This page describes the situations in which fluoxetine will be effective and discusses the practical aspects of its use.

This information is for informational purposes and should be taken as food for thought and a motivator to go with your problems to an appointment with a qualified specialist, and not as a guide to self-treatment.

Despite the fact that the word “antidepressants” implies that the drugs included in this group are used in the treatment of clinical depression, the scope of antidepressants in general and fluoxetine is much wider.

Here is a partial list of disorders for which fluoxetine treatment will be effective:

• Depression of various origins
• Obsessive Compulsive Disorders (OCD)
• Neuroses of various nature
• Panic attacks
• social phobia
• premature ejaculation
• chronic fatigue syndrome
• Irritability
• Anxiety
• Dysphoria (loss of interest in life, feelings of frustration and general dissatisfaction)
• Lack of self-confidence
• Alcoholism

Unfortunately, the arrangement modern life is such that the average urban dweller is likely to find at least one of his permanent or intermittent disorders on the list above.

Most people leave their mental state unattended, starting to do something only when the situation is completely out of control. Meanwhile, disorders occurring in the background can significantly reduce the quality of life, and also be the root cause of other diseases.

So often the root cause of hypertension is anxiety or neurosis.

This is found out after the fact: a person gets rid of a neurosis that has tormented him for many years, and is surprised to find that his blood pressure has dropped to normal or almost normal values, despite the fact that no additional measures have been taken to treat this disease.

There is a hypothesis that a tense mental state can even provoke cancerous tumors - but there is no scientific evidence for this due to the difficulty of collecting a statistical base.

side effects of fluoxetine

The possible side effects of fluoxetine are many and vary from person to person.

The most common include mydriasis (dilated pupils), insomnia, drowsiness, and increased urination.

The most stable side effect is pupil dilation, which is due to an increase in the amount of serotonin in the body.

Side effects do not always persist throughout the course of taking fluoxetine preparations. Usually they occur at the beginning of the course or when the dose is increased and last for several days, after which they disappear. It happens that one side effect is replaced by another - for example, drowsiness in the first couple of days of taking the drug is replaced by insomnia, then the condition returns to normal. This is completely normal and does not pose a danger to the body.

What is the dosage of fluoxetine

The allowed dosage of fluoxetine is from 20 mg to 80 mg per day.

They start the course with a dose of 20 mg (usually 20 mg is 1 capsule, but packaging is extremely rare where 1 capsule is 10 mg), then it is permissible to increase the dosage every week by 20 mg once.

Optimal and suitable for most patients is a dose of 40 mg. Higher dosages may be used in the treatment of OCD (60mg) and in cases of severe and refractory depression.

The exit from the course occurs according to a similar principle - every week the dose is reduced by 20 mg until it reaches the minimum 20 mg per day. Then the frequency of taking fluoxetine is reduced from daily to 1 capsule every other day. Having reached 20 mg once a week, you can completely stop taking the drug.

fluoxetine and alcohol

Fluoxetine should not be combined with the intake of alcohol, as well as narcotic drugs and groups of SSRIs and MAO inhibitors.

Alcohol and drugs cause a sharp release of serotonin, which, coupled with the serotonin-retaining effect of fluoxetine, can lead to the development of serotonin syndrome.

Similarly, with other antidepressants - they do not provide sharp releases of serotonin, but their effects are superimposed on each other, which can also cause serotonin syndrome.

fluoxetine and driving

The instructions for fluoxetine preparations say that they must be taken with caution when driving a car and performing other work that requires concentration and a high psychomotor reaction.

At the same time, the current legislation does not explicitly prohibit driving under the influence of SSRI antidepressants, including fluoxetine (Prozac). This means that during the medical examination, the collected analyzes will not reveal substances, the presence of which can be used to conclude that you are driving in a state of drug or drug intoxication.

Thus, deprivation of the rights for driving under fluoxetine can not be feared. But you should be especially careful because it can impair attention and slow down reactions - especially in the first days after starting or increasing the dosage.

Fluoxetine overdose

If the allowable daily dosage is exceeded or if the rules for increasing the dose are not followed, an overdose may occur in a person taking fluoxetine.

The good news is that no lethal dose of fluoxetine has been identified. Those. it is almost impossible to die from an overdose in the case of fluoxetine - even if you set yourself a goal and purposefully swallow a large number of capsules containing this drug.

However, an overdose of fluoxetine can lead to unpleasant consequences - depersonalization and the development of serotonin syndrome.

Depersonalization is a mental disorder in which a person no longer adequately perceives reality and himself, and evaluates his actions as if from the outside. In this state, a person is not aware of his actions and can be a danger - but not for others, but primarily for himself. This is a very painful condition, a long stay in which can provoke a suicide attempt.

Serotonin syndrome is an equally unpleasant phenomenon that occurs when there is a strong excess of serotonin in the body. Those. little serotonin is bad, but when serotonin is much higher than normal, this is also bad. Serotonin syndrome is similar to an alcohol hangover or food poisoning according to the sensations. With mild or moderate serotonin syndrome, the clarity of consciousness is not impaired, however, in severe forms, confusion, disorientation, and obsessive thoughts may occur.

Extremely rarely, serotonin syndrome can go into a malignant stage, during which a fatal outcome is possible as a result of acute cardiovascular disorders. The probability of such a development is negligible, but in any case it cannot be neglected.

Because there are no specific fluoxetine antagonists, overdose management includes gastric lavage, fluids, and rest. Call an ambulance if necessary.

side effects of taking fluoxetine

Contrary to what is widely believed in society, the effects of taking fluoxetine are usually extremely favorable.

Patients have a significantly improved quality of life, anxiety, neurosis, and depressive states disappear, irritability disappears, and social fears that make it difficult to make new acquaintances and communicate disappear.

But antidepressants are not a defense against the recurrence of the disorder in the future. Having improved your psycho-emotional state and feeling the strength to live on, you need to work on changing your lifestyle, if possible, removing from your life those things that once led to the occurrence of certain disorders.

If for some reason this is not possible, after some time it may be necessary to repeat the course of taking antidepressants.

Forgetting that food should not bring pleasure or disappointment, but primarily benefit. The result is eating disorders.

Refusal of food or, on the contrary, jamming of troubles with everything that comes to hand is a phenomenon, first of all, a psychological one. “To normalize your weight, you need to fix your nerves,” many ladies come to the conclusion. And they begin to buy affordable antidepressants in pharmacies, looking at the less affordable fluoxetine, a drug that helps get rid of depression and amass a lot of health problems.

How it works

First registered in 1974, this drug is still one of the most popular antidepressants in the world.

Its pharmacological action is based on the fact that it prevents the re-uptake of serotonin in the areas of the CNS nerve cells that are responsible for the process of excitation transfer from cell to cell. As a result, a large amount of serotonin, which is otherwise called the hormone of happiness, is collected in these areas. This, in turn, greatly tones the nervous system.

The influence of fluoxetine on the central nervous system is really great. This drug:

• increases the content of serotonin in the brain;
• indirectly affects the brain centers of saturation, due to which a person gets rid of hunger much faster, eating many times less food than before;
• contributes to the fact that serotonin affects the entire nervous system, and not just its individual parts.

The effect of the drug can be observed after a few days:

• mood rises, apathy, anxiety, irritability disappear, there is a need for communication;
• there is a need to replace the couch lifestyle with a more active one;
• the nervous feeling of hunger is dulled, eliminating the burning desire to once again seize life's troubles;
• sleep is normalized.

It may also happen that weight loss does not occur at all - if overweight postponed due to real health problems, and not due to nervous overeating. Then apart from overweight you will have to deal with a whole bunch of side effects caused by taking the drug.

Do not forget that fluoxetine is quite capable of causing addiction, which is unlikely to get rid of on your own. Weaning the body from the antidepressant will have to be under the supervision of doctors.

When it is necessary

In fairness, it must be said that in some cases, the benefits of fluoxetine are indeed invaluable.

