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Fluoxetine (Prozac)

Generic Name: Fluoxetine

Brand Name: Prozac, Rapiflux, Sarafem, Selfemra

Tablets 10 mg;
Capsules 10 mg, 20 mg, 40 mg;
Solution, oral 20 mg per 5 mL;
Capsules, delayed-release 90 mg


Fluoxetine (Prozac) is in the class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). Prozac is indicated for depression, obsessive-compulsive disorders, premenstrual dysphoria, panic disorder and bulimia nervosa. Occasionally fluoxetine is used to treat alcoholism, attention-deficit disorders, borderline personality disorders, schizophrenia, Tourette's syndrome, anxiety, and phobias.

Fluoxetine is good for depression accompanied by hypersomnia, fatigue, increased appetite or hunger. Occasionally it contributes to undesirable activation and agitation. Therefore fluoxetine may be not well tolerated by patients with panic, anxiety, or insomnia.


  • Hypersensitivity to fluoxetine. During premarketing testing of more than 5600 patients given fluoxetine, approximately 4% developed a rash or urticaria.
  • MAOI. Not to be used with an MAOI or within 14 days of discontinuing MAOI therapy.



Adults: initially 20 mg once daily in the morning. Increase after several weeks if insufficient clinical improvement noted (max, 80 mg/day). Weekly dosing (90 mg delayed-release capsule) may be started 7 days after last 20 mg/day dose. If response is not satisfactory, consider reestablishing daily dosage regimen. Studies comparing fluoxetine 20, 40, and 60 mg/day to placebo indicate that 20 mg/day is sufficient to obtain a satisfactory response in major depressive disorder in most cases.

Children and adolescents 8–18 years of age: 10 mg/day; increase after 1 week if insufficient clinical improvement noted (max, 20 mg/day).

Although symptomatic improvement may be apparent within the first 1–3 weeks of fluoxetine, optimal results usually require at least 4 weeks or more.

Premenstrual Dysphoric Disorder:

Fluoxetine (Sarafem) significantly calms irritability, dysphoria and improves social functioning in women with premenstrual syndrome (PMS) or premenstrual dysphoric disorder. Fluoxetine works within hours for premenstrual dysphoria, as opposed to 3-4 weeks for depression.

The dose is 20 mg/day continuously (every day of menstrual cycle) or intermittently (starting 14 days prior to anticipated onset of menstruation through first full day of menses and repeating with each new cycle). It may be increased if no clinical improvement noted (max, 80 mg/day).

Obsessive Compulsive Disorder:

Adults: initially 20 mg once daily in the morning; increase after several weeks if insufficient clinical improvement noted (max, 80 mg/day).

Children 7 years of age and older: Initial: 10 mg/day; increase after 2 wk if insufficient clinical improvement noted (max, 60 mg/day).

Bulimia Nervosa:

Fluoxetine cuts down the frequency of binge eating, purging, and vomiting in bulimia nervosa.
Adults: 60 mg daily in the morning; it may be advisable to titrate up to this target dose over several days.

Panic Disorder:

Adults: initially 10 mg/day; increase to 20 mg/day after 1 wk. Further increases may be considered after several weeks if no clinical improvement noted (max, 60 mg/day).

Side effects

Nervous system: headache (20%), weakness or fatigue (20%), nervousness (15%), anxiety (10%), insomnia (14%), drowsiness (12%), dizziness (9%), tremor (8%).

Gastrointestinal: nausea (21%), diarrhea (12%), anorexia (8%), xerostomia (10%), dyspepsia (6%), constipation (5%).

Cardiovascular: vasodilation (5%).

Urogenital: abnormal ejaculation (7%), impotence (7%), decreased libido (10%).

Miscellaneous: abnormal vision (3%), excessive sweating (8%), rash (4%).


  • Weight loss and anorexia may occur; may be a very undesirable for underweight depressed patients.
  • Children: Safety and efficacy has not been established in children less than 8 yr of age with depression, or less than 7 yr of age with OCD.
  • Allergy and rash: Anaphylactoid reactions, including angioedema, bronchospasm, laryngospasm, and urticaria have been reported.
  • Bipolar disorder: Fluoxetine may increase likelihood of precipitation of mania or hypomania. Prior to initiating fluoxetine, patients should be adequately screened to determine if they are at risk for bipolar depression.
  • Hepatic impairment: Metabolism of fluoxetine is delayed; lower doses are recommended in patients with liver disease.

Drug interactions

Fluoxetine is an inhibitor of CYP2D6 enzymes.

  • MAO Inhibitors: combination may lead to serious, possibly fatal, serotonin syndrome. Discontinue MAO inhibitor at least 14 days before starting fluoxetine; discontinue fluoxetine at least 5 weeks before starting MAO inhibitor.
  • NSAIDs: increased risk of GI bleeding.
  • Pimozide: a case of life-threatening sinus bradycardia has been reported.
  • Serotonergic agents, Tryptophan: potential for serotonin syndrome, caution is advised when fluoxetine is administered with other drugs that may affect serotonergic neurotransmission.
  • Thioridazine: concurrent use is contraindicated because of risk of prolongation of QTc interval and development of serious ventricular arrhythmias (eg, torsades de pointes) and sudden death.
  • Tricyclic antidepressants: increased plasma concentration of tricyclic antidepressant.
  • Warfarin: the anticoagulant effects of warfarin may be increased, possibly because of displaced protein binding.

Pregnancy & Lactation

Pregnancy Category C.
Neonates exposed to fluoxetine and other SSRIs, late in the third trimester have developed complications requiring prolonged hospitalization and supportive care. Fluoxetine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing Mothers
Because fluoxetine is excreted in human milk, nursing while on fluoxetine is not recommended.


Store at room temperature of 15C to 30C (50F to 86F). Oral liquid form should be dispensed in a light-resistant container.


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