Fluoxetine

Fluoxetine Brand Names

Prozac | Prozac Weekly | Sarafem | Selfemra

What is Fluoxetine

Fluoxetine was the first selective serotonin reuptake inhibitor (SSRI) to be marketed in the U.S.

Fluoxetine is indicated for treating major depressive disorder (MDD), obsessive-compulsive disorder (OCD), bulimia nervosa, panic disorder, and premenstrual dysphoric disorder in adults.

The long half-life of fluoxetine and its active metabolite allows for once-weekly administration for the maintenance treatment of MDD in selected adults.

Fluoxetine was the first SSRI to receive approval in pediatric patients 8 years and older with major depressive disorder and is the most extensively evaluated SSRI in pediatric depression.

The drug is also indicated for pediatric patients 7 years and older for the treatment of OCD. Fluoxetine is a potent inhibitor of CYP2D6, which can result in clinically significant interactions with CYP2D6 substrates.

Primary off-label uses of fluoxetine include premature ejaculation, hot flashes in menopausal women, posttraumatic stress disorder, and childhood anxiety disorders.

Product labels for all antidepressants contain a boxed warning related to an increased risk of suicidality in children, adolescents, and young adults during the initial stages of therapy when treating depression or other conditions; therefore, the necessity of pharmacologic therapy versus the potential risks should be carefully considered in these populations.

Indications

  1. anorexia nervosa
  2. autistic disorder
  3. bipolar depression
  4. borderline personality disorder
  5. bulimia nervosa
  6. depression
  7. fibromyalgia
  8. generalized anxiety disorder (GAD)
  9. hot flashes
  10. menopause
  11. migraine prophylaxis
  12. neurogenic orthostatic hypotension
  13. obesity
  14. obsessive-compulsive disorder (OCD)
  15. panic disorder
  16. posttraumatic stress disorder (PTSD)
  17. premature ejaculation
  18. premenstrual dysphoric disorder (PMDD)
  19. selective mutism
  20. separation anxiety disorder
  21. social phobia (social anxiety disorder)

