Fluoxentine HCl (Prozac) Acts as an antidepressant by inhibiting CNS neuronal

uptake of serotonin; blocks uptake of serotonin with little effect on norepinephrine; little
affinity for muscarinic, histaminergic, and alpha1-adrenergic receptors.
Generic Name: fluoxetine hydrochloride
Brand Name: Apo-Fluoxetine (CAN), Co-Fluoxetine (CAN), Novo-Fluoxetine (CAN),
PMS-Fluoxetine (CAN), Prozac, Prozac Pulvules, Prozac Weekly, ratio-Fluoxetine (CAN),
Sarafem
Other Info: Pregnancy Category C
Drug class: Antidepressant, SSRI

Indications

Treatment of depression; most effective in patients with major depressive

disorder

Treatment of OCD

Treatment of bulimia

Treatment of PMDD (Sarafem)

Treatment of panic disorder with or without agoraphobia

Unlabeled use: Treatment of obesity, alcoholism, numerous psychiatric

disorders, chronic pain, various neuropathies

Contraindications and cautions

Contraindicated with hypersensitivity to fluoxetine, pregnancy.

Use cautiously with impaired hepatic or renal function, diabetes mellitus,

lactation, seizures; history of suicide attempts.

Available forms
Tablets10, 20 mg; capsules10, 20, 40 mg; liquid20 mg/5 mL; DR capsules90
mg

Dosages
Individualize dosage; same for oral or IV routes because of rapid and almost complete
absorption.

ADULTS

Antidepressant: The full antidepressant effect may not be seen for up to 46

wk. Initially, 20 mg/day PO in the morning. If no clinical improvement is seen,
increase dose after several weeks. Administer doses > 20 mg/day on a bid
schedule. Do not exceed 80 mg/day. Once stabilized, may switch to 90-mg DR
capsules once a week.

OCD: Initially, 20 mg/day PO. If no clinical improvement is seen, increase

dose after several weeks. Usual dosage range, 2060 mg/day PO; may
require up to 5 wk for effectiveness. Do not exceed 80 mg/day.

Bulimia: 60 mg/day PO in the morning.

PMDD (Sarafem): 20 mg/day PO or 20 mg/day PO starting 14 days before the

anticipated beginning of menses and continuing through the first full day of
menses, then no drug until 14 days before next menses; do not exceed 80
mg/day.

Panic disorder (Prozac): 10 mg/day PO for the first week; increase to 20

mg/day if needed. Maximum dose, 60 mg/day.

PEDIATRIC PATIENTS 818 YR

Major depressive disorder: 10 mg/day PO; may be increased to 20 mg/day

after several weeks.

PEDIATRIC PATIENTS 717 YR

OCD: Initially, 10 mg/day PO. After 2 wk increase to 20 mg/day. Suggested

range, 2060 mg/day PO.

PEDIATRIC PATIENTS < 7 YR

Safety and efficacy not established.

GERIATRIC PATIENTS OR PATIENTS WITH HEPATIC OR RENAL IMPAIRMENT

Give a lower or less frequent dose. Monitor response to guide dosage.

Pharmacokinetics
Route

Onset

Peak

Oral

Slow

68 hr

Metabolism: Hepatic; T1/2: 9 days

Distribution: Crosses placenta; enters breast milk
Excretion: Feces, urine

Adverse effects

CNS: Headache,

nervousness,

insomnia,

drowsiness,

anxiety,

tremor,

dizziness, light-headedness, agitation, sedation, abnormal gait, seizures

CV: Hot flashes, palpitations

Dermatologic: Sweating, rash, pruritus, acne, alopecia, contact dermatitis

GI: Nausea,

vomiting,

diarrhea,

dry

mouth,

anorexia,

dyspepsia,

constipation, taste changes, flatulence, gastroenteritis, dysphagia, gingivitis

GU: Painful menstruation, sexual dysfunction, frequency, cystitis, impotence,

urgency, vaginitis

Respiratory: URIs, pharyngitis, cough, dyspnea, bronchitis, rhinitis

Other: weight changes, asthenia, fever

Interactions
Drug-drug

WARNING: Possible fatal reactions with MAOIs; do not administer together;

2-wk washout period needed.

Increased therapeutic and toxic effects of TCAs

Do not use with thioridazine (increased levels of thioridazine)

Decreased effectiveness if taken while smoking

Increased toxicity of lithium; avoid this combination

Additive CNS effects if combined with benzodiazepines, alcohol; avoid these

combinations

Avoid administration with other serotonergic drugs; may lead to serotonin

syndrome

Drug-alternative therapy

Increased risk of severe reaction if combined with St. Johns wort therapy

Nursing considerations
[box

type=note]CLINICAL

between Sarafem (fluoxetine)

ALERT! Name

confusion

and Serophene (clomiphene);

has

occurred

use

caution.

[/box]
Assessment

History: Hypersensitivity to fluoxetine, impaired hepatic or renal function,

diabetes mellitus, lactation, pregnancy, seizures

Physical: Weight, T; skin rash, lesions; reflexes, affect; bowel sounds, liver
evaluation; P, peripheral perfusion; urinary output, LFTs, renal function tests

Interventions

Arrange for lower or less frequent doses in elderly patients and patients with
hepatic or renal impairment.

BLACK BOX WARNING: Establish suicide precautions for severely depressed

patients. Limit quantity of capsules dispensed; high risk in children and
adolescents.

Administer drug in the morning.

Monitor patient for response to therapy for up to 4 wk before increasing dose.

Switch to once a week therapy by starting weekly dose 7 days after last 20
mg/day dose. If response is not satisfactory, reconsider daily dosing.

Teaching points

It may take up to 4 weeks before the full effect occurs. Take in the morning.
If you feel sleepy or tired, you may take it at night. If you are taking the
once-weekly capsule, mark calendar with reminders of drug day.

Do not take this drug during pregnancy. If you think that you are pregnant or
wish to become pregnant, consult your health care provider.

Keep this drug, and all medications, out of the reach of children.

You may experience these side effects: Dizziness, drowsiness, nervousness,

insomnia (avoid driving or performing hazardous tasks); nausea, vomiting,
weight loss (eat small frequent meals; monitor your weight loss); sexual
dysfunction; flulike symptoms.

Report rash, mania, seizures, severe weight loss.