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Depression: patients > 18 years of age - Initially, 20 mg in the morning; increase dosage gradually only after a trial period of several weeks if required. Maximum: 80 mg/day. Elderly patients: 20 mg/day. Use lower or less frequent dosage in patients with renal and/or hepatic impairment and those receiving multiple medications. When switching patients to a TCA, the TCA dosage may have to be reduced and plasma TCA concentrations may need prozac fluoxetine to be monitored temporarily when fluoxetine is coadministered or hs recently been discontinued. Bulimia nervosa: Adults, 60 mg/day. Assess electrolyte levels prior to starting therapy. Obsessive-compulsive disorder: 20 - 60 mg/day. Prozac's long-term efficacy in bulimia (i.e., > 16 weeks) and in obsessive-compulsive disorder (i.e., > 13 weeks) has not been evaluated in controlled trials. Contraindications: Not to be used with prozac fluoxetine an MAOI or within 14 days of discontinuing MAOI therapy. Allow at least prozac fluoxetine 5 weeks after stopping Prozac before starting an MAOI. Do not administer thioridazine with Prozac or within 5 weeks after Prozac has been discontinued. Precautions: Pregnancy, lactation, patients < 18 years of age, elderly patients. History of allergic reactions, seizures, suicidal tendency, activation of mania/hypomania, MI or unstable heart disease, diabetes, severe renal or hepatic impairment, hypokalemia (following self-induced vomiting), hyponatremia, altered platelet function. Safety/efficacy of prozac fluoxetine combined Prozac/electroconvulsive therapy not established. Side effects: Headache, nervousness, insomnia, drowsiness, fatigue or asthenia, prozac fluoxetine anxiety, tremor, dizziness or lightheadedness, nausea, dry mouth, diarrhea, anorexia, excessive sweating. Less frequently, rash, pruritus, weight loss, sexual dysfunction, convulsions. Interactions: See Contraindications. Warfarin (monitor PT). Lithium levels may be increased or decreased (monitor). Use cautiously with other CNS-active drugs (e.g. tryptophan), agents highly bound to plasma protein or metabolized by the P450 2D6 system. St. John's Wort (increase in undesirable effects). Patient tips: Full therapeutic effect may be delayed until 4 or 5 prozac fluoxetine weeks of treatment. May cause drowsiness, dizziness (NB prozac fluoxetine driving). Restrict alcohol intake. Supplied: 10mg, 20 mg prozac fluoxetine capsules; 20 mg/5 mL of mint-flavored syrup, 120 mL bottles. to top Pharmacology Antidepressant - Antiobsessional - Antibulimic The antidepressant, antiobsessional, and prozac fluoxetine antibulimic actions of fluoxetine are presumed to be prozac fluoxetine linked to its ability to inhibit the neuronal reuptake of serotonin. Fluoxetine preferentially inhibited the reuptake prozac fluoxetine of serotonin into brain synaptosomes and platelets in rats and humans. In receptor binding studies, fluoxetine was shown prozac fluoxetine to have only weak affinity for various receptor systems, namely opiate, serotonergic 5HT(1), dopaminergic, beta-adrenergic, alpha(2)-adrenergic, histaminergic, alpha(1)-adrenergic, muscarinic, and serotonergic 5HT(2) receptors. Unlike prozac fluoxetine most clinically effective antidepressants, fluoxetine did not down-regulate beta-adrenergic receptors; however, like all tested antidepressants, it caused up-regulation of GABA-B receptors. Mixed effects have been observed on serotonergic receptor sensitivity. Pharmacokinetics: Fluoxetine is well absorbed after oral administration. In man, following a single 40 mg dose, peak plasma concentrations of fluoxetine ranged from 15 to 55 ng/mL 6 to 8 hours after dosing (range=1.5 to 12 hours). The prozac fluoxetine capsule and oral solution dosage forms of fluoxetine are bioequivalent. Food appears to affect the rate but not the extent of absorption. Fluoxetine is extensively metabolized in the liver to norfluoxetine, and other, unidentified metabolites. Norfluoxetine, a desmethyl metabolite, is also a serotonin reuptake inhibitor; its pharmacological activity being similar to that of the parent drug. Norfluoxetine contributes to the long duration of action of fluoxetine. Elimination of metabolites occurs primarily in the urine with a smaller amount also being present in the feces. Clinical Issues Related to Metabolism/Elimination: The prozac fluoxetine complexity prozac fluoxetine of fluoxetine's metabolism has several consequences which may potentially affect its clinical use. Accumulation and Slow Elimination: The half-life of fluoxetine after a single dose is 2 days (range 1 to 4 days) and prozac fluoxetine after multiple dosing 4 days (range 2 to 7 days). The corresponding values for norfluoxetine are similar after single and multiple dosing, i.e., 8.6 and 9.3 days (range 4 to 15 days). After 30 days of dosing at 40 mg/day, plasma concentrations of fluoxetine and norfluoxetine ranged from 91 to 302 ng/mL and 72 to 258 ng/mL respectively. Plasma concentrations of fluoxetine were higher than those predicted from single dose studies, presumably because fluoxetine's metabolism is prozac fluoxetine not proportional to dose. Norfluoxetine, however, appears to have linear pharmacokinetics. Steady state plasma levels are attained after 4 to prozac fluoxetine 5 weeks of continuous drug administration. Patients receiving fluoxetine at doses of 40 to 80 mg/day over periods as long as 3 years exhibited, on average, plasma concentrations similar to those seen among prozac fluoxetine patients treated for 4 to 5 weeks. prozac fluoxetine Similarly because of the long prozac fluoxetine half-lives of fluoxetine and norfluoxetine, it may take up to 1 to 2 months for the active drug substance to disappear from the body. This is of potential consequence in withdrawal of fluoxetine (see Warnings). Protein Binding: Approximately 94% of fluoxetine is prozac fluoxetine protein bound. The interaction between fluoxetine and other highly protein bound drugs has not been fully prozac fluoxetine evaluated, but may be important (see Precautions). Liver Disease: As might be predicted from its primary site of metabolism, liver impairment can affect the elimination of fluoxetine. In patients with alcohol-induced cirrhosis, the elimination half-life of fluoxetine was prolonged, with a mean of prozac fluoxetine 7.6 days compared to the prozac fluoxetine range of 2 to prozac fluoxetine 3 days seen in subjects without liver disease; norfluoxetine elimination half-life was also delayed, with a mean duration of 12 days for cirrhotic patients compared to the range of 7 to 9 days in normal subjects. This suggests that the use of fluoxetine in patients with liver disease must be approached with caution prozac fluoxetine (see Precautions and Dosage). Renal Disease: In single dose studies, the pharmacokinetics of fluoxetine and norfluoxetine were similar prozac fluoxetine among subjects with all levels of impaired renal function including anephric patients on chronic hemodialysis. However, with chronic administration, additional accumulation of prozac fluoxetine fluoxetine or its metabolites (possibly including some not yet identified) may occur in patients with severely impaired prozac fluoxetine renal function and use prozac fluoxetine of a lower or less frequent dose is advised (see Precautions). Age: The effects of age upon the metabolism of fluoxetine have not been fully explored. The disposition of single doses of fluoxetine in healthy elderly subjects (greater than 65 years of age) did not differ prozac fluoxetine significantly from that in younger normal subjects. However, given the long half-life and nonlinear disposition of the drug, a single-dose study is not adequate to prozac fluoxetine rule out the possibility of altered pharmacokinetics in the elderly, particularly if they have systemic illness or are prozac fluoxetine receiving multiple drugs for concomitant diseases. to top Indications Depression: For prozac fluoxetine the symptomatic relief of depressive illness. Bulimia Nervosa: Fluoxetine has been shown to significantly decrease prozac fluoxetine binge-eating and purging activity when compared with placebo treatment. Obsessive-Compulsive Disorder: Fluoxetine prozac fluoxetine has been shown to significantly reduce the symptoms of obsessive-compulsive disorder in double-blind, placebo-controlled clinical trials. The obsessions or compulsions must be experienced as prozac fluoxetine intrusive, markedly distressing, time-consuming, or prozac fluoxetine interfering significantly with the person's social or occupational functioning. The efficacy of fluoxetine in hospitalized patients has not been studied. The effectiveness prozac fluoxetine of fluoxetine in long-term use (i.e., for more than 5 to 6 weeks in depression, for more than 16 weeks in bulimia nervosa, or prozac fluoxetine for more than 13 weeks in obsessive compulsive disorder), has not been systematically evaluated in controlled trials. Therefore, the physician prozac fluoxetine who elects to use fluoxetine for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient. to top Contraindications In patients with known hypersensitivity to the drug. MAO Inhibitors: There have been reports of serious, sometimes fatal, reactions (including hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma) in patients receiving fluoxetine in combination with a MAO inhibitor and in patients who have recently discontinued fluoxetine and then started on a MAO prozac fluoxetine inhibitor. Some cases presented with features resembling neuroleptic malignant syndrome. Therefore, fluoxetine