FLUOXETINE

Selective Serotonin Re-uptake Inhibitor (SSRI) with psychotherapeutic action

Dosage Forms

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Capsules

20 mg

Uses

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  • Treatment of major depression
  • Treatment of Bulimia nervosa
  • Treatment of obsessive compulsive disorder

Dose and Duration

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Treatment of major depression
Adult over 18 years: 20 mg once daily, increased as necessary after 3–4 weeks to a maximum of 60 mg once daily
Child 8–18 years: 10 mg once daily increased after 1–2 weeks if necessary to a maximum of 20 mg once daily
Treatment of Bulimia nervosa
Adult > 18 years: 60 mg daily as a single or in divided doses
Treatment of obsessive compulsive disorder
Adult > 18 years: 20 mg daily increased gradually if necessary to maximum 60 mg
Elderly: maximum daily dose for all uses is 40 mg

Contraindications

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  • Manic phase

Side Effects

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  • Insomnia, abnormal dreams, headache, disturbance in attention, dizziness, lethargy, hyperhidrosis (excessive sweating), fatigue
  • Anxiety, restlessness, tension, decreased libido
  • Dysgeusia (distortion of sense of taste)
  • Blurred vision
  • Palpitations, flushing
  • Yawning
  • Vomiting, dyspepsia, diarrhoea, nausea, dry mouth
  • Anorexia with weight loss
  • Rash, urticaria, pruritus
  • Joint pain, tremor
  • Frequent urination
  • Gynaecological bleeding
  • Erectile dysfunction, ejaculation disorder
  • Chills

Interactions

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  • Acetylsalicylic acid, ibuprofen (increased risk of bleeding)
  • Artemether/ Lumefantrine (risk of arrhythmias)
  • Carbamazepine (increased plasma concentrations of carbamazepine)
  • Clopidogrel (reduced antiplatelet effect of clopidogrel)
  • Haloperidol (increased concentration of haloperidol)
  • Lithium (increased risk of CNS effects)
  • MAOI (increased CNS effects of fluoxetine)
  • Phenytoin (increased concentrations of phenytoin)
  • Ritonavir (increased concentrations of fluoxetine)
  • Tramadol (increased risk of CNS toxicity)
  • Warfarin (anticoagulant effect possibly enhanced)

Pregnancy

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  • Do not use in 1ˢᵗ and 3ʳᵈ trimester

Breast-feeding

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  • Can be used

⚠️ Caution

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  • Avoid abrupt withdrawal
  • Use lowest effective dose in breast-feeding mother or discontinue breast-feeding
  • Risk of increased suicidal behaviour especially in children and adolescents
  • Avoid use in poorly controlled epilepsy and discontinue if convulsions develop during treatment
  • Fluoxetine should not be started until 2 weeks after stopping a MAOI. Conversely, a MAOI should not be started until at least 5 weeks after fluoxetine has been stopped
  • Reduce dose or give on alternate days in liver impairment