pristiq desvenlafaxine , or other SSRIs.
Symptoms of serotonin syndrome or NMS-like reactions include agitation, confusion, increased heart rate and blood pressure, sweating, headache, diarrhea, loss of muscle coordination, and possibly fever and seizures. Seek immediate medical attention if you experience any of these signs and symptoms. Prozac may cause an increased risk for bleeding. Patients taking Prozac should discuss the concomitant use of Prozac with non-steroidal anti-inflammatory drugs NSAIDs , including ibuprofen and naproxen, aspirin, warfarin or other medications that affect coagulation with their physician to avoid an increased risk for bleeding.
Before taking any of these medications, it is important to consult with your physician and call your physician immediately if you experience any bleeding or bruising. Hyponatremia low levels of sodium in the blood has been reported as a result of Prozac treatment.
It is important to be aware of the signs and symptoms associated with hyponatremia so you can recognize them if they occur. Signs and symptoms include headache, difficulty concentrating, memory impairment, confusion, weakness, unsteadiness, hallucination, passing out, seizure, coma, respiratory arrest and death.
Patients should discuss the benefits and risks of Prozac with their health care provider prior to initiation of treatment. What is the difference between Cymbalta versus Prozac?
There are a number of differences between Cymbalta duloxetine versus Prozac fluoxetine. The main differences between Cymbalta versus Prozac include mechanism of action, the way in which the drug works in the body, and indications for use approved by the U. Cymbalta is a potent inhibitor of both serotonin and norepinephrine reuptake in the central nervous system, while Prozac is a much more potent inhibitor of serotonin reuptake than norepinephrine.
The only common indication between Cymbalta and Prozac is major depressive disorder. Cymbalta belongs to a class of antidepressants known as serotonin norepinephrine reuptake inhibitors SNRI and is indicated for the treatment of major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, fibromyalgia and chronic musculoskeletal pain.
Prozac belongs to a different class of antidepressants known as selective serotonin reuptake inhibitors SSRI and is indicated for the treatment of major depressive disorder, obsessive-compulsive disorder, panic disorder and bulimia nervosa.
Another difference between Cymbalta versus Prozac is approved use in the pediatric population. While Prozac is currently approved, by the FDA, for the treatment of major depressive disorder and obsessive-compulsive disorder in the pediatric population, both in children and adolescents, the safety and effectiveness of Cymbalta in the pediatric population has not been established. Another difference between Cymbalta versus Prozac is there is currently no generic equivalent available for Cymbalta, while Prozac is available in a generic form, known as fluoxetine.
Cymbalta and Prozac have similar adverse reactions and warnings and precautions associated with treatment. However, Cymbalta has been associated with an increased risk of mydriasis prolonged dilation of the pupils of the eye and should be used cautiously in patients with controlled narrow-angle glaucoma.
Patients should be advised to discuss with their health care provider if they have a past medical history of glaucoma prior to initiation of treatment with Cymbalta. Another difference between Cymbalta versus Prozac, with regard to warnings and precautions, Cymbalta treatment was observed to worsen glycemic control in some patients with diabetes during clinical trials.
How do I take Prozac for depression? To take Prozac fluoxetine for depression, patients should be advised that treatment may require four weeks or longer before the full therapeutic effect of Prozac is observed. It is essential for patients to take Prozac for depression exactly as prescribed by a health care provider and not to adjust the dosing regimen or discontinue treatment with Prozac without the supervision of their doctor.
Prozac is indicated for the treatment of depression in adult and pediatric patients, aged 8 to 18 years. To take Prozac for depression, the initial adult dose is 20 mg per day administered in the morning. The usual dosage of Prozac for depression ranges from 20 to 80 mg daily. During clinical trials for depression, 20 mg daily was an adequate dosage, in most patients, to achieve a desired therapeutic outcome.
Research suggests that dosages higher than 20 mg per day may be administered once daily in the morning or may be administered twice daily when necessary, in the morning and at noon. To take Prozac for depression, the maximum daily dose is 80 mg. Prozac for weekly administration is also effective for treating depression in adults.
To take Prozac for depression in children and adolescents, age 8 and older, the usual dose of Prozac is 10 to 20 mg daily. For both adult and pediatric patients, an increase in dosage of Prozac may be considered after several weeks of treatment if a less than satisfactory clinical improvement is observed. It is essential that patients are periodically monitored and reassessed to determine if further treatment is required. When taking Prozac for depression, doses are typically administered in the morning unless otherwise instructed.