should prozac fluoxetine not be used in combination with a prozac fluoxetine MAO inhibitor or within 14 days of discontinuing therapy with a MAO inhibitor. Since fluoxetine and its major metabolite prozac fluoxetine have very long elimination prozac fluoxetine half-lives, at least 5 weeks should be allowed after stopping fluoxetine before starting a MAO inhibitor. prozac fluoxetine Limited reports suggest that i.v. administered dantrolene or orally administered cyproheptadine may benefit patients experiencing such reactions. to top Warnings Allergic Reactions (Rash and Accompanying Events): During premarketing testing of more than 5600 patients given fluoxetine, approximately 4% developed a rash and/or urticaria. Among these cases, almost a third were withdrawn from treatment because of the rash and/or systemic signs or symptoms associated with the rash. Clinical findings reported in association with these allergic reactions include rash, fever, leukocytosis, arthralgias, edema, carpal tunnel syndrome, respiratory distress, lymphadenopathy, proteinuria, and mild transaminase elevation. Most patients improved promptly with discontinuation of fluoxetine and/or adjunctive treatment with antihistamines or steroids, prozac fluoxetine and all patients experiencing these events were reported to recover completely. In prozac fluoxetine premarketing clinical trials 2 patients are known to have developed a serious cutaneous systemic illness. In neither patient was there an unequivocal diagnosis, but one prozac fluoxetine was considered to have a leukocytoclastic vasculitis, and the other severe prozac fluoxetine desquamation that was considered variously to be a vasculitis or erythema multiforme. Other patients have had systemic prozac fluoxetine manifestations suggestive prozac fluoxetine of serum sickness. Since the introduction of fluoxetine, systemic events, possibly related prozac fluoxetine to prozac fluoxetine vasculitis, have developed in patients with rash. Although these events are rare, they may be serious, involving the lung, kidney, or liver. Death has been reported to occur in association with these systemic events. Anaphylactoid events, including bronchospasm, angioedema, and urticaria alone and in combination, have been reported. Pulmonary events, including inflammatory processes of varying histopathology and/or fibrosis, have been reported rarely. These events have occurred with dyspnea as the only preceding prozac fluoxetine symptom. Whether these systemic events and rash have a common underlying cause or are due to different etiologies or pathogenic processes is not known. Furthermore, a specific underlying immunologic basis for these events has not been identified. Upon the appearance of rash or of other allergic phenomena for which an alternative etiology cannot be identified, fluoxetine should be discontinued. Particular caution should be exercised in patients with a history of allergic reactions. Implications of the Long Elimination Half-Life of Fluoxetine: Because of the long elimination half-lives of fluoxetine and its major active prozac fluoxetine metabolite norfluoxetine, 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 (see Pharmacology prozac fluoxetine and Dosage). Even when dosing is stopped, active drug substance will persist in the body for weeks due to the long elimination half-lives of fluoxetine and norfluoxetine. prozac fluoxetine This is of potential consequence when drug discontinuation is required or when drugs are prescribed that might interact with fluoxetine and norfluoxetine following prozac fluoxetine discontinuation of fluoxetine. to top Precautions Anxiety and Insomnia: During premarketing clinical trials, anxiety, nervousness and insomnia were reported by 10 to 15% of patients treated with fluoxetine. These symptoms led to discontinuation of the drug in 5% of the patients. Weight Change: Significant weight loss, especially in underweight depressed patients, may be an undesirable result of treatment with fluoxetine. Mania/Hypomania: During premarketing clinical trials in a patient population comprised primarily of unipolar depressives, hypomania or mania occurred in approximately 1% of fluoxetine treated patients. The incidence in a general patient population which might also include bipolar depressives is unknown. The likelihood of hypomanic or manic episodes may be increased at the higher dosage levels. Such reactions prozac fluoxetine require a reduction in dosage or discontinuation of the drug. Seizures: Fluoxetine should be used with caution in patients with a history of convulsive disorders. The incidence of seizures associated prozac fluoxetine with fluoxetine during clinical trials did not appear to differ from that prozac fluoxetine reported with other marketed prozac fluoxetine antidepressants; however, patients with a history of convulsive disorders were excluded from these trials. Concurrent prozac fluoxetine administration with electroshock therapy should prozac fluoxetine be avoided because of the absence of experience in this area. There have been rare reports prozac fluoxetine of a prolonged seizure in patients on fluoxetine receiving ECT treatment. Hypokalemia: Self-induced vomiting often leads to hypokalemia which may lower seizure threshold and/or may lead to cardiac conduction abnormalities. Electrolyte levels of bulimic patients should be assessed prior prozac fluoxetine to initiation of treatment. Suicide: The possibility of a suicide attempt is inherent in depression and may persist until significant remission occurs. Therefore, high risk patients should be closely supervised throughout therapy and consideration should be given to the possible need for hospitalization. In order to minimize the opportunity for overdosage, prescriptions for fluoxetine should be written for the smallest quantity of drug consistent with good patient management. Concomitant Illness: Clinical experience with fluoxetine in patients with concomitant systemic illness is limited and it should be used cautiously in such patients, especially those with diseases or conditions that could affect metabolism or hemodynamic responses. Fluoxetine has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease. Patients with these prozac fluoxetine diagnoses were systematically excluded from premarketing clinical studies. Retrospective evaluation of ECGs in some of these studies showed no conduction abnormalities that resulted in heart block. The mean heart rate was reduced by approximately 3 beats/minute. Fluoxetine prozac fluoxetine should be given with caution to patients suffering from anorexia nervosa and only if the expected benefits (e.g., co-morbid depression) markedly outweigh the potential weight reducing effect of the drug. In patients with diabetes, fluoxetine may alter glycemic control. Hypoglycemia has occurred during therapy with fluoxetine and hyperglycemia has developed following discontinuation of the drug. As is true with many other types of medication when taken concurrently by patients with diabetes, insulin and/or oral hypoglycemic dosage may prozac fluoxetine need to be adjusted when therapy with fluoxetine is instituted or discontinued. prozac fluoxetine Since fluoxetine is extensively metabolized, excretion of unchanged drug in urine is a minor route of elimination. However, until adequate numbers of patients with severe renal impairment have been evaluated in the course of chronic treatment, fluoxetine should be used with caution in such patients. Since clearances of fluoxetine and norfluoxetine may be prozac fluoxetine decreased prozac fluoxetine in patients with impaired liver function including cirrhosis, a prozac fluoxetine lower or less frequent dose should be used in such patients. Hyponatremia: Several cases of hyponatremia (some with serum sodium lower than 110 mmol/L) have been reported. The hyponatremia appeared to be reversible when fluoxetine was prozac fluoxetine discontinued. Although these cases were complex with varying prozac fluoxetine possible prozac fluoxetine etiologies, some were possibly due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The majority of these occurrences have been in older patients and prozac fluoxetine in patients taking diuretics or who were otherwise volume depleted. Platelet Function: There have been rare reports of altered platelet function and/or abnormal results from laboratory studies in patients taking fluoxetine. While there have been reports of abnormal bleeding in several patients taking fluoxetine, it is unclear whether fluoxetine had a causative role. Occupational Hazards: Patients should be cautioned against driving an automobile or performing hazardous tasks until they are reasonably certain that treatment with fluoxetine does not affect them adversely. prozac fluoxetine Pregnancy and Lactation: Safe use of fluoxetine during pregnancy and lactation has not been established. Therefore, it should not be administered to women of childbearing potential prozac fluoxetine or nursing mothers unless, in the opinion of the treating physician, the expected benefits to the patient markedly outweigh the possible hazards to the child or fetus. In 1 breast milk sample, the concentration of fluoxetine plus norfluoxetine was 70.4 ng/mL. The concentration in the mother's plasma was 295 ng/mL. No adverse effects on the infant were reported. Children: Safety and effectiveness in patients below the age of 18 have not been established. Geriatrics: Elderly patients should initially receive fluoxetine in low dosage with slow progressive increases only if