It is no coincidence that experts around the world prescribe it for:

• severe prolonged depression, not amenable to treatment with other drugs;
• obsessive-compulsive disorder syndromes;
• chronic bulimia and anorexia - those same eating disorders;
• long-term alcoholism.

For patients with such complex diagnoses, fluoxetine can really do a good job. But do not fall into a strong drug addiction just to get rid of a few extra pounds.

fluoxetine side effects

It should be noted right away: the side effects of fluoxetine are very diverse and many-sided, and taking the drug affects almost all the most important internal organs and systems. Before agreeing to a course of medication, it is imperative to find out how the body can respond to it.

• headache;
• muscle twitches;
• tremor;
• neuralgia;
• thinking disorders;
• inability to concentrate;
• amnesia;
• decreased visual acuity;
• photophobia;
• violation of the sense of taste;
• psychosis;
• suicidal tendencies;
• ear pain.

• tachycardia;
• heart failure;
• myocardial infarction;
• vascular thrombosis;
• blockage of cerebral vessels;
• anemia.

• nasal congestion;
• swelling of the larynx;
• inflammation and pulmonary edema;
• difficulty breathing;
• chest pain.

• gastritis;
• vomiting, nausea;
• intestinal and gastric ulcer;
• internal bleeding;
• hepatitis;
• liver failure;
• pancreatitis.

• cystitis;
• urinary tract infections;
• kidney failure;
• decreased sexual desire;
• inability to enjoy intimate relationships.

• acne
• dermatitis;
• pronounced skin pigmentation;
• shingles;
• psoriasis;
• allergic rash, itching, angioedema.

Complications due to taking the drug can be so severe that the patient falls into a coma and passes away. Such cases are well known to doctors and documented.

Antidepressants are drugs that can be taken only after prior consultation with a neurologist or psychiatrist. It is to this class that the drug "Fluoxetine" belongs. Patient reviews can be found very different: after treatment with this remedy, someone started a new and high-quality better life, while others, on the contrary, experienced a persistent deterioration in their condition. Why is this happening?

The action of the drug

It is designed to relieve the feeling of fear, reduce apathy and cheer up. Normalization of sleep and appetite are also included in this list. The effect of the drug directly depends on the state of mental health of a person. The patient may feel a surge of energy, a thirst for vigorous activity, an improvement in mood. A healthy person who, for some reason, decides to take it (in order to increase efficiency or lose weight), on the contrary, can turn into a real “vegetable” that does not have the strength and any desires. For this reason, the drug "Fluoxetine" receives the most controversial reviews.

Pharmacokinetics

The main effect of the drug is to normalize the production of serotonin (this Chemical substance, a hormone that is directly related to appetite, mood, libido, social behavior and brain function). If its natural production is reduced, a person experiences depression, apathy, and a depressed mood prevails. The drug helps to restore interest in life. Does not affect the work of the cardiovascular system and blood pressure, does not cause drowsiness and lethargy.

special instructions

You can evaluate the full result of taking the drug two weeks after the start of the course. Be sure to follow the recommendations of your doctor. The dosage should be reduced gradually: this way you will finish the course of treatment as comfortably as possible. Caution should be taken when taking funds for persons whose work requires maximum accuracy and coordination of actions.

Fluoxetine and weight management

Doctors prescribe the drug in cases of anorexia and bulimia. Both a complete refusal of food and uncontrolled gluttony are nothing more than a reaction of our psyche to the world full of stress and difficult situations.

contributes to this low level serotonin. The drug acts on the brain and helps to solve the problem. Let us not be seduced by the words about weight loss in the instructions for the drug APO-Fluoxetine. The reviews contain information about serious side effects and a difficult exit from the course of treatment, from which we can conclude that this is far from a safe drug for weight loss. It can be used only as prescribed by a doctor and in the case when it is really necessary, when there are real mental problems, and not 3-5 extra pounds.

Indications for use

• Depression, apathy, panic attacks.
• Obsessive-compulsive states, obsessions, fears, thoughts.
• Sleep disorders of varying severity.
• Severe eating disorders.
• Alcoholism.
• Schizophrenia.
• Mental disorders.

Dosage

The standard dose is one tablet (20 mg) per day. The doctor who is treating you may adjust the doses depending on how he assesses the condition. Prolonged depression often requires taking two pills a day. With bulimia, the dose rises to 60 mg per day, and the maximum allowable ranges from 60 to 80 mg. The duration of treatment is also individual, it can take from a month to six months. Only an experienced doctor can choose optimal scheme treatment and adjust if necessary. From patients taking the drug "Fluoxetine Lannacher", the reviews contain information about a fairly rapid improvement in the condition during the first three weeks of admission. However, after the withdrawal of the remedy, not everyone has the achieved result, which is also a reason for consulting a doctor.

Side effects

The same weight loss effect desired by many is actually a side effect, and it does not always appear and not for everyone. A powerful antidepressant, this drug activates the production of serotonin, which raises the mood, improves performance and at the same time suppresses appetite. Other side effects please much less.

• Headaches and dizziness, drowsiness and lethargy, anxiety and fatigue. All this is a reaction of the nervous system to the drug.
• The digestive organs can react with diarrhea, complete lack of appetite, nausea and dry mouth.
• In addition, you may notice tremors (trembling) of the limbs, heavy sweating, decreased sex drive, lack of ejaculation, and cessation of the menstrual cycle.
• The most ominous on this list may be systemic disorders from the kidneys, liver, lungs and heart.

Reviews received from people suffering from depression and taking the drug "Fluoxetine" confirm that dizziness and loss of appetite are most often felt after taking it.

Contraindications

This is a very important point on which everyone should focus their attention. If you have kidney or liver failure, severe kidney dysfunction, serious cardiovascular disease, then you need to find another treatment. It is forbidden to use the drug during pregnancy and lactation, so postpartum depression will have to be dealt with in other ways.

Another category of people who are contraindicated in treatment with this antidepressant are patients with epilepsy and diabetes mellitus. Alcohol is prohibited during treatment: interaction with the drug will result in poor health, vomiting and headache, and with minimal alcohol intake. If the patient had a history of suicidal tendencies, the drug "Fluoxetine" is contraindicated for him. Officially registered figure: in 3% of cases, taking the drug ends in suicide. This is not affected by the dosage or duration of the medication, it is an individual reaction of the nervous system.

Specifications for application

If you are taking other antidepressants, then you must first complete the course, and only then switch to Fluoxetine. With caution, you need to prescribe it to patients with anorexia. Despite the fact that this violation is included in the list of indications, the drug can stimulate weight loss, which is dangerous for a malnourished person. If there is a need to prescribe this remedy to a patient with diabetes mellitus, then constant monitoring of blood sugar levels is necessary. With modern appliances for home use, this is quite easy.

Overdose

It is highly undesirable to exceed the prescribed doses, since poisoning develops. Symptoms are typical - diarrhea or vomiting. Mental excitement or convulsions may be added. Symptomatic treatment: gastric lavage, taking activated carbon or other sorbents, condition control.

Results

This is a serious drug that gives good results, but requires a responsible attitude to your health. Although it can be bought without a prescription, doing so and taking it on your own is highly discouraged. Only those patients who were treated by experienced doctors (using the drug "Fluoxetine") reviews indicate a positive trend and a minimum of side effects.

fluoxetine side effects

Fluoxetine is a popular stimulant antidepressant that reduces tension, improves mood, relieves anxiety and fear, and eliminates dysphoria. Its undoubted advantages include the fact that it does not cause a sedative effect, orthostatic hypotension, does not harm the work of the heart and blood vessels. While taking this remedy, appetite is significantly reduced, which has made it popular among those who lose weight. Perhaps that is why the drug has maintained its leading position in the market for a long time.

Fluoxetine: indications for use

If we consider the official indications for use, you will not find the lines “for weight loss” in them. All indications are purely mental in nature. The list includes the following items:

• depression of any severity;
• uncontrollable feeling of fear;
• depression against the background of any other mental disorders;
• bulimia nervosa;
• obsessive states;
• headache.