Patients taking Prozac for depression should be informed regarding the most commonly observed adverse reactions. Prior to beginning treatment with Prozac for depression, it is essential to inform your physician of any other medications you are currently taking, including prescription medications, over the counter products and dietary or herbal supplements to avoid potentially dangerous interactions.
How can I lose weight after Prozac? In placebo-controlled clinical trials for major depressive disorder, obsessive-compulsive disorder and bulimia nervosa, altered appetite and weight after beginning Prozac treatment was reported. Patients did not report weight gain or difficulty losing weight during clinical studies or postmarketing experience with Prozac. Prozac is a potent inhibitor of neuronal serotonin reuptake in the central nervous system and therefore categorized as a selective serotonin reuptake inhibitor SSRI.
Prozac is used for the treatment of bulimia, panic disorder, obsessive-compulsive disorder and major depressive disorder. The tools with which to lose weight after Prozac are the same as those for any other individual attempting to lose weight. In general, irrespective of drug therapy, the safest and most effective method for long-term weight loss is proper diet and exercise. Eating a healthy, well-balanced diet full of fruits, vegetables and whole grains while limiting sugar, processed foods and alcohol typically people lose weight.
According to the National Heart Lung and Blood Institute NHLBI , a part of the National Institutes of Health NIH , to lose weight it is essential for individuals to make lifestyle changes which focus on reducing calories from food and drink, a healthy eating plan and proper portion control. Furthermore, the NHLBI outlines a healthy eating plan to control portion sizes and include fruits, vegetables, whole grains and fat-free or low-fat dairy products.
A healthy eating plan should also include lean meats, poultry, fish, beans, eggs and nuts and be low in saturated fat, trans fat, cholesterol, sodium and added sugars. To safely and effectively lose weight, in general and after Prozac, individuals need to expend more calories than they take in. Essentially, individuals need to reduce their daily caloric intake from food and beverages and increase calories burned through physical exercise. An appropriate diet and exercise regimen should initially be under the guidance of a physician.
How can I treat bipolar disorder with Prozac? To treat bipolar disorder with Prozac fluoxetine , another medication must be prescribed in combination. Prozac is not currently approved as monotherapy for the treatment of depressive episodes associated with bipolar disorder.
Symbyax is approved by the U. Food and Drug Administration FDA for the acute treatment of depressive episodes associated with bipolar disorder in adults. To treat bipolar disorder with Prozac in combination with olanzapine most physicians will prescribe combination Symbyax. The efficacy of Symbyax for the acute treatment of depressive episodes associated with bipolar disorder was established in controlled studies.
Symbyax should be administered once daily in the evening. While both Prozac and olanzapine individually can be administered without regard to meals, the effect of food on Symbyax specifically has not been evaluated.
According to the prescribing information for Symbyax, dosage changes should be assessed according to efficacy and patient tolerability. The ideal duration of treatment with Symbyax is unknown and patients should be periodically reassessed by a health care provider to determine if continued treatment is necessary. Patients should be advised to avoid alcohol while being treated with Symbyax.
To treat bipolar disorder with Symbyax, it is important for patients to take this medication exactly as prescribed even after mood symptoms improve. Patients should also be advised not to adjust their dosing regimen or discontinue treatment with Symbyax without the supervision of their health care provider.
What condition is Prozac used for? Is it used in weight reduction? What are the side effects? Prozac fluoxetine is a medication that is used to treat depression, panic disorder, obsessive compulsive disorder OCD , depression associated with bipolar disorder, as well as other conditions. It is in the class of medications called selective serotonin reuptake inhibitors SSRIs and works by bringing a balance to serotonin in the brain that may be the cause of symptoms. The prescribing information on Prozac lists the following as the most common side effects associated with the medication: Prozac is not approved by the U.
Weight loss appears to be a side effect that occurs in up to 2 percent of patients taking Prozac. It is not entirely clear why this medication causes weight loss, although it is generally a small amount. It may be due to the side effects of loss of appetite, diarrhea and nausea that may contribute to the weight loss.
My doctor recently told me to try to increase my 20 mg of Prozac to 40 mg. I tried it, and it made me exhausted during the day and woke me up in the middle of the night.