required prozac fluoxetine and tolerated. Patients who have concomitant systemic illnesses or who are receiving other drugs concomitantly should be under careful observation at all dosage levels. Drug Interactions: Combined use of fluoxetine and MAO inhibitors is contraindicated (see Contraindications). There have been greater than 2-fold increases of previously stable plasma levels of other antidepressants when fluoxetine has been administered in combination with these agents. There have been reports of both increased and decreased lithium levels when lithium was used concomitantly with fluoxetine. Cases of lithium toxicity have been reported. Lithium levels should be monitored when these drugs are administered concomitantly. Five patients receiving fluoxetine in combination with tryptophan experienced adverse reactions, including agitation, restlessness and gastrointestinal distress. The half-life of concurrently administered diazepam may be prolonged in some patients. Experience prozac fluoxetine with the use of fluoxetine in combination with other CNS-active drugs is limited and caution is advised if such concomitant medication is required (see Warnings). Drugs Tightly Bound to Plasma Protein: Because fluoxetine is highly bound to plasma protein, the administration of fluoxetine to a prozac fluoxetine patient taking another drug which is tightly bound to protein (e.g., warfarin, digitoxin) may cause a shift in plasma concentrations potentially resulting in an adverse effect. Conversely, adverse effects may result from displacement of protein bound fluoxetine by other tightly bound drugs. P450 isozyme (IID6): Like other selective serotonin reuptake inhibitors, fluoxetine inhibits the specific hepatic cytochrome P450 isozyme (IID6) which is responsible for the metabolism prozac fluoxetine of debrisoquine and sparteine. Although the clinical significance of this effect has not been established, inhibition of IID6 may lead to elevated plasma levels of co-administered drugs which are metabolized by this isozyme. Drugs metabolized by cytochrome P450IID6 include prozac fluoxetine the tricyclic antidepressants (e.g., nortriptyline, amitriptyline, imipramine, and desipramine), phenothiazine neuroleptics (e.g., perphenazine and thioridazine), and Type prozac fluoxetine 1C prozac fluoxetine antiarrhythmics (e.g., propafenone and prozac fluoxetine flecainide). General Anesthetics: Since little is known about the interaction between fluoxetine and general anesthetics, fluoxetine should be discontinued for as long as clinically possible prior to elective surgery. Dependence Liability: Fluoxetine has not been systematically studied, prozac fluoxetine in animals or humans, for its potential for abuse, tolerance, or physical dependence. Physicians should carefully evaluate patients for history of drug abuse and follow such patients closely, observing them for signs prozac fluoxetine of prozac fluoxetine misuse or abuse of fluoxetine. to top Adverse Effects Commonly Observed: In clinical trials, the most commonly observed adverse events prozac fluoxetine associated with the use of fluoxetine and not seen at an equivalent incidence among placebo treated patients were: CNS complaints, including headache, nervousness, insomnia, drowsiness, fatigue or asthenia, anxiety, tremor, and dizziness or lightheadedness; gastrointestinal complaints, including nausea, diarrhea, dry mouth and anorexia; and excessive sweating. Adverse Events Leading to Discontinuation of Treatment: Fifteen percent of approximately 4000 patients who received fluoxetine in North American clinical trials discontinued treatment due to an adverse event. The more common events causing discontinuation included: Psychiatric, primarily nervousness, anxiety, and insomnia; digestive, primarily prozac fluoxetine nausea; nervous system, primarily dizziness, asthenia prozac fluoxetine and headaches; skin, primarily rash and pruritus. In obsessive compulsive disorder studies, 12.1% of fluoxetine treated patients discontinued treatment early because of adverse events. Anxiety, and rash, at incidences of less than 2%, were the most prozac fluoxetine frequently reported events. In bulimia nervosa studies, 10.2% of fluoxetine treated patients discontinued prozac fluoxetine treatment early because of prozac fluoxetine adverse events. Insomnia, anxiety and rash, at incidences of less than 2%, were the most frequently reported events. Serious Adverse Reactions: Suicidal thoughts and acts are prozac fluoxetine far more common among depressed patients prozac fluoxetine than in the general population. It is estimated that suicide is 22 to 36 times more prevalent in depressed persons than in the general population. A comprehensive meta-analysis of pooled data from 17 double blind clinical trials in patients with major depressive disorder compared fluoxetine (n=1765) with a tricyclic antidepressant (n=731) or placebo (n=569), or both. The pooled incidence of emergence of substantial suicidal ideation was 1.2% for fluoxetine, 2.6% for placebo, and 3.6% for prozac fluoxetine tricyclic antidepressants. In countries prozac fluoxetine where the drug has already been marketed, prozac fluoxetine the following potentially serious adverse reactions have been reported: Interactions with MAO inhibitors and possibly other drugs, allergic reactions, cardiovascular reactions, syndrome of inappropriate prozac fluoxetine ADH secretion, and grand mal seizure. Death and life-threatening events have been associated with some of these reactions, although causal relationship to fluoxetine has not been prozac fluoxetine established. Postmarketing experience also confirms the profile of adverse reactions commonly reported during clinical trials with fluoxetine, including allergic skin reactions. prozac fluoxetine Adverse Experience Reports: The pattern of adverse events for both fluoxetine and placebo was somewhat different in prozac fluoxetine bulimia and obsessive compulsive disorder trials than in the depression studies, and is summarized in Table I. -------------------------------------------------------------------------------------------- Table I Treatment-Emergent Adverse Experience Incidence (>=5%) in Placebo-Controlled Clinical Trials for Depression, Obsessive-Compulsive Disorder and Bulimia Percentage of Patients Reporting Event Depression OCD Bulimia Body System/ Fluoxetine Placebo Fluoxetine Placebo Fluoxetine Placebo Adverse Event (N=1730) (N=799) (N=264) (N=89) (N=418) prozac fluoxetine (N=210) Nervous headache 20.3 15.5 32.6 23.6 30.1 26.9 nervousness 14.9 8.5 14.4 14.6 10.8 5.2 insomnia 13.8 prozac fluoxetine 7.1 29.6 22.5 33.1 15.0 somnolence 11.6 6.3 17.1 6.7 12.7 7.1 anxiety 9.4 5.5 13.6 6.7 16.3 11.1 tremor 7.9 2.4 9.1 1.1 13.7 2.0 dizziness 5.7 3.3 13.3 11.2 11.4 5.4 libido, decreased - - 11.4 2.3 5.9 0.9 depression - - 8.0 14.6 10.1 16.4 emotional lability - - - - 2.7 prozac fluoxetine 7.8 Digestive nausea 21.1 10.1 26.5 prozac fluoxetine 13.5 29.7 13.5 diarrhea 12.3 7.0 18.2 13.5 7.5 6.7 dry mouth 9.5 6.0 12.1 3.4 9.9 8.6 anorexia 8.7 1.5 16.7 10.1 8.8 4.4 dyspepsia 6.4 4.3 9.9 4.5 10.7 6.7 gastrointestinal disorder - - 5.7 1.1 5.7 5.9 constipation prozac fluoxetine - - 4.2 6.7 4.8 4.6 flatulence - - 3.4 5.6 - - Skin and Appendages sweating, excessive 8.4 3.8 7.2 - 8.9 1.6 rash - - 6.4 3.4 5.1 4.9 Body as a Whole asthenia - - 15.2 10.1 21.7 9.6 flu syndrome - - 9.9 6.7 10.1 5.9 back pain - - 2.7 5.6 3.9 7.0 infection - - - - 6.2 6.2 abdominal pain - - 4.9 11.2 9.6 6.5 myalgia - - - - 4.7 9.4 Respiratory upper respiratory infection 7.6 6.0 - - - - rhinitis - - 22.7 23.6 23.0 29.1 pharyngitis - prozac fluoxetine - 10.6 9.0 11.1 5.5 sinusitis - - - - 5.7 6.9 yawn - - 7.2 - 11.1 0.8 Cardiovascular vasodilatation - - 5.3 - - - Urogenital menstrual disorder - - 3.4 5.6 8.3 4.8 dysmenorrhea - - 3.4 5.6 6.1 7.8 urinary frequency - - - - 6.2 1.6 urinary tract infection - - - - 5.1 2.0 -------------------------------------------------------------------------------------------- The following adverse reactions, were reported on at least one occasion by patients during treatment with fluoxetine either during clinical trials or after marketing. All reported events are included except those where a drug cause was remote prozac fluoxetine or the event term so general as to be prozac fluoxetine unhelpful. Multiple events may have been reported by a single patient prozac fluoxetine and related to prozac fluoxetine a single condition, which may have preexisted. Therefore, while the following events occurred during treatment with fluoxetine, they were prozac fluoxetine not necessarily caused by it. Events are further classified within body system categories and enumerated in order of decreasing frequency using the following definitions: Frequent adverse prozac fluoxetine events are defined as those occurring on 1 or more occasions in at least 1% of patients; infrequent adverse events are those occurring prozac fluoxetine in less than 1% but at least 1/1000 patients; rare events are those occurring in less than 1/1000 patients. Allergic or Toxic: Frequent: Rash, pruritus. Infrequent: Chills and fever, urticaria, maculopapular rash. Rare: Allergic reaction, erythema multiforme, vesiculobullous rash, serum sickness, contact dermatitis, erythema nodosum, purpuric rash, leukocytoclastic vasculitis, leukopenia, thrombocythemia, arthralgia, angioedema, bronchospasm, lung fibrosis, allergic alveolitis, larynx edema, prozac fluoxetine respiratory distress. Neurologic: Frequent: Headache, tremor, dizziness or lightheadedness, asthenia. Infrequent: Abnormal