Prolert

Indications

Fluoxetine is an antidepressant used to treat major depression, obsessive-compulsive disorder (OCD), bulimia nervosa (an eating disorder with binge eating and purging), panic disorder and, in some cases, severe premenstrual mood symptoms (premenstrual dysphoric disorder). It is also used in some older children and teenagers with depression or OCD under specialist care.

How It Works

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). Serotonin is a brain chemical that helps regulate mood, anxiety and appetite. Fluoxetine stops nerve cells from taking serotonin back up too quickly, so more of it stays available to carry messages. The effect builds up slowly, and it usually takes 2 to 4 weeks before mood starts to improve.

Dosage and Administration

Take exactly as prescribed. For depression in adults, treatment often starts at 20 mg once a day, usually in the morning, and your doctor may adjust it depending on your condition and response. Swallow with water, with or without food. Keep taking it even when you feel better, usually for at least 6 months after recovery or as advised. Do not stop suddenly without speaking to your doctor; the dose is usually reduced gradually.

Interactions

• Do not take with MAO inhibitors (such as Selegiline or Moclobemide), Linezolid or Methylene Blue: a dangerous reaction called serotonin syndrome can occur. Leave at least 14 days after stopping an MAO inhibitor before starting Fluoxetine, and at least 5 weeks after stopping Fluoxetine before starting an MAO inhibitor.
• Do not combine with Pimozide or Thioridazine (risk of heart rhythm problems).
• Other medicines that raise serotonin, such as Tramadol, triptans for migraine, Lithium, other antidepressants and St John's Wort, increase the risk of serotonin syndrome.
• Aspirin, NSAID painkillers and Warfarin increase the risk of bleeding.
• Fluoxetine can raise levels of some medicines, such as certain antipsychotics, tricyclic antidepressants, Carbamazepine and Phenytoin, and can reduce the effect of Tamoxifen.
• Avoid alcohol.

Contraindications

• Allergy to Fluoxetine.
• Current use of, or use within the last 14 days of, an MAO inhibitor.
• Use with Pimozide or Thioridazine.

Side Effects

Common side effects include nausea, headache, trouble sleeping or drowsiness, nervousness, dry mouth, loss of appetite, diarrhoea, sweating, tremor, yawning and sexual problems (lower desire, delayed orgasm). Many settle after the first few weeks.

Less common effects include low sodium in the blood (confusion, weakness, especially in older people), easy bruising or bleeding, rash, fits, mania in people with bipolar disorder and changes in heart rhythm. In children, teenagers and young adults, thoughts of self-harm may increase early in treatment.

Get urgent medical help if you have thoughts of harming yourself, a high fever with agitation, muscle stiffness or twitching and fast heartbeat (possible serotonin syndrome), a fit, fainting or a pounding irregular heartbeat, black stools or vomiting blood, or a severe rash or swelling of the face and throat.

Pregnancy and Lactation

Talk to your doctor before using Fluoxetine if you are pregnant or planning a pregnancy. Untreated depression also carries risks, so the decision is made together. Use late in pregnancy may cause temporary breathing or feeding problems in the newborn and a rare lung blood pressure problem. Fluoxetine passes into breast milk; if used while breastfeeding, watch the baby for irritability, poor feeding or sleepiness and follow your doctor's advice.

Precautions and Warnings

Tell your doctor if you have epilepsy, bipolar disorder, heart disease, diabetes (blood sugar may change), glaucoma, liver disease, a bleeding disorder, or if you are having electroconvulsive therapy. Family and carers should watch for worsening mood, agitation or suicidal thoughts, especially in the first weeks and after dose changes. Fluoxetine may affect alertness; take care when driving until you know how it affects you.

Overdose

Overdose may cause nausea, vomiting, agitation, fast heartbeat, drowsiness, fits and heart rhythm problems, especially if taken with other medicines or alcohol. Seek emergency medical help immediately.

Therapeutic Class

Selective serotonin reuptake inhibitor (SSRI) antidepressant.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.