Prozac fluoextine belongs to the class of drugs called selective serotonin reuptake inhibitors SSRIs. Common side effects of Prozac include dry mouth, drowsiness, nausea, and weight changes. Other side effects of Prozac include gas, sleep problems, and loss of appetite. This increase may be clinically relevant as adverse reactions to bicalutamide are related to dose and exposure. Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: Major Potential QT prolongation has been reported in limited case reports with metronidazole.
Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include fluoxetine. Bismuth Subsalicylate; Metronidazole; Tetracycline: Moderate Close clinical monitoring is advised when administering fluoxetine with boceprevir due to an increased potential for boceprevir-related adverse events.
If fluoxetine dose adjustments are made, re-adjust the dose upon completion of boceprevir treatment. Although this interaction has not been studied, predictions about the interaction can be made based on the metabolic pathways of fluoxetine and boceprevir. Fluoxetine is an inhibitor of the hepatic isoenzyme CYP3A4; boceprevir is metabolized by this isoenzyme. When used in combination, the plasma concentrations of boceprevir may be elevated. Minor Agents that inhibit cytochrome P 3A4 may increase the exposure to bortezomib and increase the risk for toxicity; however, bortezomib is also metabolized by other CYP isoenzymes.
Therefore, the clinical significance of concurrent administration of bortezomib with fluoxetine is not known. Fluoxetine may inhibit both of these isoenzymes and thereby increase the plasma concentrations of bosentan. It is prudent to monitor for potential adverse effects of bosentan during coadministration with fluoxetine; excessive dosage may result in hypotension or elevated hepatic enzymes. Fluoxetine is a strong inhibitor of CYP2D6. If these agents are used in combination, the patient should be carefully monitored for brexpiprazole-related adverse reactions.
It should be noted that no dosage adjustment is needed in patients taking a strong CYP2D6 inhibitor who are receiving brexpiprazole as adjunct treatment for major depressive disorder because CYP2D6 considerations are already factored into general dosing recommendations.
CYP2D6 inhibitors, such as fluoxetine, could theoretically impair timolol metabolism; the clinical significance of such interactions is unknown. Moderate Avoid coadministration of oral budesonide and fluoxetine due to the potential for increased budesonide exposure.
Use caution with inhaled forms of budesonide as systemic exposure to the corticosteroid may also increase. In the presence of a strong CYP3A4 inhibitor, the systemic exposure to oral budesonide was increased by 8-fold. Known inhibitors of CYP3A4, such as fluoxetine, may result in increased systemic levels of bupivacaine when given concurrently, with potential for toxicity.
Moderate Concomitant use of systemic lidocaine and fluoxetine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Monitor for lidocaine toxicity if used together. Major Due to the potential for QT prolongation, cautious use and close monitoring are advisable if concurrent use of fluoxetine and buprenorphine is necessary.
Buprenorphine has been associated with QT prolongation and has a possible risk of torsade de pointes TdP. Fluoxetine also has a possible risk for QT prolongation and TdP. FDA-approved labeling for some buprenorphine products recommend avoiding use with Class 1A and Class III antiarrhythmic medications while other labels recommend avoiding use with any drug that has the potential to prolong the QT interval.
In addition, concurrent use of opioids with other drugs that modulate serotonergic function, such as fluoxetine, has resulted in serotonin syndrome in some cases. If combination treatment is required, patients should be carefully observed, particularly during treatment initiation and during dose adjustments of the serotonergic drug; discontinue buprenorphine if serotonin syndrome is suspected.
In addition, since the metabolism of buprenorphine is mediated by CYP3A4, co-administration of a CYP3A4 inhibitor such as fluoxetine may decrease the clearance of buprenorphine resulting in prolonged or increased opioid effects.
If co-administration is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider dose adjustments until stable drug effects are achieved. The effect of CYP3A4 inhibitors on buprenorphine implants has not been studied, and the effect may be dependent on the route of administration. Moderate Bupropion and hydroxybupropion, the major active metabolite, are inhibitors of CYP2D6 in vitro.
Coadministration of bupropion with medications that are metabolized by CYP2D6 should be approached with caution. Major Because of the potential risk and severity of serotonin syndrome, caution should be observed when coadministering drugs that have serotonergic properties such as buspirone and fluoxetine. In addition, buspirone is a primary CYP3A4 substrate and concurrent use with an inhibitor of CYP3A4, such as fluoxetine, may decrease systemic clearance of buspirone leading to increased or prolonged effects.