For the treatment of major depression

for the treatment of depression with a daily dosage formulation

Side Effects

  1. abdominal pain
  2. abnormal dreams
  3. acne vulgaris
  4. agitation
  5. akathisia
  6. alopecia
  7. amenorrhea
  8. amnesia
  9. anaphylactoid reactions
  10. anemia
  11. angina
  12. angioedema
  13. anorexia
  14. anxiety
  15. aplastic anemia
  16. apnea
  17. appetite stimulation
  18. arrhythmia exacerbation
  19. arthralgia
  20. asthenia
  21. ataxia
  22. atopic dermatitis
  23. atrial fibrillation
  24. bleeding
  25. blepharitis
  26. bone fractures
  27. bone pain
  28. bradycardia
  29. breast discharge
  30. breast enlargement
  31. bronchospasm
  32. cardiac arrest
  33. cataracts
  34. chest pain (unspecified)
  35. chills
  36. cholecystitis
  37. cholelithiasis
  38. colitis
  39. confusion
  40. conjunctivitis
  41. constipation
  42. coronary vasospasm
  43. cystitis
  44. dehydration
  45. depression
  46. diabetes mellitus
  47. diabetic ketoacidosis
  48. diarrhea
  49. diplopia
  50. dizziness
  51. drowsiness
  52. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  53. dysarthria
  54. dysgeusia
  55. dyskinesia
  56. dyspepsia
  57. dysphagia
  58. dyspnea
  59. dystonic reaction
  60. dysuria
  61. ecchymosis
  62. edema
  63. EEG changes
  64. ejaculation dysfunction
  65. elevated hepatic enzymes
  66. emotional lability
  67. eosinophilic pneumonia
  68. epistaxis
  69. eructation
  70. erythema multiforme
  71. erythema nodosum
  72. esophageal ulceration
  73. esophagitis
  74. euphoria
  75. exfoliative dermatitis
  76. exophthalmos
  77. fecal incontinence
  78. fever
  79. flank pain
  80. flatulence
  81. flushing
  82. furunculosis
  83. galactorrhea
  84. gastritis
  85. GI bleeding
  86. GI obstruction
  87. glossitis
  88. glycosuria
  89. gout
  90. growth inhibition
  91. gynecomastia
  92. hallucinations
  93. headache
  94. hearing loss
  95. heart failure
  96. hematemesis
  97. hematoma
  98. hematuria
  99. hemolytic anemia
  100. hemoptysis
  101. hepatic failure
  102. hepatic necrosis
  103. hepatitis
  104. hiccups
  105. hirsutism
  106. hostility
  107. hyperacusis
  108. hypercholesterolemia
  109. hyperesthesia
  110. hyperglycemia
  111. hyperhidrosis
  112. hyperkalemia
  113. hyperkinesis
  114. hyperlipidemia
  115. hyperprolactinemia
  116. hypersalivation
  117. hypertension
  118. hypertonia
  119. hyperuricemia
  120. hyperventilation
  121. hypocalcemia
  122. hypoesthesia
  123. hypoglycemia
  124. hypokalemia
  125. hyponatremia
  126. hyporeflexia
  127. hypotension
  128. hypothermia
  129. hypothyroidism
  130. hypoventilation
  131. hypoxia
  132. impotence (erectile dysfunction)
  133. increased urinary frequency
  134. influenza
  135. insomnia
  136. iritis
  137. jaundice
  138. laryngeal edema
  139. laryngospasm
  140. leukopenia
  141. leukorrhea
  142. libido decrease
  143. libido increase
  144. lupus-like symptoms
  145. lymphocytosis
  146. maculopapular rash
  147. malaise
  148. mania
  149. mastalgia
  150. melena
  151. memory impairment
  152. menorrhagia
  153. migraine
  154. muscle cramps
  155. muscle paralysis
  156. myasthenia
  157. mydriasis
  158. myocardial infarction
  159. myoclonia
  160. myopathy
  161. nausea
  162. neonatal abstinence syndrome
  163. neuritis
  164. neuropathic pain
  165. nocturia
  166. ocular hypertension
  167. oliguria
  168. optic neuritis
  169. oral ulceration
  170. orgasm dysfunction
  171. orthostatic hypotension
  172. osteopenia
  173. osteoporosis
  174. otalgia
  175. pallor
  176. palpitations
  177. pancreatitis
  178. paranoia
  179. paresthesias
  180. parosmia
  181. pelvic pain
  182. peptic ulcer
  183. peripheral edema
  184. persistent pulmonary hypertension of the newborn
  185. petechiae
  186. pharyngitis
  187. phlebitis
  188. photophobia
  189. photosensitivity
  190. platelet dysfunction
  191. pneumothorax
  192. polydipsia
  193. polyuria
  194. priapism
  195. proteinuria
  196. pruritus
  197. psoriasis
  198. psychosis
  199. pulmonary edema
  200. pulmonary embolism
  201. pulmonary fibrosis
  202. pulmonary hypertension
  203. purpura
  204. QT prolongation
  205. rash
  206. renal failure (unspecified)
  207. seborrhea
  208. seizures
  209. serotonin syndrome
  210. serum sickness
  211. SIADH
  212. sinusitis
  213. skin discoloration
  214. skin ulcer
  215. Stevens-Johnson syndrome
  216. stomatitis
  217. stroke
  218. suicidal ideation
  219. syncope
  220. synovitis
  221. tardive dyskinesia
  222. teeth grinding (bruxism)
  223. thrombocytopenia
  224. thrombosis
  225. thrombotic thrombocytopenic purpura (TTP)
  226. tinnitus
  227. torsade de pointes
  228. torticollis
  229. toxic epidermal necrolysis
  230. tremor
  231. urinary incontinence
  232. urinary retention
  233. urinary urgency
  234. urticaria
  235. vaginal bleeding
  236. vasculitis
  237. ventricular fibrillation
  238. ventricular tachycardia
  239. vertigo
  240. visual impairment
  241. vomiting
  242. weight gain
  243. weight loss
  244. withdrawal
  245. xerophthalmia
  246. xerostomia
  247. yawning

Monitoring Parameters

  • blood pressure
  • growth rate
  • heart rate
  • thyroid function tests (TFTs)
  • weight

Contraindications

  • abrupt discontinuation
  • anorexia nervosa
  • anticoagulant therapy
  • apheresis
  • AV block
  • bipolar disorder
  • bleeding
  • bone fractures
  • bradycardia
  • breast-feeding
  • cardiomyopathy
  • celiac disease
  • children
  • closed-angle glaucoma
  • dehydration
  • diabetes mellitus
  • diarrhea
  • driving or operating machinery
  • electroconvulsive therapy (ECT)
  • electrolyte imbalance
  • ethanol ingestion
  • females
  • fever
  • geriatric
  • growth inhibition
  • heart failure
  • hepatic disease
  • human immunodeficiency virus (HIV) infection
  • hyperparathyroidism
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hyponatremia
  • hypothermia
  • hypothyroidism
  • hypovolemia
  • increased intraocular pressure
  • long QT syndrome
  • mania
  • MAOI therapy
  • myocardial infarction
  • neonates
  • osteoporosis
  • pheochromocytoma
  • poor metabolizers
  • pregnancy
  • QT prolongation
  • rheumatoid arthritis
  • seizure disorder
  • sickle cell disease
  • sleep deprivation
  • stroke
  • suicidal ideation
  • systemic lupus erythematosus (SLE)
  • thrombolytic therapy
  • ventricular arrhythmias