It is known that the use of fluoxetine in obesity not only will not give the desired result, but can also be harmful to health. The fact is that with obesity, all internal organs carry an excessive load, and this drug further reinforces it. As a result, a variety of diseases of the internal organs or blood vessels can develop.

Fluoxetine: contraindications

Like any medicine, fluoxetine has a whole list of contraindications in which it is forbidden to take it:

• hypersensitivity to the components of the drug;
• severe liver failure;
• chronic renal failure;
• suicidal mood;
• any manic states;
• pregnancy;
• lactation period.

In addition, taking fluoxetine in diabetes mellitus, epileptic syndrome and epilepsy, cachexia, compensated renal and hepatic insufficiency can be dangerous. In these diseases, the remedy is used with caution, under the strict supervision of a physician.

Fluoxetine: dosage of tablets

Fluoxetine for depression begins to be taken only in the morning, 20 mg per day. If necessary, the dose is increased once a week by 20 mg per day. The maximum possible dose is 80 mg, and it must be divided into 2-3 doses. The course in any case should last 3-4 weeks.

fluoxetine overdose

In case of overdose, nausea, vomiting, convulsions and agitation occur. Treatment is based on symptoms, but gastric lavage and activated charcoal are always necessary.

fluoxetine side effects

There is a possibility of a number of side effects, in which case it is possible to cancel the drug and replace it with another one.

The list is quite large:

• lethargy, increased fatigue;
• dizziness, headache;
• manic syndrome or hypomania;
• dry mouth or hypersalivation;
• loss of appetite;
• weight loss
• drowsiness or insomnia;
• skin rash, urticaria;
• asthenia. tremor, agitation;
• anxiety;
• suicidal tendencies;
• nausea, diarrhea;
• increased sweating;
• decreased libido;
• systemic disorders of the lungs, kidneys or liver;
• vasculitis.

Perhaps the occurrence of a deadly side effect - a malignant neuroleptic syndrome. However, it occurs most often when taking antipsychotics. That is why, if you are taking fluoxetine for depression or for any other purpose, it is important not to do this uncontrollably, but to consult a doctor.

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Fluoxetine - a powerful antidepressant or a narcotic substance?

One of the most popular antidepressants in the world is Fluoxetine, aka Prozac. Like its analogues, this drug is addictive, as a result of which patients "sit down" on it like a drug. What is a common antidepressant and why exactly is it dangerous?

Antidepressant drug fluoxetine

Prozac, better known under the brand name Fluoxetine, is a drug from the group of antidepressants. It is prescribed in the treatment of depression and obsessive-compulsive disorders, in which the patient experiences constant fear and increased anxiety.

The drug began to be actively used in the treatment of depressive disorder since 1980, when in America the prevalence of this disease had already assumed the proportions of a national catastrophe. Residents of the United States and Canada began to actively treat the new drug, as a result of which they themselves began to call themselves the “Prozac generation”. Now, according to statistics, 40 million people around the world take Fluoxetine.

So, some girls use the drug for weight loss, because Prozac reduces appetite. The danger lies in the fact that it tends to accumulate in the body, resulting in serious damage to the central nervous system.

Although the antidepressant is designed to restore lust for life, the effect is reversed with prolonged use. Initially, a side effect in the form of euphoria is possible. However, later a person begins to be haunted by nightmares, he develops neuroses and suicidal tendencies.

Indications

The drug Fluoxetine is mainly prescribed for mental disorders, including:

According to some reports, the drug also helps with anorexia nervosa, alcoholism, social phobia, diabetic neuropathy, affective disorders, autism, panic attacks, kleptomania. The full list of additional indications for use is very wide, but at the same time it is controversial. There is evidence from studies according to which the effect of the use of Prozac is comparable to the effect of "placebo".

Photo of fluoxetine tablets

Operating principle

Fluoxetine selectively inhibits the reuptake of serotonin in brain cells. As a result, the concentration of this substance increases in the synapses responsible for the transmission of neurotransmitters from neuron to neuron. The action of serotonin on the postsynaptic links of the receptors is prolonged, while the drug does not affect the reuptake of dopamine, noradrenaline and other neurotransmitters.

This is the pharmacological action of Fluoxetine. Outwardly, it manifests itself in an improvement in mood and a stimulating effect. At the same time, anxiety disappears, appetite decreases, but the drug does not have a calming effect.

You can trace the relationship between the effect on the body of Prozac and the drug. This antidepressant has a very strong effect and seriously affects the nervous system.

Uncontrolled intake of pills instead of returning the craving for life provokes the re-development of obsessive-compulsive disorders. After a short euphoria, a person has obsessive thoughts that haunt him and force him to take actions to overcome them.

There are also known cases of hallucinations and psychosis on the background of the use of Prozac. All this often leads to suicide attempts, the risk of which is especially high at the age of 24 years.

On the video about the effect of antidepressants on the body:

Danger and side effects

Long-term use of Fluoxetine, especially when self-administered, is fraught with many side effects from almost all organs and systems. About this in Canada, where the drug has become incredibly popular, they even made a film called "The Prozac Generation." It was also shown in Russia, but this video did not provoke a public outcry.

The main danger of an antidepressant lies in its effect on the central nervous system, from which it is possible:

• dizziness and headaches;
• nightmares;
• euphoria;
• anxiety;
• psychomotor agitation;
• neuroses;
• thinking disorders;
• loss of coordination of movements;
• attention disorders;
• lethargy.

In the 1980s, during testing in Germany, the country's licensing authority determined: Fluoxetine is absolutely not suitable for the treatment of depression. Then scientists found out that the drug causes hallucinations and psychoses, and in general, its side effects reach an unacceptable level by medicine.

In addition, according to unofficial statistics, fluoxetine provokes 5.6 times more suicide attempts than other antidepressants. Among Americans alone, over 9 years, 4 million people experienced a fatal reaction to the drug.

Also widely known worldwide was the shooting at an American school in 2005. The criminal turned out to be a young man who took Prozac. Subsequently, this drug scored the highest number of complaints in history associated with a huge number of side effects, suicides and crimes committed under its influence.

In addition to the CNS, fluoxetine affects cardiovascular system and blood, provoking:

An antidepressant can cause serious damage to the organs of the gastrointestinal tract, which provokes:

• loss of appetite;
• anorexia;
• enlargement of the salivary glands;
• peptic ulcer;
• constipation and diarrhea;
• intestinal obstruction;
• colitis;
• gastritis;
• intestinal obstruction;
• pancreatitis.

Decreased appetite often leads to anorexia, which is why some girls take the drug in order to lose weight. Cases have also been described where fluoxetine led to an increase in the tonsils, pharyngitis, chills and fever, neuroleptic malignant syndrome, and even death.

Overdose

As a result of an overdose of the drug, all side effects increase.

The first symptoms to watch out for are:

Also officially recorded 2 cases of death due to an overdose of fluoxetine. Patients took the drug simultaneously with Codeine, Temazepam and Maprotiline.

There is no such thing as an antidote to Prozac. Therefore, at the first signs of an overdose, a person needs to urgently perform a gastric lavage and give him activated charcoal to drink.

Subsequently, the patient will require symptomatic and supportive treatment. As medical practice shows, hemodialysis, diuretics and blood transfusion with an overdose of Fluoxetine are ineffective.

Legality

Due to the high number of suicides under the influence of Prozac, this drug caused a lot of scandals in Europe. As a result, in a number of countries it was officially banned and withdrawn from sale. In Russia, despite all the excitement around the antidepressant, it was included in the Register of Medicines and allowed for free sale in pharmacies.

Fluoxetine can only be purchased with a doctor's prescription. However, the widespread popularity of the drug around the world leads some people to acquire it illegally. There are even companies on the Internet that offer related services.