If buspirone is administered with fluoxetine, a low initial dose of buspirone is advisable with subsequent dosage adjustments based on clinical response.
Patients receiving this combination should be monitored for the emergence of serotonin syndrome or other adverse effects. If serotonin syndrome occurs, all serotonergic drugs should be discontinued and appropriate medical treatment should be initiated. Moderate Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering selective serotonin reuptake inhibitors SSRIs with other drugs that have serotonergic properties such as cabergoline.
Patients receiving cabergoline with an SSRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions. Moderate Platelet aggregation may be impaired by selective serotonin reuptake inhibitors SSRIs due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication e. Patients should be instructed to monitor for signs and symptoms of bleeding while taking an SSRI concurrently with an antiplatelet medication and to promptly report any bleeding events to the practitioner.
Moderate Use caution if coadministration of capecitabine with fluoxetine is necessary, and monitor for an increase in fluoxetine-related adverse reactions. Fluoxetine inhibits CYP3A4 and may decrease carbamazepine metabolism and increase carbamazepine plasma concentrations.
Decreased metabolism of cariprazine may lead to clinically important adverse reactions that are associated with antipsychotic use, such as extrapyramidal symptoms. Major Periodically monitor electrolytes and ECGs in patients receiving concomitant treatment with ceritinib and fluoxetine; an interruption of ceritinib therapy, dose reduction, or discontinuation of therapy may be necessary if QT prolongation occurs.
Ceritinib causes concentration-dependent prolongation of the QT interval. QT prolongation and torsade de pointes TdP have also been reported in patients treated with fluoxetine. Inhibitors of either of these isoenzymes, such as the SSRIs, would be expected to lead to an increase in cevimeline plasma concentrations. Major Coadminister chloroquine with other drugs known to prolong the QT interval, such as fluoxetine, with caution. Chloroquine is associated with an increased risk of QT prolongation and torsade de pointes TdP ; fatalities have been reported.
The risk of QT prolongation is increased with higher chloroquine doses. QT prolongation and TdP have been reported in patients treated with fluoxetine. Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: Major Fluoxetine is associated with a possible risk of QT prolongation and torsade de pointes TdP and chlorpromazine also has an established risk of QT prolongation and TdP.
Combination therapy with these agents should be avoided if possible. Fluoxetine is a potent inhibitor of CYP2D6 and may result in increases in serum phenothiazine concentrations, which may lead to phenothiazine-related side effects such as cardiac side effects, hypotension, CNS sedation, or extrapyramidal symptoms. The effects of fluoxetine on hepatic metabolism of interacting drugs may persist for a time after discontinuation of fluoxetine because of its long elimination half-life. Choline Salicylate; Magnesium Salicylate: Major Cilostazol is extensively metabolized by the CYP3A4 hepatic isoenzyme and appears to have pharmacokinetic interactions with many medications that are potent inhibitors of CYP3A4, including fluoxetine.
These agents have been shown to increase both cilostazol AUC and Cmax when administered concurrently. Moderate Although no clinical data are available, it is possible that inhibitors of hepatic enzymes such as cimetidine may decrease the metabolism of fluoxetine.
Until more data are available, cimetidine should be used cautiously in patients receiving fluoxetine. Moderate Cinacalcet, a strong in vitro inhibitor of the CYP2D6 cytochrome P enzyme, may theoretically increase serum concentrations of other drugs metabolized by this enzyme, such as fluoxetine. Drugs with a possible risk for QT prolongation and TdP include ciprofloxacin.
Severe Cisapride is metabolized by CYP3A4 isozyme, a pathway that fluoxetine is known to inhibit, and may inhibit the clearance of and potentiate the toxicity of cisapride. QT prolongation and ventricular arrhythmias, including torsade de pointes and death, have been reported when inhibitors of CYP3A4 are coadministered with cisapride. Due to the serious nature of cisapride toxicity, fluoxetine should be avoided in these patients. Severe Due to the similarity in pharmacology of fluoxetine and citalopram and the potential for serious adverse reactions, including serotonin syndrome, these selective serotonin reuptake inhibitors SSRIs should not be administered together.
Also, both fluoxetine and citalopram have been associated with QT prolongation and torsade de pointes TdP , which could theoretically result in additive effects on the QT interval. Extrapolation from pharmacogenomic data indicates that concurrent use of clobazam with moderate or potent inhibitors of CYP2C19 may result in up to a 5-fold increase in exposure to N-desmethylclobazam. Adverse effects, such as sedation, lethargy, ataxia, or insomnia may be potentiated. A dosage reduction of CYP2D6 substrates may be necessary during co-administration of clobazam.