gait, ataxia, akathisia, buccoglossal syndrome, hyperkinesia, prozac fluoxetine hypertonia, incoordination, neck rigidity, extrapyramidal syndrome, convulsions, photophobia, myoclonus, vertigo, migraine, tinnitus, hypesthesia, neuralgia, neuropathy, acute brain syndrome. Rare: Dysarthria, dystonia, torticollis, prozac fluoxetine decreased reflexes, nystagmus, paralysis, paresthesia, carpal tunnel syndrome, stupor, coma, abnormal EEG, chronic brain syndrome, dyskinesia and prozac fluoxetine other movement disorders (including worsening of preexisting conditions prozac fluoxetine or appearance in patients with risk factors [e.g., Parkinson's disease, prozac fluoxetine treatment with neuroleptics or other drugs known to be associated with movement disorders]) neuroleptic malignant syndrome-like events. Behavioral: Frequent: Insomnia, anxiety, nervousness, agitation, abnormal dreams, drowsiness and fatigue. Infrequent: Confusion, delusions, hallucinations, manic reaction, paranoid reaction, psychosis, depersonalization, apathy, emotional lability, euphoria, hostility, amnesia, increased libido. Rare: Antisocial reaction, hysteria, suicidal ideation, violent behaviors. Autonomic: Frequent: Excessive sweating. Infrequent: Dry mouth, constipation, urinary retention, vision disturbance, diplopia, mydriasis, hot flushes. Cardiovascular: Infrequent: Chest pain, hypertension, syncope, hypotension prozac fluoxetine (including postural hypotension), prozac fluoxetine angina pectoris, prozac fluoxetine arrhythmia, tachycardia. Rare: Bradycardia, ventricular arrhythmia, first degree AV block, bundle branch block, myocardial prozac fluoxetine infarct, cerebral ischemia, cerebral vascular accident, thrombophlebitis. Gastrointestinal: Frequent: Nausea, disturbances of appetite, diarrhea. Infrequent: Vomiting, prozac fluoxetine stomatitis, dysphagia, eructation, esophagitis, gastritis, gingivitis, glossitis, melena, thirst, abnormal liver function tests. Rare: Bloody diarrhea, hematemesis, gastrointestinal hemorrhage, duodenal ulcer, stomach prozac fluoxetine ulcer, mouth ulceration, hyperchlorhydria, colitis, enteritis, cholecystitis, cholelithiasis, hepatitis, hepatomegaly, liver tenderness, jaundice, increased salivation, salivary gland enlargement, tongue discoloration, fecal incontinence, pancreatitis. Respiratory: Frequent: Bronchitis, rhinitis, yawn. Infrequent: Asthma, dyspnea, hyperventilation, pneumonia, prozac fluoxetine hiccups, epistaxis. Rare: Apnea, lung edema, hypoxia, pleural effusion, hemoptysis. Endocrine: Frequent: Weight loss. Infrequent: Generalized edema, peripheral edema, face edema, tongue edema, hypoglycemia, hypothyroidism, weight gain. Rare: Dehydration, gout, goitre, hyperthyroidism, hypercholesteremia, hyperglycemia, hyperlipemia, hyperprolactinemia, prozac fluoxetine hypokalemia, hyponatremia, iron deficiency anemia, syndrome of inappropriate ADH secretion. Hematologic: Infrequent: Anemia, lymphadenopathy, hemorrhage. Rare: Bleeding time increased, leukocytosis, lymphocytosis, thrombocytopenia, thrombocytopenic purpura, thrombocythemia, retinal hemorrhage, petechia, purpura, prozac fluoxetine sedimentation rate increased, aplastic anemia, pancytopenia, prozac fluoxetine immune-related hemolytic anemia. Dermatologic: Infrequent: Acne, alopecia, dry skin, herpes simplex. Rare: Eczema, psoriasis, seborrhea, skin hypertrophy, skin discoloration, herpes zoster, fungal dermatitis, hirsutism, ecchymoses. Musculoskeletal: Frequent: Muscle pain, back pain, joint pain. Infrequent: Arthritis, bone pain, bursitis, tenosynovitis, twitching. Rare: Bone necrosis, osteoporosis, pathological fracture, chrondrodystrophy, myositis, prozac fluoxetine rheumatoid arthritis, muscle hemorrhage. Urogenital: Frequent: Painful menstruation, sexual dysfunction, urinary tract infection, frequent micturition. Infrequent: Abnormal ejaculation, impotence, menopause, amenorrhea, menorrhagia, ovarian disorder, vaginitis, leukorrhea, fibrocystic breast, breast pain, cystitis, dysuria, prozac fluoxetine urinary urgency, urinary incontinence. Rare: Breast enlargement, galactorrhea, abortion, dyspareunia, uterine spasm, vaginal prozac fluoxetine hemorrhage, metrorrhagia, hematuria, albuminuria, polyuria, pyuria, epididymitis, orchitis, pyelonephritis, salpingitis, urethritis, kidney calculus, urethral pain, urolithiasis. Miscellaneous: Frequent: Chills. Infrequent: prozac fluoxetine Amblyopia, conjunctivitis, cyst, ear pain, eye pain, jaw pain, neck pain, pelvic pain, hangover effect, malaise. Rare: Abdomen enlarged, blepharitis, cataract, corneal lesion, glaucoma, iritis, ptosis, strabismus, deafness, taste loss, moniliasis, hydrocephalus, LE syndrome. to top Overdose During clinical trials, there were 2 deaths among approximately 38 reports of acute overdose with fluoxetine, either alone or in combination with other drugs and/or alcohol. One death prozac fluoxetine involved a combined overdose with approximately 1800 mg of fluoxetine and an undetermined prozac fluoxetine amount of maprotiline. Plasma concentrations of fluoxetine and maprotiline were 4.57 mg/L and 4.18 mg/L, respectively. A second death involved 3 drugs yielding plasma concentrations as follows: Fluoxetine, 1.93 mg/L; norfluoxetine, 1.10 mg/L; codeine, 1.80 mg/L; temazepam 3.80 mg/L. One other patient who reportedly took up to 3000 mg of fluoxetine experienced 2 grand mal seizures that remitted spontaneously without specific treatment. Since vomiting occurred, the amount of drug absorbed may prozac fluoxetine have prozac fluoxetine been less than that ingested. In the postmarketing phase, there have been 16 confirmed reports of overdose of fluoxetine taken alone. The amount of drug ingested has varied from prozac fluoxetine 80 mg to 2000 mg and the patients have ranged in age from 13 to 51 years. There have been no deaths in this group prozac fluoxetine of patients, some of whom were treated vigorously with activated charcoal in the acute phase. Furthermore, patient recoveries were remarkable in the prozac fluoxetine absence of serious adverse events with the exception of a 13 year old male who ingested 1880 mg and experienced 2 brief seizures but thereafter had an uneventful recovery. Since introduction, reports of death attributed to overdose of fluoxetine alone have been rare. Symptoms: Nausea and vomiting were prominent in overdoses involving higher fluoxetine doses. Other prominent symptoms of overdose included agitation, restlessness, hypomania, and other signs of CNS excitation, including seizures. Treatment: Establish and maintain an airway; ensure adequate oxygenation and prozac fluoxetine ventilation. Activated charcoal, which may be used with sorbitol, may be as prozac fluoxetine or more effective than emesis or lavage, and should be considered in treating overdose. Cardiac and vital signs monitoring is recommended, along with general symptomatic and supportive measures. Based on experience in animals, which may not be relevant to humans, fluoxetine-induced seizures which fail to remit spontaneously may respond to diazepam. There are no specific antidotes for fluoxetine. Due to the large volume of distribution of fluoxetine, forced diuresis, dialysis, prozac fluoxetine hemoperfusion, and exchange transfusion are unlikely to be of benefit. In managing overdosage, prozac fluoxetine consider the possibility of multiple drug involvement. The physician should consider contacting a poison control prozac fluoxetine centre on the treatment of any overdosage. to top Dosage Since it may take up prozac fluoxetine to 4 or 5 weeks to reach steady state plasma levels of fluoxetine, sufficient time should be allowed to elapse before dosage is gradually increased. Higher dosages are usually associated with an increased incidence prozac fluoxetine of adverse reactions. Depression: Adults: The recommended initial dosage is 20 mg administered once daily in the morning. A gradual dose increase should be considered prozac fluoxetine only after a trial period of several weeks if the expected clinical improvement does not occur. Bulimia Nervosa: Adult: The recommended prozac fluoxetine dosage is 60 mg/day, although studies show that lower doses may prozac fluoxetine also be efficacious. Electrolyte levels should be assessed prior to initiation of treatment. Obsessive-Compulsive Disorder: A dose range of 20 mg/day to 60 mg/day is recommended for the treatment of obsessive-compulsive disorder. For any indication, the total fluoxetine dosage should not exceed a maximum of 80 mg/day since clinical experience with doses above 80 prozac fluoxetine mg/day is very limited. During maintenance therapy, the dosage should be kept at the lowest effective level. A lower or less frequent prozac fluoxetine dosage should be used in patients with prozac fluoxetine renal and/or hepatic impairment and in those on multiple medications. Geriatrics: A lower prozac fluoxetine or less frequent dosage prozac fluoxetine is also recommended in the elderly. Children: The safety and effectiveness of fluoxetine in prozac fluoxetine patients below prozac fluoxetine the age of 18 years have not been established. to top Supplied Liquid: Each 5 mL clear, colorless, syrup solution, with an odor of mint, contains: Fluoxetine HCl equivalent to fluoxetine 20 mg. Nonmedicinal ingredients: Benzoic acid, glycerin, prozac fluoxetine mint flavor, purified water and sucrose. Amber glass bottles prozac fluoxetine of 120 mL (M-5120). Capsules: 10 mg: Each green and grey capsule, printed with Lilly 3104 and Prozac 10 mg, contains: Fluoxetine HCl equivalent to fluoxetine 10 mg. Nonmedicinal ingredients: prozac fluoxetine Silicone and starch. prozac fluoxetine The capsule shell prozac fluoxetine contains FD&C Blue No. 1, iron oxide yellow, titanium dioxide, gelatin, sodium lauryl prozac fluoxetine sulfate, sodium propionate, benzyl alcohol, methylparaben, carboxymethylcellulose sodium and edetate calcium disodium. Amber bottles of 30 and 100. 