* 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
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