It should be noted that because fluoxetine is metabolized by multiple enzyme systems, inhibition of one pathway may not appreciably decrease its clearance. Major Use clopidogrel and fluoxetine together with caution and monitor for reduced clopidogrel effectiveness. Consider alternative therapy to fluoxetine, if possible. Fluoxetine may reduce the antiplatelet activity of clopidogrel through potent inhibition of the CYP2C19 metabolism of clopidogrel to its active metabolite.
This risk was more pronounced in patients 65 years and older. Additionally, because SSRIs affect platelet activation, concomitant use with clopidogrel may increase the risk of bleeding.
In this study, bleeding events did occur in both groups; however, there were no meaningful differences in bleeding events between groups. Moderate Fluoxetine could theoretically inhibit CYP3A4 metabolism of oxidized benzodiazepines, including clorazepate.
Clozapine is associated with a possible risk of QT prolongation and TdP. Modest less than 2-fold elevations in concentrations of clozapine and its metabolites have been reported during concurrent use of fluoxetine. Decreased metabolism of clozapine may lead to clinically important adverse reactions such as seizures or orthostatic hypotension.
According to the manufacturer of clozapine, concomitant use of clozapine and substrates or inhibitors of CYP2D6 may require lower doses of either drug. Cobicistat; Elvitegravir; Emtricitabine; Tenofovir Alafenamide: Major If concurrent use of cobimetinib and fluoxetine is necessary, use caution and monitor for increased cobimetinib-related adverse effects.
Simulations showed that predicted steady-state concentrations of cobimetinib at a reduced dose of 20 mg administered concurrently with short-term less than 14 days treatment of a moderate CYP3A inhibitor were similar to observed steady-state concentrations of cobimetinib 60 mg alone.
The manufacturer of cobimetinib recommends avoiding coadministration with moderate to strong CYP3A inhibitors, and significantly reducing the dose of cobimetinib if coadministration with moderate CYP3A inhibitors cannot be avoided.
Guidance is not available regarding concomitant use of cobimetinib with weak CYP3A inhibitors. Major Promethazine carries a possible risk of QT prolongation.
Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with promethazine include fluoxetine. Drugs that inhibit CYP3A4 such as fluoxetine may increase plasma concentrations of estrogens and cause estrogen-related side effects such as nausea and breast tenderness.
Patients receiving estrogens should be monitored for an increase in adverse events. Major Monitor ECGs for QT prolongation and monitor electrolytes in patients receiving crizotinib and fluoxetine concomitantly.
An interruption of therapy, dose reduction, or discontinuation of crizotinib therapy may be necessary. Crizotinib has been associated with concentration-dependent QT prolongation. Major Cyclobenzaprine is structurally similar to tricyclic antidepressants, which have been reported to prolong the QT interval, especially when given in excessive doses or in overdosage. Because QT prolongation has been reported with both cyclobenzaprine and fluoxetine, concurrent use should be approached with caution.
In addition, serotonin syndrome has been reported during concurrent use of cyclobenzaprine and SSRIs e. Because of the potential risk and severity of serotonin syndrome, cautious use is recommended, particularly during initiation of treatment and dose increases. If serotonin syndrome occurs, cyclobenzaprine and fluoxetine should be discontinued immediately and supportive symptomatic treatment should be initiated.
Moderate Fluoxetine is a CYP3A4 inhibitor and may decrease the clearance of cyclosporine, with the potential to cause cyclosporine toxicity, including nephrotoxicity or seizures, or require the downward dosage adjustment of cyclosporine. Moderate Cyproheptadine is a serotonin antagonist in the CNS and can oppose the pharmacologic actions of selective serotonin reuptake inhibitors SSRIs.
Cyproheptadine reportedly has interfered with the antidepressant and anti-bulimia actions of fluoxetine but more data are needed to confirm a direct drug-drug interaction. Major Patients should be instructed to monitor for signs and symptoms of bleeding while taking a selective serotonin reuptake inhibitor SSRI concurrently with dabigatran and to promptly report any bleeding events to their prescriber.