20 mg: Each green and white prozac fluoxetine capsule, printed with Lilly 3105 and Prozac 20 mg, prozac fluoxetine contains: Fluoxetine HCl equivalent to fluoxetine prozac fluoxetine 20 prozac fluoxetine mg. Nonmedicinal prozac fluoxetine ingredients: Silicone and starch. The capsule shell contains FD&C Blue No. 1, iron oxide yellow, titanium dioxide, gelatin, sodium lauryl sulfate, sodium propionate, benzyl alcohol, methylparaben, carboxymethylcellulose sodium and edetate calcium disodium. Amber bottles of 100. Store at 15 to 25°C. to top Research The research information is available separately on Internet Mental Health. Note: This information is from a Canadian monograph. There can be differences in indications, dosage forms and warnings for this drug in other countries. to top Internet Mental Health (www.mentalhealth.com) copyright © 1995-2005 by Phillip W. Long, M.D. Prozac (fluoxetine) - The Crazy Meds run-down US Brand Name: Prozac A link here prozac fluoxetine will take you to prozac fluoxetine the official website for the drug. See below for additional brand names Generic Name: fluoxetine hydrochloride Other Forms: Prozac Weekly, Sarafem (for PMDD), oral solution Class: Antidepressant, specifically SSRI. Read up on these sections if you haven't done so already, because they cover a lot of information about multiple medications that I'm not going to prozac fluoxetine repeat on many pages. I'm just autistic that way about not repeating myself. FDA Approved Uses: Major Depression, Obsessive-Compulsive Disorder, Panic Disorder, Bulima Nervosa, Premenstrual Dysphoric Disorder (as Sarafem). Prozac (fluoxetine hydrochloride) is the only SSRI (and modern antidepressant in general) approved for use by the under-18 set for depression, probably due to its long half-life and lower potency. Off-Label Uses: prozac fluoxetine Fibromyalgia, Arthritis, Chronic Fatigue, Multiple Sclerosis, Bipolar Depression, Lupus, Headaches, Irritable Bowel Syndrome (IBS), ADD/ADHD, Premature Ejaculation, Autistic Spectrum Disorders Prozac's pros and cons:Pros: Prozac's long half-life makes the issue of prozac fluoxetine med compliance a little less of a big deal, hence the approval for depressed teenagers. prozac fluoxetine It prozac fluoxetine also has studies backing it up for PMDD, by Lilly and independent researchers, including the Amen clinic, where I'm treated. You can prozac fluoxetine see at the Amen Clinic's case studies in practice the more common form of PMDD that responds to SSRIs will respond to whichever SSRI you get along with the best. Prozac Weekly does have an advantage for certain forms of PMDD. Cons: That really long half-life means it prozac fluoxetine takes forever to wean yourself off of Prozac (fluoxetine hydrochloride) to avoid SSRI discontinuation syndrome. But only if the discontinuation syndrome hits prozac fluoxetine you hard, which is fairly uncommon with Prozac (fluoxetine hydrochloride). In fact some more enlightened doctors will prescribe the liquid form to help wean patients off of other SSRIs and Effexor (venlafaxine). The sexual side effects, though, are pretty bad. For being the weakest prozac fluoxetine of the SSRIs prozac fluoxetine the side effects are pretty gnarly. Prozac's side effects: Typical Side Effects: The usual for SSRIs - headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation, weight gain, loss of prozac fluoxetine libido. Most everything but the weight gain and loss of libido usually goes away within a couple of weeks. With Prozac prozac fluoxetine (fluoxetine hydrochloride) it's a coin toss as to losing or gaining weight. Sometimes it will just kill your appetite. For tips on how to cope with these side prozac fluoxetine effects, please see our side effects page. These aren't all prozac fluoxetine the side effects possible, just the most prozac fluoxetine popular ones. Not prozac fluoxetine So Common Side Effects: Rash, 'flu-like symptoms, anger/rage. These may or may not happen to you prozac fluoxetine don't, so don't be surprised one way or the other. Freaky Rare Side Effects: Bleeding gums, amnesia, anti-social prozac fluoxetine reaction (oh, come on, like we're not anti-social already), herpes (again, blaming the med for an STD), excessive hair growth, engorged breasts, involuntary tongue protrusion (in prozac fluoxetine one 77-year-old woman who stopped sticking her tongue out at everyone after they stopped giving her Prozac (fluoxetine hydrochloride)). You aren't going to get these. I promise. Interesting Stuff Your Doctor Probably Won't Tell You: Prozac prozac fluoxetine (fluoxetine hydrochloride) has been found to make prozac fluoxetine a lot of other drugs work better. Great, huh? Not always, as with prozac fluoxetine some meds it can be to the point of overdose. But it was that effect that lead to the breakthrough of the antipsychotic & antidepressant cocktail to treat bipolar depression. Anyway, Tegretol (carbamazepine) could suddenly get toxic on you and Xanax (alprazolam) could knock you prozac fluoxetine out if you add Prozac (fluoxetine hydrochloride) to them, or add them to Prozac prozac fluoxetine (fluoxetine hydrochloride), so be careful and always prozac fluoxetine check your drug-drug interactions! A big part of this is the usual pharmacokinetic stuff of liver enzymes being able to deal with only so much, and Prozac (fluoxetine hydrochloride) gives your liver a bit of a workout. But that doesn't explain the entire effect of all of the prozac fluoxetine drug-drug interactions. There's some pharmacodynamic (how meds work in your brain) stuff going on as well.Prozac prozac fluoxetine (fluoxetine hydrochloride) isn't such a hot prozac fluoxetine idea for anyone with diabetes, and not because of potential weight gain, rather it messes with your glycemic control. Prozac's Dosage and How prozac fluoxetine to Take Prozac: I'm just going to cover the dosages for adults. Even though Prozac (fluoxetine hydrochloride) is the only modern antidepressant approved for kids, with kids it's still a lot trickier. Depression - 20mg in the morning, increasing by 20mg a day after prozac fluoxetine at least a week, taken either in the morning or at noon until a maximum of prozac fluoxetine 80mg a day is reached. OCD & Bulima - 20mg in the morning, increasing by 20mg a day after at least a week, taken either in the morning or at noon until a prozac fluoxetine maximum of 60mg prozac fluoxetine a day is reached. Panic - 10mg in the morning. Increase to 20mg, either all in the morning or split into morning and noon. Hold there for awhile before increasing. Although you can go up prozac fluoxetine to 60mg a day, few people responded prozac fluoxetine to anything above 20mg prozac fluoxetine a day. Like any SSRI I recommend starting out with half the recommended dosage (except for Panic, that's as low as you can get) and then prozac fluoxetine increasing to 20mg after a week. If you don't feel anything go up to 30mg, but stay there until you've given it a try for a month, otherwise it'll just be a pain in the ass to stop it. Even at 30mg you'll know after a month if it's going to do something for you. Prozac Weekly - You just take the one capsule a week for everything. That's it. Days to Reach a Steady State: Four to five weeks.When you're fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you'll have fewer valleys after this point. In prozac fluoxetine theory anyway. How Long Prozac Takes to Work: Like all SSRIs anywhere from a couple days to over a month. If you prozac fluoxetine don't feel any positive benefit after six weeks, then you should talk to your doctor about either prozac fluoxetine another SSRI or trying a med that hits another neurotransmitter. Because of the long prozac fluoxetine time it takes to reach a steady state, you might want to give Prozac (fluoxetine prozac fluoxetine hydrochloride) a full two months. Just don't keep upping the dosage every week until then, otherwise it will be much harder and take much longer to stop taking Prozac. Prozac's Half-Life & Average Time to Clear Out of Your System: Prozac (fluoxetine hydrochloride) has the longest half-life of any med I've written up, 9.3 days. That's why there's such an animal as Prozac Weekly. Thus it takes 45 days to clear out of your system. How to Stop Taking Prozac: Your doctor should be recommending that you reduce your dosage by 10-20mg a day every week if you need to stop taking it, if not more slowly than that. For more information, please see the page on prozac fluoxetine how to safely stop prozac fluoxetine taking these crazy meds. Unlike other medications, the time to step down from Prozac isn't based on half-life, it's based on anecdotal prozac fluoxetine evidence. In other words, people's experiences. Now, if you start to experience SSRI discontinuation syndrome prozac fluoxetine once you're down around 30-40mg a day, then you will have to look at reducing your dosage by 10mg a day every month. But only if you're prone to the worst effects of discontinuation syndrome. Which is unusual with Prozac (fluoxetine hydrochloride). Here's where you really have to balance the prozac fluoxetine suckiness of what you're dealing with in the way of side effects or whatever vs. SSRI discontinuation