DESCRIPTION
Fluoxetine belongs to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs), also referred to as antidepressants, which can alter levels of brain chemicals and are used for mental depression and panic disorder. Depression often accompanies other symptoms in MS and antidepressants may be included in treatment regimens. Before depression is diagnosed, doctors should rule out poor sleep patterns, medical conditions, and any other possible drug side effects. Patients should be encouraged to exercise regularly along with taking antidepressant drugs.

Fluoxetine is among many antidepressants prescribed for depression as well as fatigue in MS. It is generally well tolerated, yet should be taken in the morning to avoid sleep disturbances. Other common side effects include dry mouth and dizziness.

ORIGINAL USES (ON-LABEL)
Major depressive disorder, obsessive compulsive disorder, bulimia nervosa, panic disorder, premenstrual dysphoric disorder.

NEWLY DISCOVERED USES (OFF-LABEL)
Attention deficit/hyperactivity disorder (ADHD), alcoholism (cravings & dependence), Alzheimer’s disease, anorexia nervosa, bipolar disorder, childhood anxiety, chronic fatigue syndrome, fibromyalgia, impulsive aggressive disorder, migraine prevention, stroke (motor control), multiple sclerosis, narcolepsy, nocturnal enuresis, premature ejaculation, post-traumatic stress disorder (PTSD), Raynaud’s syndrome, schizoaffective disorder, social phobia, tension headache prevention, vasovagal syncope.

POTENTIAL SIDE EFFECTS
Abnormal thinking, anxiety, dizziness, headache, decreased libido, manic reaction, nervousness, somnolence, excessive sweating, abdominal pain, anorexia, constipation, diarrhea, dry mouth, upset stomach, nausea, vomiting, urinary frequency, rhinitis, abnormal vision, fever, flu-syndrome, pain, weight loss, low sodium levels, changes in blood glucose, abnormal dreams, rash, sexual dysfunction, sinusitis.

CAUTIONS
  • Use may be associated with the development of suicidal thinking and behavior (see special information section).
  • Do not use if you have been taking an MAO inhibitor (such as phenelzine, tranylcypromine, isocarboxazid) within the past 14 days. When used with MAO-Is fever, high blood pressure, increased heart rate, confusion, seizures, and deaths have been reported.
  • Gradually decrease in dosage upon discontinuation of therapy.
  • Notify your doctor if you have a history of mania, seizures, and alcoholism.
  • Use caution if you have liver dysfunction, or kidney insufficiency, or if you are elderly.
  • Concurrent use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of bleeding.
DRUG INTERACTIONS
MAO inhibitors (such as phenelzine, isocarboxazid, or linezolid), selegiline, warfarin, cimetidine, linezolid, cyproheptadine, metoclopramide, sibutramine, tramadol, phenytoin, L-tryptophan, tricyclic antidepressants (such as nortriptyline, amitriptyline, imipramine, etc.), benzodiazepines (such as diazepam, flurazepam, etc.), beta-blockers, buspirone, carbamazepine, clozapine, cyclosporine, haloperidol, lithium, olanzapine, phenothiazines, propafenone, ritonavir, trazodone.

FOOD INTERACTIONS
May be given with or without food. Avoid alcohol.

HERBAL INTERACTIONS
Valerian, St John’s wort, SAMe, kava kava.

PREGNANCY AND BREAST-FEEDING CAUTIONS
FDA Pregnancy Risk Category C. Excreted in breast milk. Not recommended during breast-feeding.

SPECIAL INFORMATION
  • Therapeutic response may take 4-6 week.
  • May cause insomnia, administer in am; sedating antidepressants, in small doses (i.e. trazadone 50 mg), frequently administered H.S., concurrently.
In one case study from Canada, a 41-year-old woman with multiple sclerosis (MS) and a 12-month history of severe depression (non-suicidal) had been treated previously with doxepin hydrochloride with limited effects. Doxepin hydrochloride was discontinued and exchanged for this nidicine. Six weeks after beginning fluoxetine, she reported mood improvements, less hostility, less emotional lability, and improved concentration at work. One side effect was fatigue, which resolved when she switched to nighttime administration. Her sensory problems, including numbness, also improved.
In a clinical trial of Prozac and amitriptyline in MS patients, this drug had a greater effect on cognitive disturbances (another symptom of MS) than amitriptyline.

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What is Prozac?
This drug inhibits the reuptake of serotonin at the neuron and thus increases levels of serotonin in the body and in the brain.
BRAND NAME
Prozac Weekly, Sarafem, Prozac

GENERIC NAME
Fluoxetine

CHEMICAL CLASS
Trifluoro propylamine derivative.

THERAPEUTIC CLASS
Antidepressant (selective serotonin reuptake inhibitor)
AVAIL FORMS
Capsules — Oral 10 mg, 20 mg.
DOSAGE
Adult
Major depressive disorder, obsessive-compulsive disorder, premenstrual dysphoric disorder: PO 20 mg qAM, increase after 4-6 wks prn, max 80 mg/day; doses >20 mg can be divided into morning and noon doses; for premenstrual dysphoric disorder can also use intermittantly starting 14 days prior to anticipated onset of menses and continuing through 1st full day of menses and repeating with each new cycle.
Bulimia nervosa: PO 60 mg qam; may be advisable to titrate to target dose over several days in some patients.
Maintenace therapy in depression: PO 20 mg qd or 90 mg qwk starting 7 days after last daily dose of 20 mg.
Child (8-18 yrs)
Major depressive disorder: PO 10-20 mg q AM.
Obsessive-compulsive disorder: PO 10 mg q AM; may increase gradually after 2 wks. Dose range of 20-60 mg is recommended for adolescents and higher weight children.

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