Reviews of doctors

Although fluoxetine causes many side effects, doctors continue to prescribe it to their patients. However, most of them note that this drug shows a positive result only in severe forms of depression. In all other cases, the antidepressant acts like a placebo.

There is also an opposite opinion regarding the effect of Fluoxetine. So, scientists from the University of Hull published the results of a number of studies of the drug.

According to the data obtained, even in severe depression, this drug works exactly the same as a pacifier without the active substance. Positive dynamics was observed only in a small part of the subjects. Accordingly, American scientists argue that the appointment of Fluoxetine is inappropriate in most cases.

All doctors agree on one thing. Fluoxetine is a potent drug, so self-medication is unacceptable. An antidepressant should be used only on the recommendation of the attending physician and under his supervision.

5 Comments

This drug saved my life, you go ...

The article is utter nonsense, none of the listed terrible effects from this drug have been noticed, this is the best antidepressant that allows you to continue vigorous activity without having to fall out of reality like from other antidepressants. Many have been tried, and only fluoxetine really helped once and for all. There were no thoughts of suicide, on the contrary, a craving for life and a desire to live it fully and efficiently! The article is clearly custom-made in nature, deliberately discrediting a drug that saves people's lives !!

Halfdan, the article is for informational purposes and this article repeatedly focuses on the fact that all problems primarily arise due to self-administration of the drug in cases where its use is not indicated (for example, for weight loss or in the absence of depression) and their abuse.

By the way, suicidal tendencies are a side effect of many antidepressants, which is why the intake of these drugs should be strictly controlled by the doctor, and in case of undesirable effects, the treatment should be corrected in a timely manner.

However, no one denies that the drug works in case of severe depression, and you may not have had side effects while taking fluoxetine. Therefore, if the drug was prescribed to you by a doctor and it suits you, this is fine and you can safely take it.

The main thing is not to use psychoactive drugs for the sake of entertainment, interest, or to self-medicate.

Nonsense. But one take is not enough. You have to do something else yourself. The side effects are really quite harsh, especially drowsiness, coupled with the inability to fall asleep and Negative influence to the urinary tract. But it's better that way than on illegal drugs, risking freedom or complete amotivation and suicide.

The drug really helps, especially with alcoholic depression, causes a feeling of euphoria, there is a persistent refusal to take alcohol, promotes weight loss, however, suicidal thoughts sometimes arise and problems with sexual desire and erection, but still I am satisfied, I take a month, I am afraid that further a negative reaction from the psyche will begin, but if you don’t take a day, then you want to drink, so it’s better to take the drug.

Should I use fluoxetine for weight loss: truth and myths

Fluoxetine is a “worthy” choice for those who do not think about the consequences at all in pursuit of the ghostly ideal of a slender body.

What do we know about the drug

The Russian Fluoxetine, or Fluxen, is an analogue of the old French drug Prozac, on which at one time European doctors "hooked" patients suffering from eating disorders.

In medical practice, this drug is intended for the treatment of various mental disorders. The tool is a fairly strong antidepressant, and the indications for it are extensive.

Among them is bulimia, a rare disorder in which, in a state of nervous shock, the patient absorbs food in exorbitant quantities, subsequently causing vomiting.

It is for this reason that the drug has firmly taken root in the circles of those who are losing weight, who manage to get it by any means. The medicine is quite rightly not dispensed without a prescription. But some pharmacists and pharmacists make a kind of "criminal" deal with buyers, selling fluoxetine in the public domain.

Mechanism of action of fluoxetine

This is a really high-quality antidepressant, but only in the conditions of its reception for a specific purpose. It is prescribed to patients with bulimia, alcoholism, schizophrenia and other mental disorders.

The mechanism of its action is based on the increased production of serotonin, a kind of “hormone of joy”. Deficiency of this substance leads a person to nervous stress, depression, insomnia, apathy and compulsive overeating.

You can safely drink the drug if it is prescribed to you by a qualified specialist. If you decide to take it on your own, be prepared for the most unexpected complications.

Meanwhile, the dubious reputation of Prozac did not originate in "volunteer" circles at all. High-profile lawsuits and litigation have affected manufacturers due to the strange effects of the drug on really sick patients.

Perhaps their diagnoses were set incorrectly, or perhaps a strong antidepressant "finished off" the already vulnerable psyche of a mass of adolescents and young people.

However, the litigation took place under the auspices of public concern about a wave of suicides and massacres against the background of taking this drug. Peter Breggin, a well-known psychiatrist, gave an opinion in 2013 on the occasion of the mass shooting at the headquarters of the US Navy.

He wrote on his website that such aggression was provoked by the shooters while taking the sleeping pill Trazadone. He stressed that this drug has an extremely dangerous effect on the psyche, like the notorious Fluoxetine.

The effect of the drug was investigated by journalist Patricia Kelly O'Meara, who concluded that it was the side effects of Prozac that made the public think about the dangers of antidepressants. Media coverage of the event oddly coincided with a decline in teen suicide.

What does the official manufacturer's summary say?

In the cells of the brain, the very “happiness hormone” - serotonin - is actively synthesized. At the same time, the central nervous system is not inhibited, but on the contrary, it is stimulated by excipients.

The centers of hunger, localized in the brain, are effectively blocked, as a result of which there is a feeling of satiety and uncontrolled appetite is suppressed.

As a result of complex biochemical processes launched by the agent in the body, the following changes occur:

• The feeling of hunger and the desire to "seize" stress with various delicacies are eliminated;
• Portions of food for full saturation are halved;
• Rapid weight loss occurs
• Together with this, physical activity increases, self-confidence arises, a feeling of readiness to “turn mountains”;
• Irritability and apathy against the background of hunger no longer bother a woman;
• Night sleep becomes calm and strong.

It would seem that Fluoxetine is an ideal tool for weight loss. And it is not for nothing that their appearance on the pharmaceutical market has been transformed into a real fashionable canon. You eat little, you can follow any strict diet, while your mood remains upbeat, and physical activity and the energy is growing exponentially...

If everything were so perfect, drug manufacturers would have made a billion-dollar fortune, and not lawsuits in their favor.

"Backward Effect"

Fluoxetine is a powerful drug that has a powerful effect on the functioning of the brain and nervous system. It does not have fat-burning, and even stimulating effects. Moreover, it will not "kill" your exorbitant appetite if you just like to have a snack or a big meal.

It can reduce cravings for food only if it is due to a deficiency of the “hormone of joy”, i.e. has a nervous connotation. Competent physicians do not allow their patient to take the drug if they are not 100% sure of the nature and genesis of his disorder.

Fluoxetine is officially indicated to be taken in such conditions:

• Chronic depression (do not confuse with blues);
• insomnia;
• CNS disorders;
• Schizophrenia;
• migraine conditions;
• neuroses;
• Obsessive states (in particular, fear);
• Bulimia.

If the medicine is taken absolutely a healthy person arbitrarily, this provokes an excess of serotonin, the consequences of which can become even more deplorable than with its deficiency.

Side effects of application

The easiest complications that you can notice in yourself against the background of unauthorized use of an antidepressant:

• Diarrhea;
• Tachycardia;
• Headaches and syncope (fainting);
• Feeling thirsty and dry mouth;
• Hyperhidrosis;
• Violation of visual acuity;
• Increased fatigue and apathy;
• Pain in the mammary glands (in women);
• Amenorrhea (in women);
• Nausea and vomiting;
• "Noise in ears;
• chronic fatigue syndrome;
• Insomnia;
• Dyspepsia;
• Aches in the bones;
• Skin rashes of unknown etiology;
• Suppression of libido (sexual desire).

More serious consequences:

• Manic syndromes;
• A state of persistent depression;
• Uncontrolled bouts of aggression;
• Obsessive suicidal thoughts (often - suicide attempts);
• Anxiety;
• Asthenia;
• Violation of coordination of movement, permanent tremor in the limbs;
• Systemic disorders of the kidneys, liver, lungs and heart;
• Allergic and anaphylactic reactions to the components of the drug.

