Use:
SSRI. Depression: patients > 18 years of age - Initially, 20 mg in the
morning; increase dosage gradually only after a trial period of several
weeks if required. Maximum: 80 mg/day. Elderly patients: 20 mg/day. Use
lower or less frequent dosage in patients with renal and/or hepatic
impairment and those receiving multiple medications. When switching
patients to a TCA, the TCA dosage may have to be reduced and plasma TCA
concentrations may need to be monitored temporarily when
fluoxetine is coadministered or hs recently been discontinued. Bulimia nervosa: Adults,
60 mg/day. Assess electrolyte levels prior to starting therapy.
Obsessive-compulsive disorder: 20 - 60 mg/day.
Prozac's long-term efficacy in bulimia (i.e., > 16
weeks) and in obsessive-compulsive disorder (i.e., > 13 weeks) has not
been evaluated in controlled trials.
Precautions:
Pregnancy, lactation, patients < 18 years of age, elderly patients.
History of allergic reactions, seizures, suicidal tendency, activation of
mania/hypomania, MI or unstable heart disease, diabetes, severe renal or
hepatic impairment, hypokalemia (following self-induced vomiting),
hyponatremia, altered platelet function.
Contraindications:
Not to be used with an MAOI or within 14 days of discontinuing MAOI
therapy. Allow at least 5 weeks after stopping Prozac before starting an
MAOI. Do not administer thioridazine with Prozac or within 5 weeks after
Prozac has been discontinued.
Safety/efficacy of combined Prozac/electroconvulsive
therapy not established.
Side effects:
Headache, nervousness, insomnia, drowsiness, fatigue or asthenia, anxiety,
tremor, dizziness or lightheadedness, nausea, dry mouth, diarrhea,
anorexia, excessive sweating. Less frequently, rash, pruritus, weight
loss, sexual dysfunction, convulsions.
Patient tips:
Full therapeutic effect may be delayed until 4 or 5 weeks of treatment.
Prozac may cause drowsiness, dizziness (NB driving). Restrict
alcohol intake.
Supplied:
Prozac comes in 10mg, 20 mg capsules; 20 mg/5 mL of
mint-flavored syrup, 120 mL bottles.
Interactions:
See Contraindications. Warfarin (monitor PT). Lithium levels may be
increased or decreased (monitor). Use cautiously with other CNS-active
drugs (e.g. tryptophan), agents highly bound to plasma protein or
metabolized by the P450 2D6 system. St. John's Wort (increase in
undesirable effects).
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