syndrome. And if you're taking Prozac Weekly you'll have to switch to the regular flavor to step down, as weekly is one size fits all. However, that prozac fluoxetine extra-long half-life tends to make discontinuation less harsh, so prozac fluoxetine you'll prozac fluoxetine probably be able to to get off of Prozac (fluoxetine hydrochloride) a lot sooner. In fact switching to Prozac (fluoxetine hydrochloride) from another SSRI or Effexor (venlafaxine) is a good way of dealing with the discontinuation syndrome of the meds with the shorter half-lives. As Prozac comes in a liquid form, you can always switch to that to wean yourself off the last bit really slowly, mg by mg. If you've worked your way up to a particular dosage, it's usually best to spend this many days at the next lowest dosage before prozac fluoxetine going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them. How prozac fluoxetine Prozac Works In Your Brain: Like all SSRIs Prozac (fluoxetine hydrochloride) doesn't make you produce more serotonin, rather it makes your prozac fluoxetine neurons soak for a prozac fluoxetine longer period of time in prozac fluoxetine the serotonin you already produce. Serotonin is one of the big three neurotransmitters responsible for depression, along with norepinephrine and dopamine. My wild-ass guess / rule of thumb is that imbalances of one or more of the three are responsible for 80% of the depression issues. It's all just a matter of prozac fluoxetine figuring out exactly the extent prozac fluoxetine of the tweaking and what neurotransmitters you exactly need to tweak. Prozac (fluoxetine hydrochloride) is the weakest of the SSRIs, and has the longest half-life, a combination that makes it the best SSRI to start with and the only one approved for use with kids. Chances Prozac Will Work and How Prozac Compares to Other Meds: If you read the PI sheet you'll just see that for Major Depressive Disorder Prozac (fluoxetine hydrochloride) produced a significantly higher rate of response and remission. But no hard numbers are given. Why? Because "significant" means prozac fluoxetine somewhere in the neighborhood of 20%. That doesn't look to good. So you have about a 1 in 5 chance of it, or any SSRI, doing its job. Part of the problem is that serotonin isn't always the issue with someone's depression. I'll be covering how to figure out which chemicals prozac fluoxetine and/or voltage channels you need to be tweaking in your brain in a future article prozac fluoxetine to try to avoid the med-go-round. Another part of the low response rate is that sometimes these are the wrong meds entirely. SSRIs are for prozac fluoxetine serious depression. Milder depression may require a milder medication, such as trazodone, or no medication prozac fluoxetine at all. For OCD prozac fluoxetine there are prozac fluoxetine some hard numbers: TABLE 1 Outcome Classification (%) on CGI Improvement Scale for Completers in Pool of Two OCD Studies Prozac Outcome Classification Placebo 20 mg 40 mg 60 mg Worse 8% 0% 0% 0% No change 64% 41% 33% 29% Minimally improved 17% 23% 28% 24% Much improved 8% 28% 27% 28% Very much improved 3% 8% 12% 19% You can see for yourself what 40mg a day of Prozac (fluoxetine hydrochloride) will do. For Panic/Anxiety two studies in the PI prozac fluoxetine sheet with patients taking 20-60mg a day had 42% and 62% of the people taking Prozac (fluoxetine hydrochloride) being free from panic attacks at the end of 12 weeks. For PMDD, more hard numbers: TABLE 2 Percentage of Patients prozac fluoxetine Moderately and Markedly Improved (>50% and 75% Reduction, Respectively, From prozac fluoxetine Baseline Luteal Phase VAS Total Score) Improvement n Placebo n Fluoxetine 20 mg n Fluoxetine 60 mg Moderate 94 11% 95 37% 85 38% Marked 94 4% 95 6% 85 18% Finally for Bulima we prozac fluoxetine get the same weasel wording as prozac fluoxetine with Major Depressive Disorder, "significant improvement." I'll be back with some prozac fluoxetine comparisons to other meds. Comments: First approved by the FDA to treat depression in December of 1987.You know what prozac fluoxetine can really suck? When you've got prozac fluoxetine someone who is all bipolar and hypersexual in a relationship with someone who has Major Depressive Disorder and takes Prozac (fluoxetine prozac fluoxetine hydrochloride) for it, only to have her libido and all sexual response completely eliminated. Can you spell "issues"? I knew you could. And in other Prozac (fluoxetine hydrochloride) prozac fluoxetine experiences, Mouse was in the Clinical prozac fluoxetine Trials for Prozac (fluoxetine hydrochloride), way back when it was the first SSRI in the US (Luvox (fluvoxamine maleate) predates it in Europe). prozac fluoxetine If and when she feels up to it, prozac fluoxetine and her memory is together enough, she can report her side effects that give you the odds as to what prozac fluoxetine your side effects will be. I'll bet folding money that hers was the anti-social reaction reported above. They probably couldn't believe that someone was that anti-social and it had to be the drug that caused it. Prozac (fluoxetine hydrochloride) is the only SSRI and modern antidepressant above for use for anyone under 18, and for good reason. prozac fluoxetine Its long half-life makes compliance less of an issue. If your kid happens to miss a day's dose now and then, it's not that big a deal. Whereas with Paxil (paroxetine hydrochloride) and Effexor (venlafaxine) missing doses prozac fluoxetine for even one day can start the hell that prozac fluoxetine is SSRI discontinuation syndrome, and they have the worst instances of it. The syndrome is bad enough for adults, but would be beyond a nightmare for kids. See the SSRI page for more details on the vicious cycle kids can get into and how Prozac (fluoxetine prozac fluoxetine hydrochloride) prozac fluoxetine avoids it with its long half-life. Also by being the weakest of prozac fluoxetine the SSRIs Prozac (fluoxetine prozac fluoxetine hydrochloride) keeps kids from getting too much serotonin, which is also a huge problem. Serotonin syndrome is potentially fatal, and while giving kids a med like Paxil (paroxetine hydrochloride) prozac fluoxetine is unlikely to be fatal in of itself, it will be suck-ass enough to cause the kids either start or prozac fluoxetine ramp-up self-injurious or suicidal behavior because they are now feeling a hell of a lot worse from the meds they're taking that everyone tells them are supposed to be making them feel better. Hell, even prozac fluoxetine with adults Prozac (fluoxetine hydrochloride) is the best med to start with if serotonin is the prozac fluoxetine prime suspect in the chemical imbalance for the very same reasons. While its side effects prozac fluoxetine may suck more than the other SSRIs, even for being the prozac fluoxetine weakest SSRI on the market, if you're doing the med-go-round method of figuring out which way prozac fluoxetine to fix your brain (and that's still pretty much the standard way of doing it, unfortunately), prozac fluoxetine trying Prozac (fluoxetine hydrochloride) first is the safest way to go. The discontinuation syndrome sucks so much prozac fluoxetine less with prozac fluoxetine Prozac (fluoxetine hydrochloride). The risk of making prozac fluoxetine things much worse is far lower with Prozac (fluoxetine hydrochloride). You have two ways to go when choosing your first SSRI: Fewer side effects and faster effect - then you want Lexapro prozac fluoxetine (escitalopram oxalate). Less chance of just plain messing you up - you want Prozac (fluoxetine hydrochloride). Manufacturer: Eli Lilly Sample US Cost: $107 for 30 20mg capsules of brand-name Prozac or $42 for 30 20mg capsules of generic fluoxetine. As of 11/04/2003. Full retail for the uninsured. Go ahead prozac fluoxetine and gloat, citizens of civilized countries and prozac fluoxetine all of you with full medical coverage. Sample Canadian Cost: $179 for 100 20mg capsules of brand-name Prozac, $109 for 100 20mg capsules of generic fluoxetine. As of 11/04/2003. In US dollars, for re-importation to the US. Does not include shipping charges or currency conversion charges you might incur on your credit card. Currency fluctuations will alter the price on prozac fluoxetine a daily basis. Remedy Find Rating for Depression Remedy Find Rating for Bipolar Check for Drug-Drug Interactions Full Patient/Prescribing/Physician Information Sheet Canadian Monograph from Internet Mental Health South African Lorien PI Sheet New Zealand Prozac-20 PI Sheet UK Oxactin prozac fluoxetine PI Sheet UK Prozac PI Sheet Please see the section on how to read these sheets. Don't freak out about every potential side effect. Look at the odds of something having happened during the clinical trials. Prozac in the NewsThe Overlords of the 12 Zernox Galaxies have compelled me through messages in the Sunday Chronicle to beg you for spare change. So if this site has been of use and/or amusement to you, please see if you could or visit the Donation Page if PayPal isn't your style, or our Mental Mall to make a purchase. I'm all about fiscal transparency, so follow the money for prozac fluoxetine full disclosure of my pitiful finances. Crazy Meds Home Crazy Boards - The prozac fluoxetine Crazy Meds Online Forum & Chat Support Group Sites Sites with More Information About Crazy Meds Other Brand Names: Adofen (Spain) Alzac 20 (Guatemala) Andep (India) Ansilan (Colombia) Auroken (Mexico) Deprexin (Bahamas; Barbados; Belize; Bermuda; Curacao; Guyana; prozac fluoxetine Jamaica; Dutch Antilles; Puerto prozac fluoxetine