If you consider that you feed your body with serotonin, which is already produced in sufficient quantities in it, this can lead to serotonin syndrome, which can lead to coma or death.

The most "popular" complication of uncontrolled use of the drug was suicide. You can verify this by reading the mass media publications on this topic. At the same time, neither the dosage nor the frequency of administration affected the outcome. If you decide to take an antidepressant and you allow yourself to drink, you should also be prepared for delirium tremens (acute alcoholic psychosis).

If you still have not given up on the idea of ​​taking fluoxetine, contact your doctor first and find out the specific reason excess weight. Admit it, it is likely that overeating haunts you not at all from stress, but from a banal desire to enjoy your favorite fast food, when the stomach does not even hint at a state of hunger.

For weight loss, there is nothing better than a balanced diet and moderate physical activity. Taking heavy drugs to lose weight is the biggest crime you can commit against your physical and mental health.

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Fluoxetine is medicinal product, which improves mood, reduces anxiety, has a mild stimulant effect and suppresses appetite. Fluoxetine is generally well tolerated, but side effects may occur in some cases.

Why does it appear side effect fluoxetine

Side effects of fluoxetine are a consequence of its mechanism of action based on blocking the reuptake of serotonin in the synapses of neurons (nerve cells) of the central nervous system. As a result, a large amount of serotonin accumulates in synapses (places of transmission of excitation from neuron to neuron), which transmits nerve impulses.

Side effects of fluoxetine from the central and peripheral nervous system

From the side of the central and peripheral nervous system, increased anxiety may appear , irritability , nervousness, increased fatigue, sleep disturbances (insomnia or drowsiness), frightening dreams, headache. Sometimes, against this background, the tendency to suicide increases. Disorders of thought, impaired coordination of movements, trembling throughout the body, a painfully increased excited state, and other mental disorders may develop.

Perhaps the appearance of twitches of individual muscle groups, muscle stiffness, against the background of increased muscle tone, tics, states of restlessness, the desire to constantly change the position of the body may occur. Any involuntary movements may occur and persist for a long time, there may be tension in the muscles of the tongue, swallowing and chewing muscles, in which there is an irresistible desire to stick out the tongue.

The most severe manifestation of such side effects is neuroleptic malignant syndrome, which is characterized by a rise in very high temperature, increased muscle tone, sudden changes in blood pressure, rapid breathing, sweating and impaired consciousness.

On the part of the sense organs, visual disturbances, dilated pupils, and taste disturbances may occur.

Side effects of fluoxetine from other organs and systems

In addition, fluoxetine can cause the following side effects:

• from the gastrointestinal tract - nausea, vomiting, diarrhea or constipation, swallowing disorders (dysphagia), complete lack of appetite and a sharp decrease in body weight;
• from the genitourinary system - urination disorders (frequent urination, incontinence, urinary retention), decreased sexual desire, disorder of various parts of sexual intercourse, menstrual disorders in the form of very painful menstruation;
• on the part of the circulatory organs - attacks of increased heartbeat, a sharp decrease in blood pressure with fainting during the transition from horizontal to vertical position(orthostatic hypotension);
• other side effects - the appearance of pinpoint skin hemorrhages on the skin; in patients with diabetes, a sharp decrease in blood sugar during treatment with fluoxetine and a sharp increase in this indicator against the background of drug withdrawal are possible; a significant decrease in the amount of sodium in the blood, especially in elderly patients;
• allergic reactions - manifested by various kinds of skin rash (including urticaria), itching, Quincke's edema, fever, muscle and joint pain.

Things to consider while taking fluoxetine

Taking fluoxetine has a number of contraindications, which are taken into account by the doctor when prescribing this drug. In addition, it cannot be combined with the intake of alcoholic beverages and psychotropic drugs. that depress the central nervous system - this can cause an increase in side effects.

Antidepressant, a propylamine derivative. The mechanism of action is associated with selective blockade of neuronal reuptake of serotonin in the CNS. Fluoxetine is a weak antagonist of cholino-, adreno- and histamine receptors. Unlike most antidepressants, fluoxetine does not appear to cause a decrease in the functional activity of postsynaptic β-adrenergic receptors. Helps improve mood, reduces feelings of fear and tension, eliminates dysphoria. Does not cause sedation. When taken in average therapeutic doses, it practically does not affect the functions of the cardiovascular and other systems.

Pharmacokinetics

Absorbed from the gastrointestinal tract. Weakly metabolized during the "first pass" through the liver. Eating does not affect the degree of absorption, although it may slow down its rate. C max in plasma is achieved after 6-8 hours. C ss in plasma is achieved only after continuous administration for several weeks. Protein binding 94.5%. Easily penetrates through the BBB. It is metabolized in the liver by demethylation to form the main active metabolite of norfluoxetine.

T 1/2 fluoxetine is 2-3 days, norfluoxetine - 7-9 days. Excreted by the kidneys 80% and through the intestines - about 15%.

Release form

10 pieces. - cellular contour packings (2) - packs of cardboard.
10 pieces. - cellular contour packings (3) - packs of cardboard.
10 pieces. - cellular contour packings (5) - packs of cardboard.

Dosage

Initial dose - 20 mg 1 time / day in the morning; if necessary, the dose can be increased after 3-4 weeks. The frequency of admission is 2-3 times / day.

The maximum daily oral dose for adults is 80 mg.

Interaction

With simultaneous use with drugs that have a depressant effect on the central nervous system, with ethanol, a significant increase in the inhibitory effect on the central nervous system is possible, as well as an increase in the likelihood of convulsions.

With simultaneous use with MAO inhibitors, furazolidone, procarbazine, tryptophan, serotonin syndrome may develop (confusion, hypomania, restlessness, agitation, convulsions, dysarthria, hypertensive crisis, chills, tremor, nausea, vomiting, diarrhea).

With simultaneous use, fluoxetine inhibits the metabolism of tricyclic and tetracyclic antidepressants, trazodone, carbamazepine, diazepam, metoprolol, terfenadine, phenytoin, which leads to an increase in their concentration in blood serum, an increase in their therapeutic and side effects.

With simultaneous use, it is possible to inhibit the biotransformation of drugs metabolized with the participation of the CYP2D6 isoenzyme.

With simultaneous use with hypoglycemic agents, their action may be enhanced.

There are reports of an increase in the effects of warfarin when it is used simultaneously with fluoxetine.

With simultaneous use with haloperidol, fluphenazine, maprotiline, metoclopramide, perphenazine, periciazine, pimozide, risperidone, sulpiride, trifluoperazine, cases of extrapyramidal symptoms and dystonia have been described; with dextromethorphan - a case of the development of hallucinations is described; with digoxin - a case of increasing the concentration of digoxin in the blood plasma.

With simultaneous use with lithium salts, an increase or decrease in the concentration of lithium in the blood plasma is possible.

With simultaneous use, it is possible to increase the concentration of imipramine or desipramine in the blood plasma by 2-10 times (may persist for 3 weeks after the abolition of fluoxetine).

With simultaneous use with propofol, a case is described in which spontaneous movements were observed; with phenylpropanolamine - a case is described in which dizziness, weight loss, hyperactivity were observed.

With simultaneous use, it is possible to enhance the effects of flecainide, mexiletine, propafenone, thioridazine, zuclopenthixol.

Side effects

From the side of the central nervous system: anxiety, tremor, nervousness, drowsiness, headache, sleep disturbances are possible.

From the digestive system: diarrhea, nausea are possible.

From the side of metabolism: increased sweating, hypoglycemia, hyponatremia (especially in elderly patients and with hypovolemia) are possible.

From the reproductive system: decreased libido.

Allergic reactions: possible skin rash, itching.

Other: pain in the joints and muscles, shortness of breath, fever.

Indications

Depression of various origins, obsessive-compulsive disorders, bulimic neurosis.