Interactions

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  • Methysergide
  • Metoclopramide
  • Metolazone
  • Metoprolol
  • Metronidazole
  • Mexiletine
  • Midazolam
  • Midostaurin
  • Mifepristone
  • Miglitol
  • Milnacipran
  • Mirabegron
  • Mirtazapine
  • Modafinil
  • Monoamine oxidase inhibitors
  • Morphine
  • Morphine; Naltrexone
  • Moxifloxacin
  • Nabilone
  • Nanoparticle Albumin-Bound Paclitaxel
  • Naproxen; Sumatriptan
  • Naratriptan
  • Nebivolol
  • Nebivolol; Valsartan
  • Nefazodone
  • Netupitant, Fosnetupitant; Palonosetron
  • Nicardipine
  • Nifedipine
  • Nilotinib
  • Nimodipine
  • Nisoldipine
  • Nitroglycerin
  • Nonsteroidal antiinflammatory drugs
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Olanzapine
  • Olodaterol
  • Ombitasvir; Paritaprevir; Ritonavir
  • Ondansetron
  • Oritavancin
  • Osilodrostat
  • Osimertinib
  • Oxaliplatin
  • Oxybutynin
  • Oxycodone
  • Oxymorphone
  • Ozanimod
  • Paclitaxel
  • Paliperidone
  • Palonosetron
  • Panobinostat
  • Paricalcitol
  • Paroxetine
  • Pasireotide
  • Pazopanib
  • Peginterferon Alfa-2b
  • Pentamidine
  • Pentazocine
  • Pentazocine; Naloxone
  • Pentosan
  • Pergolide
  • Perindopril; Amlodipine
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phenelzine
  • Phentermine
  • Phentermine; Topiramate
  • Phenylephrine; Promethazine
  • Phenytoin
  • Pimavanserin
  • Pimozide
  • Pirbuterol
  • Pitolisant
  • Posaconazole
  • Pramlintide
  • Prasugrel
  • Primaquine
  • Procainamide
  • Procarbazine
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Propoxyphene
  • Propranolol
  • Protriptyline
  • Quazepam
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranolazine
  • Rasagiline
  • Remifentanil
  • Reteplase, r-PA
  • Ribociclib
  • Ribociclib; Letrozole
  • Rilpivirine
  • Risperidone
  • Ritonavir
  • Rivaroxaban
  • Rizatriptan
  • Rolapitant
  • Romidepsin
  • Ruxolitinib
  • Safinamide
  • Salmeterol
  • Salsalate
  • Saquinavir
  • Saxagliptin
  • Selegiline
  • Selpercatinib
  • Semaglutide
  • Sertraline
  • Sevoflurane
  • SGLT2 Inhibitors
  • Short-acting beta-agonists
  • Sibutramine
  • Sildenafil
  • Simeprevir
  • Simvastatin; Sitagliptin
  • Siponimod
  • Sirolimus
  • Sitagliptin
  • Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
  • Sofosbuvir; Velpatasvir
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Spironolactone
  • St. John’s Wort, Hypericum perforatum
  • Streptokinase
  • Sufentanil
  • Sulfonylureas
  • Sumatriptan
  • Sunitinib
  • Tacrolimus
  • Tadalafil
  • Tamoxifen
  • Tamsulosin
  • Tapentadol
  • Tedizolid
  • Telaprevir
  • Telavancin
  • Telithromycin
  • Tenecteplase
  • Terbinafine
  • Terbutaline
  • Tetrabenazine
  • Tezacaftor; Ivacaftor
  • Thiazolidinediones
  • Thiethylperazine
  • Thioridazine
  • Thrombin Inhibitors
  • Thrombolytic Agents
  • Ticagrelor
  • Ticlopidine
  • Timolol
  • Tinzaparin
  • Tiotropium; Olodaterol
  • Tipranavir
  • Tirofiban
  • Tofacitinib
  • Tolterodine
  • Tolvaptan
  • Topiramate
  • Toremifene
  • Torsemide
  • Tramadol
  • Trandolapril; Verapamil
  • Tranylcypromine
  • Trazodone
  • Triamterene
  • Triazolam
  • Triclabendazole
  • Trifluoperazine
  • Trimipramine
  • Triptorelin
  • Ubrogepant
  • Ulipristal
  • Umeclidinium; Vilanterol
  • Urokinase
  • Valbenazine
  • Valerian, Valeriana officinalis
  • Vandetanib
  • Vardenafil
  • Vasopressin, ADH
  • Vemurafenib
  • Venetoclax
  • Venlafaxine
  • Verapamil
  • Vilazodone
  • Vinblastine
  • Vinorelbine
  • Vorapaxar
  • Voriconazole
  • Vorinostat
  • Vortioxetine
  • Warfarin
  • Ziprasidone
  • Zolmitriptan
  • Zolpidem
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