Although clinical data are limited, SSRIs may potentiate the hypoprothrombinemic effects of anticoagulants, perhaps by inhibiting platelet aggregation. Major Platelet aggregation may be impaired by selective serotonin reuptake inhibitors SSRIs due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication in patients receiving anticoagulants, like danaparoid.
Patients should be monitored for increased anticholinergic effects if these drugs are coadministered. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Major Because both ritonavir and fluoxetine are associated with a possible risk for QT prolongation and torsade de pointes TdP , the combination should be used cautiously and with close monitoring.
A dose reduction of fluoxetine may be necessary during co-administration of ritonavir. Concurrent use of CYP2D6 substrates, such as fluoxetine, with ritonavir could result in increases up to 2-fold in the AUC of fluoxetine.
Close monitoring for adverse effects is prudent. Major Coadministration of dasabuvir; ombitasvir; paritaprevir; ritonavir and fluoxetine should be undertaken cautiously and with careful monitoring; a dose reduction of fluoxetine may be necessary. Both fluoxetine and ritonavir have been associated with dose-related QT prolongation, and coadministration can result in elevated concentrations of both fluoxetine and ritonavir. Neurologic adverse events have also been reported when ritonavir was concurrently administered with fluoxetine.
In addition, paritaprevir and dasabuvir minor are metabolized by CYP3A4; therefore, their concentrations may also be affected by coadministration. Major Coadministration of dasabuvir; ombitasvir; paritaprevir; ritonavir or ombitasvir; paritaprevir; ritonavir and fluoxetine should be undertaken cautiously and with careful monitoring; a dose reduction of fluoxetine may be necessary.
Major Monitor for evidence of QT prolongation and torsade de pointes TdP if coadministration of dasatinib and fluoxetine is necessary. In vitro studies have shown that dasatinib has the potential to prolong the QT interval. Acute cardiotoxicity can occur during administration of daunorubicin, doxorubicin, epirubicin, or idarubicin; cumulative, dose-dependent cardiomyopathy may also occur.
Sinus tachycardia is the most common arrhythmia, but other arrhythmias such as supraventricular tachycardia SVT , ventricular tachycardia, heart block, and premature ventricular contractions PVCs have been reported.
Drugs with a possible risk for QT prolongation and TdP include degarelix. Fluoxetine impairs both of these pathways at therapeutic doses. Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions.
This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
This drug comes with several warnings. Allergy warning This medication can cause a severe allergic reaction. Taking it again could be fatal cause death. Warnings for people with certain health conditions For people with blood clotting disorders: This drug may cause you to bleed more easily. If you take another drug to thin your blood, it could cause dangerous bleeding.
Major Coadministration of efavirenz and fluoxetine may increase the 80mg for QT prolongation and torsade de pointes TdP. Research in animals has shown once effects to the fetus when the mother takes the drug. Major Due to similarity of pharmacology and the potential for additive adverse effects, including serotonin syndrome, daily serotonin reuptake inhibitors SSRIs should generally not be administered with serotonin norepinephrine reuptake inhibitors SNRIs such as venlafaxine, desvenlafaxine, duloxetine, and milnacipran. The lowest dose of Prozac that is available in capsules is 10mg. The most common side effects with Prozac include abnormal dreams, abnormal ejaculation, prozac 80mg once daily, anorexia, anxiety, asthenia weaknessdiarrhea, dry mouth, dyspepsia, flu syndrome, impotence, insomnia, prozac decreased, nausea, nervousness, pharyngitis, rash, sinusitis, somnolence, sweating, tremor, vasodilatation, and yawn, prozac 80mg once daily. A specific caution involves patients who are taking or have recently taken fluoxetine 80mg might ingest excessive quantities 80mg a TCA. Clinicians should be particularly cautious in patients with fluoxetine due prozac the extremely long elimination half-life of its metabolite, prozac 80mg once daily, norfluoxetine days, prozac 80mg once daily. The prescribing information on fluoxetine states that up to 11 percent of patients once this medication experience a decrease in sex drive. In addition, fluoxetine treatment was daily with a decrease in alkaline phosphatase levels. The concentration in the mother's plasma was Rat exposures to the major metabolite, norfluoxetine, are approximately 0. One of the side effects of Prozac is drowsiness and so this may be what is causing prozac to be tired in the afternoon. Decreased metabolism of cariprazine may lead to clinically daily once reactions that are associated with antipsychotic use, such as extrapyramidal symptoms.
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