Fluoxetine (HCl) is the prototype of antidepressant drug that selectively inhibits serotonin reuptake. Selective serotonin reuptake inhibitors (SSRIs) is the new class of chemically unique antidepressant drugs
Indications
Fluoxetine (HCl) is primarily indicated in conditions like Bulimia nervosa, Control of muscarinic side-effects of neostigmine, Depression, Depressive illness, Obsessive-compulsive disorders, Panic disorders, Parkinson's disease, Suspected methotrexate overdosage, and can also be given in adjunctive therapy as an alternative drug of choice in Fibromyalgia.
Contraindications
Fluoxetine (HCl) is contraindicated in conditions like Renal failure, Hypersensitivity, Breastfeeding.
Side Effects
The severe or irreversible adverse effects of Fluoxetine (HCl), which give rise to further complications include Serum sickness, Vasculitis, Seizures, Extrapyramidal symptoms, Sinus bradycardia, Mania, Altered platelet function, Hypersensitivity pneumonitis, Leukocytoclastic vasculitis. The signs and symptoms that are produced after the acute overdosage of Fluoxetine (HCl) include Nausea, Vomiting, Grand Mal Seizures (epilepsy), Agitation, Restlessness, Hypomania, CNS excitation. The symptomatic adverse reactions produced by Fluoxetine (HCl) are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Drowsiness, Fatigue, Nausea, Anorexia, Diarrhea, Anxiety, Palpitation, Insomnia, Nervousness, Tremors, Weight Loss, GI upset, Sweating, Asthenia, Elevation of liver enzymes, Sinus tachycardia, Vison disturbance, Sinusitis, Erythema multiforme, Hyponatremia.
Warnings
Patient should observe caution while driving or performing other task requiring alertness because it may produce dizziness. Fluoxetine should be used with caution in patient with history of seizures, in kidney or liver impairment, with diseases or conditions that could effect metabolism or hemodynamic response.
High Risk Groups
Drug should not be given to Paediatrics, Pregnant Mothers, patients suffering from Liver Malfunction, and Neonates. If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Adult Dosage
20 to 80 mg (50 (50)) 24 hourly PO — If inadequate response, increase the dose no more often than every month by 10-20 mg/kg/day to a maximum of 80 mg/day.
Child Dosage
( ) — Not recommended in this age group
Neonatal Dosage
( ) — Not recommended in this age group
Drug Interactions
Fluoxetine (HCl) is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAdinazolamAlcoholAlprazolamFluoxetine reduces the clearance of alprazolamAtomoxetine HClThe effect and toxicity of atomoxetine could be increased by CYP2D6 inhibitor.Bupropion (HCl)CarbamazepinePlasma concentration of Carbamazepine increased by Fluvoxamine.MajorClarithromycinClomipramine (HCl)ClozapineFluoxetin increases the srum level of clozapine upto 76% by inhibiting its hepatic metabolism.ModerateDose of clozapine should be reduced if necessary.Close clinical monitoring is advised.DextromethorphanDiazepamfluoxetine prolong the half life of diazepamDigitoxinDigoxinSerum concentration of digoxin may increased by fluoxetine.MinorIf interaction occur dose adjustment is needed.EscitalopramContraindicatedFosphenytoinHaloperidolfluoxetine increase plasma concentration of haloperidoliloperidonecan inhibit iloperidone elimination and cause increased blood levels.Iloperidone doses should be reduced by one-half when administered with fluoxetineInsulin GlulisineFluoxetine (HCl), oral antidiabetic products, pramlintide, ACE inhibitors, fibrates, monoamine oxidase inhibitors, salicylates, and somatostatin analogs, may increase the blood glucose-lowering effect of insulins and therefore increase the risk of hypoglycemia.Lithiumco administration may lead to lithium toxicity, symptomps include agitation, restlessness, GI distresslithium level should be monitoredLoratadineFluoxetine (HCl) inhibit metabolism of loratidineMetoprolol (Tartrate)Fluoxetin may potentiate the pharmacological effect of metoprolol by inhibiting metabolic clearence result in development of bradycardia, hypotension, and complete heart block.ModerateClosely monitor the cardiac function of patient and adjust the dose of metoprolol accordingly.MoclobemideNaratriptanConcurrent use is not recommended, but dosages should be adjusted if concurrent use is required.NifedipineFluoxetine potentiate the effects of nifedipine.MinorNortriptyline (HCl)PergolideTheoretical potential for FLUOXETINE HYDROCHLORIDE increasing the EXTRAPYRAMIDAL side effects of PERGOLIDE MESILATE. Usually no risk. Usually no action necessary.PhenelzinePhenytoin (Na)toxcity of phenytoin is precipitated by fluoxetineRitonavirRizatriptanConcurrent use may increase drowsiness.Selegiline (HCl)TryptophanVORICONAZOLEAdditive QTc prolongation may occur. Consider alternate therapy or monitor for QTc prolongation Vortioxetineincreases the level of vortioxetinemoniotr closely, use alternativeWarfarin (Na) These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Storage
Caps, Soln Store in a well closed container, Below 40°C. Protect from Sunlight and Moisture.