Contraindications

Glaucoma, atony Bladder, severe renal dysfunction, benign hyperplasia prostate, simultaneous appointment of MAO inhibitors, convulsive syndrome of various origins, epilepsy, pregnancy, lactation, hypersensitivity to fluoxetine.

Application features

Use during pregnancy and lactation

Contraindicated for use during pregnancy and lactation.

Application for violations of liver function

Use with extreme caution in patients with impaired liver function.

Application for violations of kidney function

Contraindicated in severe renal impairment. Use with extreme caution in patients with moderate and mild renal impairment.

Use in children

Use in elderly patients

special instructions

Use with extreme caution in patients with impaired liver and kidney function, with a history of epileptic seizures, cardiovascular diseases.

In patients with diabetes mellitus, a change in blood glucose levels is possible, which requires correction of the dosing regimen of hypoglycemic drugs. When used in debilitated patients while taking fluoxetine, the likelihood of developing epileptic seizures increases.

With the simultaneous use of fluoxetine and electroconvulsive therapy, prolonged epileptic seizures may develop.

Fluoxetine can be used no earlier than 14 days after the abolition of MAO inhibitors. The period after the abolition of fluoxetine before the start of therapy with MAO inhibitors should be at least 5 weeks.

Elderly patients require correction of the dosing regimen.

The safety of fluoxetine in children has not been established.

Avoid drinking alcohol during treatment.

Influence on the ability to drive vehicles and control mechanisms

During the period of treatment, one should refrain from potentially hazardous activities that require increased attention and rapid psychomotor reactions.

fluoxetine-prozac

Fluoxetine (Prozac)

Pharmacological group: Antidepressants
Pharmacological action: Antidepressant, propylamine derivative. The mechanism of action is associated with selective blockade of neuronal reuptake of serotonin in the CNS. Fluoxetine is a weak antagonist of cholino-, adreno- and histamine receptors. Unlike most antidepressants, fluoxetine does not appear to cause a decrease in the functional activity of postsynaptic β-adrenergic receptors. Helps improve mood, reduces feelings of fear and tension, eliminates dysphoria. Does not cause sedation. When taken in average therapeutic doses, it practically does not affect the functions of the cardiovascular and other systems.
Systematic (IUPAC) name: (RS)-N-methyl-3-phenyl-3- propane-1-amine
Trade names: Prozac, among others
Consumption: orally
Bioavailability: 72% (peak - after 6-8 hours)
Protein binding: 94.5%
Metabolism: liver
Half-life: 1-3 days (fast), 4-6 days (slow)
Excretion: renal (80%), fecal (15%)
Formula: C 17 H 18 F 3 NO
Mol. mass: 309.33 g mol-1
Melting point: 179-182°C (354-360°F)
Boiling point: 395°C (743°F)
Solubility in water: 14 mg/ml (20°C)

Fluoxetine (also known under the trade names Prozac, Sarafem, Fontex, etc.) is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class of antidepressants. Fluoxetine was first registered in 1974 by scientists from Eli Lilly and Company. In February 1977, the drug was submitted to the US FDA, and in December 1987, Eli Lilly received final approval to bring the drug to market. In August 2001, the patent for fluoxetine expired. Fluoxetine is approved for the treatment of major depressive disorder (including childhood depression), obsessive-compulsive disorder (in both adults and children), bulimia nervosa, panic disorder, and dysphoric disorder. In addition, fluoxetine is used to treat trichotillomania, in case of unsatisfactory results of cognitive-behavioral therapy. It is marketed in combination with olanzapine under the name Symbyax. Despite the availability of new drugs, the popularity of Fluoxetine is not declining. In 2010, over 24.4 million generic prescriptions for fluoxetine were filled in the United States alone. Fluoxetine is the third most prescribed antidepressant after (SSRI; became generic in 2006) and Citalopram (SSRI; became generic in 2003). In 2011, there were 6 million prescriptions for fluoxetine in the UK.

Application

Action

Selective serotonin reuptake inhibitor (SSRI), antidepressant. The chemical structure is not similar to classical antidepressants (tricyclic, tetracyclic). Does not show affinity for adrenergic receptors a1, a2 i β, serotonergic, muscarinic, histamine H1, dopaminergic receptors and GABA. After oral administration, it is well absorbed; food intake does not affect the bioavailability of the drug; tmax is 6-8 hours, steady state is reached after a few weeks of use. Contacts proteins of plasma approximately for 95%. In the liver, it is demethylated with the participation of the CYP2D6 isoenzyme, and one of the active metabolites is norfluoxetine. t1 / 2 fluoxetine is about 4-6 days, and norfluoxetine - about 4-16 days. Determined plasma concentrations are detected several weeks after discontinuation of the drug. Excreted as metabolites - 60% in the urine, 16% in the feces.

Indications

Depressive disorders in adults. Depression of varying severity in children and adolescents over the age of 8 in cases where psychotherapy does not bring the expected effect. Obsessive-compulsive disorder. Bulimia.

Contraindications

Hypersensitivity to any of the components of the drug, the parallel use of MAO inhibitors. Fluoxetine can be started 14 days after stopping an irreversible MAO inhibitor and at least 24 hours after stopping a reversible MAO inhibitor (eg, moclobemide). Therapy with an MAO inhibitor can be started no earlier than 5 weeks after stopping the use of fluoxetine (if fluoxetine has been used for a long time and / or in high doses, a longer interval should be considered). With extreme caution should be used in patients with pharmacologically controlled epilepsy, as well as with a history of seizures; should not be used in patients with refractory epilepsy. The drug should be discontinued if seizures develop. Caution should be used in patients with a history of mania or hypomania; in the case of the development of a manic phase, the drug should be discontinued. Patients with diabetes may need to adjust the dose of antidiabetic drugs. During the course of therapy (especially during the first week), patients with depression should be carefully monitored for worsening symptoms of depression and the appearance of suicidal thoughts and / or suicide attempts. Due to the possibility of developing abnormal skin hemorrhages, it should be used with caution in patients taking SSRIs, especially in the case of concomitant use of oral anticoagulants, drugs that affect platelet function, and in patients with a history of bleeding disorders. During the first weeks of taking the drug, psychomotor agitation may develop (increasing the dose in this case may be harmful). Care must be taken when using electroconvulsive therapy - there is evidence of the development of prolonged epileptic seizures against its background. There have been cases of hyponatremia, usually in the elderly or in people taking diuretics. Due to the lack of sufficient clinical data, it should be used with caution in patients with concomitant cardiovascular diseases. Abrupt discontinuation of the drug may lead to the development of a withdrawal syndrome; it is recommended to reduce the dose gradually. Drugs containing lactose should not be administered to patients with congenital galactose intolerance, primary lactase deficiency or malabsorption syndrome of glucose-galactose absorption.