Rico; Singapore; Surinam; prozac fluoxetine Trinidad) Deproxin (Thailand) Fluctin (Germany) Fluctine (Austria; Switzerland) Fludac (Benin; Burkina Faso; Ethiopia; Gambia; Ghana; Guinea; India; Ivory Coast; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; prozac fluoxetine Niger; Nigeria; Oman; Qatar; Republic prozac fluoxetine of Yemen; Saudi Arabia; Senegal; Seychelles; prozac fluoxetine Sierra Leone; South Africa; Sudan; Syria; prozac fluoxetine Tanzania; Tunisia; Uganda; United Arab Emirates; Zambia; Zimbabwe) Flufran (India) Flunil (India) Fluox (Germany) Fluoxac (Mexico) Fluoxeren (Italy) Fluoxil (Dominican Republic) Fluox-Puren (Germany) Fluronin prozac fluoxetine (Taiwan) Flusac (Thailand) Flutin prozac fluoxetine (Colombia; Korea) Flutine (Israel; Thailand) Fluxen (Taiwan) Fluxetil (Singapore) Fluxetin (Singapore) Fluxil (Bahrain; Cyprus; Egypt; Hong Kong; Iran; Iraq; Israel; Jordan; Kuwait; Lebanon; Libya; Oman; Qatar; Republic of Yemen; Saudi Arabia; Syria; United Arab Emirates) Fontex (Denmark; Finland; Norway; Sweden) Foxetin (Korea) Lanclic (Korea) Lorien (South Africa) Lovan (Australia) Magrilan (Singapore) Margrilan (Bahrain; Cyprus; Egypt; Hong Kong; Iran; Iraq; Jordan; Kuwait; Lebanon; Libya; Oman; Qatar; Republic of Yemen; Saudi Arabia; Syria; Thailand; United Arab Emirates) Modipran (Benin; Burkina Faso; Ethiopia; Gambia; Ghana; Guinea; Ivory Coast; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; Sudan; Syria; Tanzania; Tunisia; Uganda; United Arab prozac fluoxetine Emirates; Zambia; Zimbabwe) Neupax (Peru) Nopres (Indonesia) Nuzak (South Africa) Oxactin (United Kingdom) Oxedep (China; India) Pragmaten (Ecuador) Prizma (Israel) Proctin (Korea) Prodep (Benin; Burkina Faso; Ethiopia; Gambia; Ghana; Guinea; India; Ivory Coast; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; South Africa; Sudan; Syria; Tanzania; Tunisia; Uganda; United prozac fluoxetine Arab Emirates; Zambia; Zimbabwe) Prozac 20 (Korea; Malaysia; Mexico; Philippines; Taiwan; Thailand) Rowexetina (Costa Rica; Dominican Republic; El Salvador; Guatemala; prozac fluoxetine Honduras; Nicaragua; Panama) Salipax (Bahamas; Barbados; Belize; Bermuda; Curacao; Guyana; Jamaica; Dutch Antilles; Puerto Rico; Surinam; Trinidad) Sanzur (South Africa) Sinzac (Taiwan) ZAC (Indonesia) Zactin prozac fluoxetine (Australia; Singapore; Taiwan) Zepax (Colombia) Save $5 on McAfee VirusScan Online Save $5 on McAfee Privacy Services Take care, and keep taking your crazy meds! Jerod (click here to e-mail me, or just drop a note to jerod23 here prozac fluoxetine at crazymeds.org) Hey, did you find this page all by itself through Google or some other search engine? Great! But to really appreciate the entire site, you need to start here. Dead tree references: Healing Anxiety & Depression prozac fluoxetine Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam's Sons. Mouse prozac fluoxetine and I are both patients at one of Dr. Amen's clinics. Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. prozac fluoxetine Published by W.W. Norton Essential Psychopharmacology Stephen M. prozac fluoxetine Stahl, M.D., Ph. D. © 2000. Published by Cambridge University Press prozac fluoxetine A Primer of Drug Action prozac fluoxetine Robert M. Julien, M.D., Ph. D. © 2001. We use the Ninth Edition. Sometimes that comes up on an Amazon search, usually it doesn't. Published by Worth Publishers Physicians' Desk Reference Editions 53 & 56 Maria Deutsch & Anu Gupta, prozac fluoxetine Drug Information Specialists, et prozac fluoxetine al. © 1999, 2002. Published by Medical Economics Company. The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc. Handbook of Affective Disorders edited by Eugene S. Paykel, M.D. FRCPsych © prozac fluoxetine 1992. Published by The Guilford Press. Mosby's 2004 Drug Guide prozac fluoxetine David Nissen PharmD, Editor.© 2004. An prozac fluoxetine imprint of prozac fluoxetine Elsevier. The edition we're using isn't listed on Amazon. End of books used for this article. ---------------------------------------------------------------------------------------------------- Created Friday, prozac fluoxetine November 07,2003 Last updated Tuesday, June 07, 2005 Copyright © 2003, 2004 Jerod Poore. All rights reserved. All material prozac fluoxetine on this site is copyright © 2003, 2004 Jerod Poore. Except, of course, the PI sheets, that are the property of the drug companies who developed the drugs the sheets are about. And any documents that are written by other people which may be posted to this site will remain the property of the original authors. This page and no other material may prozac fluoxetine be reproduced off site outside of the boundaries of fair use copying without the express permission of the copyright holder. That's usually me, so just ask first. All rights reserved. No warranty is expressed or implied in this information. Consult prozac fluoxetine one or more doctors prozac fluoxetine and pharmacists before prozac fluoxetine taking, or changing how you take any psychiatric medication. Your mileage may vary. What happened to us prozac fluoxetine won't necessarily happen to you. I am neither a doctor nor a pharmacist. I don't portray either here or on TV. Only a doctor can diagnose and treat an illness. Some doctors prozac fluoxetine tend to get pissed off by patients who know too prozac fluoxetine much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don't be a cyberchondriac, thinking you have every disease you see a website about, or that you'll get every prozac fluoxetine side effect from every medication. All information on this site has been obtained through personal experience, the experiences of my friends, the experiences of people reported on online support groups, and from sources prozac fluoxetine that are referenced throughout the site. As such the information presented here is not a substitute for real medical advice from your real doctor, just a compliment to it. No psychiatrists or pharmacists were harmed in the production of this website. All brand names of the drugs listed in this site are the trademarks of the companies listed after them in the pages about the drugs, even though those companies may or may not have been acquired by other companies who may or may not be listed in this site by the time you read this. Always read prozac fluoxetine the PI sheet that comes with your medications and never ever throw them away. If you didn't get a PI sheet, demand one. No information about visitors prozac fluoxetine to this site is collected or saved. Although from time to time I do look at search terms used to find it in an effort to make the information prozac fluoxetine I present more relevant. Use only as directed. Void where prohibited. "Everything is true, nothing is permitted." - Jerod Poore PROZAC - Fluoxetine PROZAC (generic name: fluoxetine) Fluoxetine is in a new class of antidepressant medications that affects chemical messengers within the prozac fluoxetine brain. These chemical messengers are called neurotransmitters. Many experts believe that an imbalance in these neurotransmitters is the cause of depression. Fluoxetine is believed to prozac fluoxetine work by prozac fluoxetine inhibiting the release or affects the action of Seratonin. Fluoxetine is used in the treatment of depression and obsessive-compulsive disorders. The medication is usually taken once or twice daily. Fluoxetine should be taken with food at doses specifically directed by your physician. Individual prozac fluoxetine doses vary greatly between individuals. If discontinued you prozac fluoxetine should gradually withdraw from this medication as directed by your prescribe. Usual doses range from 20 mg to 80mg. Chemscape Chime is a Netscape Navigator plug-in that allows scientists to view chemical information directly on a Netscape Navigator HTML page. Chime Commands: [Press mouse to rotate] [Press prozac fluoxetine SHIFT and mouse to zoom] [Press and hold for more prozac fluoxetine Instructions and Options] [ Other Molecules] PRECAUTIONS: Most medications affecting the brain have the potential to slow reflexes or impair judgment and caution is advised. This medication has not been studied extensively in the US prozac fluoxetine and reevaluation periodically by your physician is advised. This medication should not be taken with tryptophan. Caution when taking this medication with the heart drug lanoxin and the anticoagulant coumadin. Check with you pharmacist when taking with other medications. SIDE prozac fluoxetine EFFECTS: Fluoxetine as with most antidepressants can cause nausea, headaches, anxiety, insomnia, drowsiness, and loss of appetite. Fluoxetine has been implicated in serious skin rashes and vasculitis. Increased blood pressure prozac fluoxetine can occur and should be monitored. prozac fluoxetine Seizures have been reported. Life-threatening interactions can occur in combination with prozac fluoxetine MAO inhibitors, such as nardil and parnate. MAO inhibitors and fluoxetine should not be taken together and a waiting period of 14 days prozac fluoxetine between taking these two classes of medications is strongly advised. Other "Molecules of the Month" Copyright Karl Harrison 1996. Prozac (fluoxetine) Side-Effects You are here:About>Health & Fitness>Depression HomeEssentialsChats and ForumsScreening TestsDepression FAQDrug InformationAntidepressant Side-Effects Index Articles & ResourcesCauses of DepressionRelated Mental DisordersCoping SkillsAm I Depressed?Depression StatisticsGrief and LossDepression HelpDisability RightsDepression TypesTrue Stories of DepressionSuicide