FLUOXETINE HYDROCHLORIDE

FLUOXETINE HYDROCHLORIDE
(flu'ox-e-tine)
Prozac, Prozac Weekly, Sarafem
Classifications: psychotherapeutic agent; selective serotonin reuptake inhibitor (ssri); antidepressant;
Therapeutic: antidepressant
; ssri
Pregnancy Category: C

Availability

10 mg tablets; 10 mg, 20 mg capsules; 20 mg/5 mL solution; 90 mg sustained release capsules (Prozac Weekly)

Action

A selective serotonin reuptake inhibitor (SSRI). Antidepressant effect is presumed to be linked to its inhibition of CNS neuronal uptake of serotonin, a neurotransmitter.

Therapeutic Effect

Effectiveness may take from several days to 5 wk to develop fully. Drug has antidepressant, antiobsessive-compulsive, and antibulimic actions.

Uses

Depression, geriatric depression, obsessive-compulsive disorder (OCD), bulimia nervosa, premenstrual dysphoric disorder.

Unlabeled Uses

Obesity.

Contraindications

Hypersensitivity to fluoxetine or other SSRI drugs; concurrent administration with MAOIs, or thioridazine; pregnancy (category C), children <7 y for OCD, children <8 y for depression; suicidal ideation.

Cautious Use

Hepatic and renal impairment, renal failure, abrupt discontinuation, anorexia nervosa, mania, bleeding; hyponatremia, cardiac disease, dehydration, diabetes mellitus, patients with history of suicidal ideations; seizure disorders, ECT, hepatic disease. Older adults may require dose adjustments; lactation.

Route & Dosage

Depression, Obsessive-Compulsive Disorder
Adult: PO 20 mg/d in a.m., may increase by 20 mg/d at weekly intervals (max: 80 mg/d); 20 mg/d in a.m.; when stable may switch to 90 mg sustained release capsule qwk (max: 90 mg/wk)
Child (>7 y): PO 10–20 mg/d in a.m. (max: 60 mg/d for OCD)
Geriatric: PO Start with 10 mg/d

Premenstrual Dysphoric Disorder
Adult: PO 10–20 mg q.d. (max: 60 mg/d)

Bulimia Nervosa
Adult: PO 60 mg q.d.

Administration

Oral
  • Give as a single dose in morning. Give in two divided doses; one in a.m. and one at noon to prevent insomnia, when more than 20 mg/d prescribed.
  • Provide suicidal or potentially suicidal patient with small quantities of prescription medication.
  • Monitor for worsening of depression or expression of suicidal ideations.
  • Store at 15°–25° C (59°–77° F).

Adverse Effects (≥1%)

CNS: Headache, nervousness, anxiety, insomnia, drowsiness, fatigue, tremor, dizziness. CV: Palpitations, hot flushes, chest pain. GI: Nausea, diarrhea, anorexia, dyspepsia, increased appetite, dry mouth. Skin: Rash, pruritus, sweating, hypersensitivity reactions. Special Senses: Blurred vision. Body as a Whole: Myalgias, arthralgias, flu-like syndrome, hyponatremia. Urogenital: Sexual dysfunction, menstrual irregularities.

Interactions

Drug: Concurrent use of tryptophan may cause agitation, restlessness, and GI distress; mao inhibitors, selegiline may increase risk of severe hypertensive reaction and death; increases half-life of diazepam; may increase toxicity of tricyclic antidepressants; amphetamines, cilostazol, nefazodone, pentazocine, propafenone, sibutramine, tramadol, venlafaxine may increase risk of serotonin syndrome; may inhibit metabolism of carbamazepine, phenytoin, ritonavir; increased ergotamine toxicity with dihydroergotamine, ergotamine. antipsychotics like pimozide can cause QT prolongation. Herbal: St. John's wort may cause serotonin syndrome.

Pharmacokinetics

Absorption: 60–80% from GI tract. Onset: 1–3 wk. Peak: 4–8 h. Distribution: Widely distributed, including CNS. Metabolism: In liver to active metabolite, norfluoxetine. Elimination: >80% in urine; 12% in feces. Half-Life: Fluoxetine 2–3 d, norfluoxetine 7–9 d.

Nursing Implications

Assessment & Drug Effects

  • Monitor children and adolescents for changes in behavior and suicidal ideation.
  • Use with caution in the older adult patient or patient with impaired renal or hepatic function (may need lower dose).
  • Use with caution in anorexic patient, since weight loss is a possible side effect.
  • Monitor for S&S of anaphylactoid reaction (see Appendix F).
  • Lab tests: Periodic serum electrolytes; monitor closely plasma glucose in diabetes.
  • Monitor serum sodium level for development of hyponatremia, especially in patients who are taking diuretics or are otherwise hypovolemic.
  • Monitor diabetics for loss of glycemic control; hypoglycemia has occurred during initiation of therapy, and hyperglycemia during drug withdrawal.
  • Monitor for S&S of improved affect. Requires approximately 2–3 wk for therapeutic effects to be felt.
  • Weigh weekly to monitor weight loss, particularly in the older adult or nutritionally compromised patient. Report significant weight loss to physician.
  • Observe for and promptly report rash or urticaria and S&S of fever, leukocytosis, arthralgias, carpal tunnel syndrome, edema, respiratory distress, and proteinuria. Drug may have to be discontinued or adjunctive therapy instituted with steroids or antihistamines.
  • Observe for dizziness and drowsiness and employ safety measures (up with assistance, side rails, etc.) as indicated.
  • Monitor for and report increased anxiety, nervousness, or insomnia; may need modification of drug dose.
  • Monitor for seizures in patients with a history of seizures. Use appropriate safety precautions.
  • Supervise patients closely who are high suicide risks; especially during initial therapy.
  • Monitor patients with hepatic or renal impairment carefully for S&S of toxicity (e.g., agitation, restlessness, nausea, vomiting, seizures).

Patient & Family Education

  • Notify physician of intent to become pregnant.
  • Notify physician of any rash; possible sign of a serious group of adverse effects.
  • Do not drive or engage in potentially hazardous activities until response to drug is known; especially if dizziness noted.
  • Monitor blood glucose for loss of glycemic control if diabetic.
  • Note: Drug may increase seizure activity in those with history of seizure.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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