drug interaction

When considering the need to use a drug that interacts with fluoxetine, one should always take into account the long period of elimination of fluoxetine and its pharmacologically active metabolite from the body. Should not be used in combination with MAO-A inhibitors due to the risk of developing serotonin syndrome. During therapy in combination with an MAO-B inhibitor (eg, selegiline), or serotonergic drugs (eg, tramadol, triptans), care must be taken due to the possibility of developing serotonin syndrome. Lithium salts and tryptophan may enhance the effect of drugs from the SSRI group. With the parallel use of drugs that affect the central nervous system, there is the possibility of changing the concentration in the blood of such drugs as: carbamazepine, haloperidol, clozapine, diazepam, phenytoin, alprazolam, imipramine, desipramine; care should be taken to consider changing the dosing regimen and observe the patient for the development of side effects. In the case of simultaneous use or use within 5 weeks after stopping taking fluoxetine, drugs metabolized by CYP2D6 with a narrow therapeutic index (for example, encainide, flecainide, vinblastine, carbamazepine, tricyclic antidepressants), the minimum effective dose should be used. Preparations containing the herb St. John's wort can lead to aggravation of side effects. There is a possibility of interaction of fluoxetine with drugs that bind strongly to plasma proteins; the concentration of concomitantly used digoxin should be monitored. In patients taking anticoagulants, coagulation parameters should be monitored. Therapy in combination with ritonavir, saquinavir or efavirenz may be associated with an increased risk of serotonin syndrome. No drug interactions of fluoxetine with chlorthiazide, secobarbital and tolbutamide were found. There is no information on cases of drug interactions with alcohol, but it is not recommended to use it while taking fluoxetine. Fluoxetine and norfluoxetine inhibit many isoenzymes of the cytochrome P450 system, which makes drug metabolism possible. Both substances are potent inhibitors of CYP2D6 (the main enzyme responsible for their metabolism) and mild to moderate inhibitors of CYP1A2, CYP2B6, CYP2C9/2C19, and CYP3A4. In addition, they inhibit the activity of P-glycoprotein, a type of membrane transport protein that plays an important role in drug transport and metabolism. This extensive effect on drug metabolism pathways in the body provides a wide potential for interactions with many commonly used drugs. The concomitant use of fluoxetine with triptans, tramadol, or other serotonergic drugs can lead to the development of a rare but potentially life-threatening adverse reaction called "serotonin syndrome". Fluoxetine has been shown to have antimicrobial activity against several groups of microorganisms, mainly Gram-positive microorganisms. The drug also shows a synergistic effect in combination with certain antibiotics against a number of bacteria.

Side effects

Often: headache, dizziness, restlessness, drowsiness or insomnia, abnormal dreams, asthenia, fatigue, agitation, euphoria, nausea, vomiting, dyspepsia, diarrhea, dry mouth, taste disturbances, rash, itching, increased sweating, blurred vision, frequent urination, urinary retention, sexual dysfunction, priapism, galactorrhea. Not very common: difficulty concentrating and thinking, mania, panic attacks, confusion, self-perception disorder, tremors, ataxia, tics, convulsions, psychomotor agitation, yawning, dilation blood vessels, orthostatic hypotension, pharyngitis, shortness of breath, urticaria, alopecia, hypersensitivity reactions, chills, hypersensitivity to light. Rare: bleeding, bruising, hyponatremia, abnormal antidiuretic hormone secretion, pulmonary symptoms (including inflammation with variable histopathology and/or fibrosis), hepatic dysfunction, idiosyncratic hepatitis. Very rare: hallucinations, serotonin syndrome, arthralgia, myalgia, toxic epidermal necrolysis. After discontinuation of fluoxetine - withdrawal syndrome (weakness, paresthesia, headache, anxiety, nausea). In the first weeks of treatment, the risk of suicide increases. Symptomatic and supportive therapy is recommended; there is no specific antidote.

Sexual dysfunction is a common side effect of SSRIs. In particular, side effects often include difficulty becoming aroused, erectile dysfunction, lack of interest in sex, and anorgasmia (inability to achieve orgasm). Other possible side effects include: genital anesthesia, loss or decreased response to sexual stimuli, and ejaculatory anhedonia. While these sexual side effects are usually reversible, they can last for months, years, or a lifetime after the drug is completely stopped. This phenomenon is known as "post-SSRI sexual dysfunction". Eli Lilly, maker of Prozac brand name Fluoxetine, says the drug is contraindicated in people taking monoamine oxidase inhibitors, pimozide (Orap) or Thioridazine (Mellaril). The recommendations for the use of the drug indicate that the treatment of patients with liver failure "should be approached with caution." In these patients, fluoxetine and its metabolite norfluoxetine are eliminated approximately twice as fast, resulting in a proportional increase in drug exposure. The use of Ibuprofen in combination with fluoxetine can cause serious intestinal bleeding. Among the common side effects associated with fluoxetine and listed in the annotation to the drug, the largest difference with placebo are: nausea (22% vs. 9% in the placebo group), insomnia (19% vs. 10% in the placebo group), drowsiness (12% vs. 5% placebo), anorexia (10% vs 3% placebo), anxiety (12% vs 6% placebo), nervousness (13% vs 8% placebo), asthenia (11% vs 6% in the placebo group) and tremor (9% vs. 2% in the placebo group). The side effects most commonly leading to treatment interruption are anxiety, insomnia, and nervousness (1-2% each), and in pediatric trials, mania (2%). Fluoxetine shares sexual side effects with other SSRIs, including anorgasmia and decreased libido. In addition, rash or urticaria, sometimes severe, was observed in 7% of patients in clinical trials, and treatment was discontinued in a third of these cases. In post-marketing reports, there are several cases of complications that developed in patients with a rash. Symptoms included vasculitis and a lupus-like syndrome. In addition, in some cases, these side effects have been fatal. Akathisia, that is internal stress, restlessness and inability to stand still, often accompanied by "constant aimless movements of the feet and legs, and marked restlessness", is a common side effect of fluoxetine. Akathisia usually begins to manifest after the start of treatment or increase in dose and disappears after discontinuation of fluoxetine, dose reduction or after treatment with propranolol. There are reports of a direct link between akathisia and suicidal attempts, with patients feeling better after stopping fluoxetine; and with repeated use of fluoxetine, they experienced the re-development of severe akathisia. These patients reported that "the development of akathisia provoked suicidal thoughts in them and their previous suicide attempts were associated with this." The experts note that because of the association of akathisia with suicide and the distress it creates for the patient, “raising awareness among staff and patients about the symptoms of this disease is vital.” More rarely, fluoxetine has been associated with movement disorders, acute dystonia, and tardive dyskinesia. The use of fluoxetine during pregnancy is also associated with an increase in the number of newborns with a poor compensatory-adaptive response. Since fluoxetine is excreted in mother's milk, the use of the drug during lactation is not recommended. When studying the effects of fluoxetine on neonatal mice, it was shown that with early postnatal administration of the drug in adult mice, depression and anxiety behavior are subsequently developed, similar to induced depression, for the treatment of which fluoxetine is used. The American Pediatrics Association classifies fluoxetine as a drug whose effect on the nursing infant is unknown and may be of concern.

Pregnancy and lactation

Caution should be exercised when used during pregnancy, especially in the third trimester and before childbirth due to the serotonergic effect of the drug or the possibility of developing withdrawal symptoms in newborns (irritability, tremor, hypotension, constant crying, difficulty sucking, poor sleep). Fluoxetine passes into breast milk; consideration should be given to stopping breastfeeding; if breastfeeding is continued, the lowest effective dose should be used.

Dosage and administration

Inside, regardless of the meal. Adults. depressive disorders. 20 mg per day in the morning. Clinical improvement is achieved after 1-4 weeks of taking the drug. If no improvement occurs after 3-4 weeks, consideration should be given to increasing the dose to max. 60 mg per day. After the disappearance of symptoms, it is necessary to continue treatment for at least 6 months. Obsessive-compulsive disorders. The initial dose is 20 mg per day in the morning; if improvement does not occur after a few weeks of therapy, the dose should be increased to max. 60 mg per day. Bulimia. 60 mg per day. Doses > 20 mg daily given in 2 divided doses (morning and afternoon). The maximum dose for syndromes that are difficult to treat is 80 mg per day. Episodes of severe depression with a moderate or severe course in children and adolescents over the age of 8 years, if psychotherapy does not work. The initial dose is 10 mg per day. After 1-2 weeks, the dose can be increased to 20 mg per day. The dose is selected individually; the lowest effective dose should be used. Treatment must be carried out in combination with psychotherapy. In elderly patients, the maximum dose is 60 mg per day. In patients with impaired liver function or taking other drugs that may interact with fluoxetine, the dose should be reduced or the intervals between doses should be increased. The drug should be stopped gradually (for at least 1-2 weeks.).

Notes

Fluoxetine does not affect intellectual or psychomotor functions, but, like other psychotropic drugs, it can cause impaired concentration, both in connection with the disease itself and in connection with the drug. For this reason, patients should be informed that the drug adversely affects the ability to drive vehicles and maintain mechanical equipment.