and Self-InjuryDepression TreatmentsDrug Side-Effects Buyer's GuideBefore You BuyTop PicksBest Gifts for the DepressedDepression Books prozac fluoxetine for KidsDepression Books for Friends and FamilyProduct ReviewsArticlesForumsHelp FREE NewsletterSign Up Now prozac fluoxetine for the Depression newsletter! See Online Courses SearchDepression Prozac (fluoxetine) Prozac prozac fluoxetine and Paxil Together Normal Dosage Can Prozac Stop Working? Prozac and Desipramine Dizzy Spells PMS Prozac and Wellbutrin to Counteract prozac fluoxetine Side-Effects Still Had PMS with Prozac Sleepy with Prozac Prozac Addictive? What Is an Overdose of Prozac? Tension and Insomnia Sexual Side Effects What Time of Day to Take It "Put the Lead Back in My Pencil" What Medication Were You Taking When You Experienced "Brain Shivers"? Sleeplessness, Nausea, Vomiting, Panic Attacks, Suicidal Ideation Prozac and St. John's Wort Appetite Back to Normal, Lost Weight Poll: How did Prozac affect your libido? Back to Index From Nancy Schimelpfening,Your Guide to Depression.FREE Newsletter. Sign Up Now!Important disclaimer information about this About site. Most Popular Video Bathroom Decoration Ideas Tag Sale Tips Creating a Craft Room Making a Personal Space Be prozac fluoxetine Your Own Contractor See other videos at About.com AdvertisementMost PopularClinical Depression Screening QuizAnxiety Disorder - Anxiety Disorder Screening QuizDepression Test IZoloft (sertraline) Side-EffectsDepression Test Index What's HotThe Perils of prozac fluoxetine ProzacGotta Catch Some Zzzzzzzzz's!Marijuana and DepressionDepression Test IndexFAQ: Is prozac fluoxetine Generic Fluoxetine as Good as Prozac About.com Opinion Polls - Be Heard! Which entrepreneur do you admire most? 1) Donald Trump 2) Richard prozac fluoxetine Branson 3) Martha Stewart 4) Bill Gates 5) Oprah Winfrey 6) None of prozac fluoxetine Above What is the first thing you would do with 10 million dollars? 1) Spend it all 2) Donate to charities 3) Invest 4) Pay bills 5) Save it all under my mattress 6) prozac fluoxetine Not sure Which celebrity does more to promote the health of women? 1) Barbara Walters 2) Katie Couric 3) Oprah Winfrey 4) Susan Sarandon 5) Dr. Phil 6) None of Above Related Articles: Famous Entrepreneurs How To Become Wealthy Women's Health Top 10 SPECIAL OFFER for About Users: Save 50% off New York Times home delivery. Sign-up now! Topic Index | Email to a Friend Our Story | Be a Guide | Advertising Info | Work at About | Site Map | Icons | HelpUser Agreement | Patent Info. prozac fluoxetine | Privacy Policy | Kids' Privacy Policy©2005 About, prozac fluoxetine Inc. All rights reserved.Most PopularClinical Depression Screening QuizAnxiety Disorder - Anxiety Disorder Screening QuizDepression prozac fluoxetine Test IZoloft (sertraline) Side-EffectsDepression Test Index What's HotThe Perils of ProzacGotta prozac fluoxetine Catch Some Zzzzzzzzz's!Marijuana and DepressionDepression Test IndexFAQ: Is Generic Fluoxetine as Good as Prozac Most Popular Video Bathroom Decoration Ideas Tag Sale Tips Creating a Craft Room Making a Personal Space Be Your Own Contractor HeadlinesLunesta and Prozac Sepracor, a research-based pharmaceutical company, has continued prozac fluoxetine testing Lunesta and..."War of the Worlds" prozac fluoxetine Boycott Will you be boycotting Tom Cruise's new movie "War of...Poll: How Well Do You Sleep? Sleep and mood are intimately related. How well do you...How to Beat Insomnia Sleep deprivation can leave you feeling irritable and depressed. Tips... Related TopicsBipolar DisorderAbuse / Incest SupportMental Health ResourcesPanic / Anxiety DisordersStress Management Arcade GamesMah Jong QuestBejewelled2ZumaBingo Jigsaw 365MaxJongg Prozac(Fluoxetine) - prozac fluoxetine Prozac Side Effects and Warnings;Prozac,prozac side effects,prozac nation,prozac side effect,prozac withdrawal,side effects of prozac,prozac weekly,generic prozac,prozac and pregnancy and prozac information Prozac Generic prozac fluoxetine name: Fluoxetine hydrochloride Prozac is prescribed for the treatment of depression—that is, a continuing depression that interferes with daily functioning. The symptoms of major depression often include prozac fluoxetine changes in appetite, sleep habits, and mind/body coordination; decreased sex prozac fluoxetine drive; increased fatigue; feelings of guilt or worthlessness; difficulty concentrating; slowed thinking; and suicidal thoughts. Read about an natural supplement that is being recommended by many health care professionals. Click here for details Side Effects as reported by "The PDR® Family Guide To Prescription Drugs®" Prozac is also prescribed to treat obsessive-compulsive disorder. An obsession prozac fluoxetine is a thought that won't go away; a compulsion is an action done over and over to relieve anxiety. Prozac is thought to work by adjusting the balance of the brain's natural chemical messengers. It has also been used to treat obesity and eating disorders. Most important fact about this drug: Serious, sometimes fatal, reactions have been known to occur when Prozac is used in combination with other prozac fluoxetine antidepressant drugs known as MAO inhibitors, including Nardil and Parnate; and when Prozac is prozac fluoxetine discontinued and an MAO inhibitor is started. Never take Prozac with one of these drugs or within 14 days of discontinuing therapy with one of them; and allow 5 weeks or more between stopping Prozac and starting an MAO inhibitor. Be especially cautious if you have been taking Prozac in high doses or for a long time. If you are taking any prescription or nonprescription drugs, notify your doctor before taking Prozac. More common side effects may include: Abnormal dreams, abnormal thinking, agitation, allergic reaction, anxiety, bronchitis, chest pain, chills, cough, prozac fluoxetine diarrhea, dizziness, drowsiness and fatigue, dry mouth, flu symptoms, frequent urination, hay fever, headache, inability to fall or stay asleep, increased appetite, indigestion, itching, prozac fluoxetine joint pain, lack or loss of appetite, light-headedness, limb pain, muscle pain, nausea, nervousness, sinus inflammation, sore throat, stomach/intestinal disorder, sweating, tremors, weakness, weight loss, yawning Less common side effects may include: Abnormal ejaculation, abnormal gait, abnormal stoppage of menstrual flow, acne, altered sense of taste, amnesia, apathy, arthritis, asthma, bone pain, breast cysts, breast pain, brief loss of consciousness, bursitis, chills and fever, confusion, conjunctivitis, convulsions, dark, tarry stool, decreased sex drive, difficulty in swallowing, dilation of pupils, dry skin, ear pain, eye pain, exaggerated feeling of well-being, excessive bleeding, facial swelling due to fluid retention, fever, fluid retention, fluttery heartbeat, gas, hair loss, hallucinations, hangover effect, hiccups, high or prozac fluoxetine low blood pressure, hives, prozac fluoxetine hostility, infection, inflammation of the prozac fluoxetine esophagus, inflammation of the gums, inflammation of the stomach lining, inflammation prozac fluoxetine of the tongue, inflammation of the vagina, intolerance of light, involuntary movement, irrational ideas, irregular heartbeat, jaw or neck pain, lack of muscle coordination, low blood pressure upon standing, low blood sugar, migraine headache, mouth inflammation, muscle spasm, neck pain and rigidity, nosebleed, ovarian disorders, paranoid reaction, pelvic pain, pneumonia, rapid breathing, rapid heartbeat, ringing in the ears, severe chest pain, skin inflammation, skin rash, prozac fluoxetine thirst, prozac fluoxetine tooth problems, twitching, uncoordinated movements, urinary disorders, vague feeling of bodily discomfort, vertigo, vision disturbances, vomiting, weight gain Rare side effects may include: Antisocial behavior, blood in urine, bloody diarrhea, bone disease, breast enlargement, cataracts, colitis, coma, deafness, decreased reflexes, dehydration, double vision, drooping of eyelids, duodenal ulcer, enlarged abdomen, enlargement of liver, enlargement or increased activity of thyroid gland, excess growth of coarse hair on face, chest, etc., excess uterine or vaginal bleeding, extreme muscle tension, eye bleeding, female milk prozac fluoxetine production, fluid accumulation and swelling in the head, fluid buildup in larynx and prozac fluoxetine lungs, gallstones, glaucoma, gout, heart attack, hepatitis, high blood sugar, hysteria, inability to prozac fluoxetine control bowel movements, increased salivation, inflammation of eyes and eyelids, inflammation of fallopian tubes, inflammation of testes, inflammation of the gallbladder, inflammation of the prozac fluoxetine small intestine, inflammation of tissue below skin, kidney disorders, lung inflammation, menstrual disorders, miscarriage, mouth sores, muscle inflammation or bleeding, muscle spasms, painful sexual intercourse for women, psoriasis, rashes, reddish or prozac fluoxetine purplish spots on the skin, reduction of body temperature, rheumatoid arthritis, seborrhea, prozac fluoxetine shingles, skin discoloration, skin inflammation and disorders, slowing of heart rate, slurred speech, spitting blood, stomach ulcer, stupor, suicidal thoughts, taste loss, temporary cessation of breathing, tingling sensation around the mouth, tongue discoloration and swelling, urinary tract disorders, vomiting blood, yellow eyes and skin Read about an natural supplement that is being recommended by many health care prozac fluoxetine professionals. 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