Medical use

Fluoxetine is often used to treat depression, obsessive-compulsive disorder, post-traumatic stress disorder, bulimia nervosa, panic disorder, body dysmorphia , dysphoric disorder and trichotillomania. Caution should be exercised when taking any SSRI for bipolar disorder, as it may increase the chance of mania; however, in bipolar disorder, fluoxetine may be used in conjunction with antipsychotics (eg, quetiapine). The drug has also been used to treat cataplexy, obesity and alcohol addiction, as well as compulsive binge eating.

Depression

In a six-week, double-blind, controlled trial, fluoxetine was shown to be effective in treating depression, as well as reducing anxiety and improving sleep. Fluoxetine was shown to be superior to placebo in preventing relapse of depression when patients who initially responded positively to fluoxetine were given it for an additional 38 weeks. Placebo-controlled studies have also demonstrated the effectiveness of fluoxetine in the treatment of depression in the elderly and in children. However, two meta-analyses of randomized placebo-controlled trials suggest that in patients with mild or moderate symptoms, the clinical efficacy of the drug is not very significant. Studies show that much of the resistance to SSRIs such as (Paxil) and (Celexa) can be explained by genetic variation in the glycoprotein transporter. Paroxetine and Citalopram, glycoprotein substrates, are actively transported by this protein from the brain. Fluoxetine is not a glycoprotein substrate, and thus taking fluoxetine instead of paroxetine or citalopram may be beneficial in patients who are resistant to SSRIs.

Obsessive Compulsive Disorder

In two adults and one child, a placebo-controlled 13-week study demonstrated the effectiveness of fluoxetine in the treatment of. When taking higher doses of fluoxetine, an improvement in response was observed, while an inverse relationship was observed with the treatment of depression. In two controlled studies of patients with panic disorder, fluoxetine has been shown to cause a dramatic 40-50% reduction in the frequency of panic attacks. Three double-blind studies have shown that fluoxetine causes a significant reduction in binge eating and bulimic episodes. In long-term treatment for one year in patients who showed an initial response to fluoxetine, the drug was shown to be superior to placebo in the prevention of bulimic episodes.

Antiviral agent

In 2012, researchers at the University of California, Los Angeles found that fluoxetine and various other SSRIs may act as antiviral drugs in therapy against enteroviruses such as poliomyelitis. The American Society for Microbiology called this discovery a "major breakthrough" because there are currently no drugs used against enteroviruses.

withdrawal syndrome

Several cases of severe withdrawal symptoms have been reported in the literature following abrupt discontinuation of fluoxetine. However, various studies have shown that side effects upon discontinuation of fluoxetine are rare and usually quite mild, especially when compared with paroxetine, venlafaxine and fluvoxamine, which may be due to the relatively long pharmacological half-life of fluoxetine. One of the recommended strategies for controlling withdrawal from other SSRIs, in cases where dose reduction of the original SSRI is not effective, is to replace the original drug with fluoxetine. The effectiveness of this strategy is confirmed by data from double-blind controlled studies. Several studies have not shown that the drug causes any increase in side effects when fluoxetine treatment is interrupted for a short time (4-8 days) and then resumed, and this result is not consistent with the slow elimination of the drug from organism. When treatment was interrupted (Zoloft), more side effects were observed, and when treatment with Paroxetine was interrupted, significantly more. In a longer duration, 6-week, blinded discontinuation study, there was a non-significant increase (32% vs. 27%) in the overall rate of new or worsened adverse events in the fluoxetine stop group compared to the continued treatment group. However, in patients who stopped treatment, there was a significant increase (4.2%) in sleepiness at week 2 and an increase in the number of dizziness by 5-7% at weeks 4-6. This long period of withdrawal symptoms and dizziness, which persisted until the very end of the study, is also consistent with the long half-life of fluoxetine in the body. According to a 2007 summary report of available data, fluoxetine had the lowest rate of withdrawal among the antidepressants studied, including paroxetine and venlafaxine.

Suicide

The FDA has now required all manufacturers of antidepressants to display a black box warning on their products stating that antidepressants may increase the risk of suicide in people under 25 years of age. This warning is based on statistical analyzes conducted by two independent FDA panels that showed a 2-fold increase in suicidal thoughts and behaviors in children and adolescents, and a 1.5-fold increase in suicidal ideation in individuals in aged 18-24 years. These rates were slightly lower in the 24+ group, and much lower in the 65+ group. Donald Klein criticized this analysis, noting that suicidal tendencies, that is, suicidal thoughts and behavior, do not necessarily lead to suicide, and that the possibility that antidepressants may prevent the possibility of actual suicide, despite an increase in suicidal thoughts, cannot be denied. Fluoxetine, compared with antidepressants in general, has relatively little data. To carry out the above analysis of antidepressants, the FDA pooled the results of 295 trials of 11 antidepressants. When considered separately, the use of fluoxetine in children caused a 50% increase in the risk of suicide, while in adults this risk was reduced by about 30%. In addition, an analysis by the UK Medicines and Healthcare Products Regulatory Agency (MHRA) showed a 50% increase in the number of suicidal thoughts and behaviors in children and adolescents when taking fluoxetine compared with placebo. According to the MHRA, in adults, fluoxetine does not change the number of self-harm and statistically significantly reduces the number of suicidal thoughts by 50%.

Violence

Psychiatrist David Healy and some active patient groups have reported cases of violent acts committed by individuals taking fluoxetine or other SSRIs. The report says that taking these drugs can lead susceptible individuals to commit violent acts. Serial reviews of this type have been criticized because disease effects are often mistaken for treatment effects. Other studies, including randomized clinical trials and observational studies, have shown that fluoxetine and other SSRIs may reduce violence. Randomized clinical trial The American National Institute of Mental Health showed that fluoxetine causes a decrease in acts of violence in the family of alcoholics with a history of such behavior. A second clinical trial at the University of Chicago showed that fluoxetine caused a reduction in aggressive behavior in patients with intermittent aggression disorder. In a clinical trial, fluoxetine was found to reduce aggressive behavior in patients with borderline personality disorder. These results are indirectly supported by studies demonstrating that other SSRIs may reduce the risk of violence and aggressive behavior. An NBER study examining international trends in antidepressant benefit and crime rates in the 1990s found that an increase in antidepressant prescriptions was associated with a decrease in violent crime.

Pharmacokinetics

Fluoxetine has a relatively high bioavailability (72%), and peak plasma concentrations after administration are reached within 6 to 8 hours. It binds well to plasma proteins, mainly to. Fluoxetine is metabolized in the liver by cytochrome P450 isoenzymes, including CYP2D6. The role of CYP2D6 in fluoxetine metabolism may be clinically important as there is great genetic variability in the functioning of this enzyme among individuals. Only one fluoxetine metabolite, norfluoxetine (N-demethylated fluoxetine), is biologically active. Fluoxetine and its active metabolite norfluoxetine are distinguished from other antidepressants by extremely slow excretion from the body. Over time, fluoxetine and norfluoxetine inhibit their own metabolism, so that the half-life of fluoxetine, instead of 1 day, begins to be up to 3 days after a single dose, and from 4 to 6 days after long-term use. In addition, after prolonged use, the half-life of norfluoxetine increases (16 days). Thus, during the first few weeks of treatment, the concentration of the drug and its active metabolite in the blood continues to increase. Steady-state blood levels are reached after four weeks of use. In addition, at least during the first five weeks of treatment, the concentration of fluoxetine and its metabolites in the brain continues to increase. This means that after the current dose, the drug will have its effect after at least a month. For example, in one 6-week study, the median time to achieve a consistent response was 29 days. In addition, the complete elimination of the drug from the body can take several weeks. During the first week after stopping treatment, the concentration of fluoxetine in the brain decreases only by 50%, the level of norfluoxetine in the blood 4 weeks after stopping treatment is about 80% of the level at the end of the first week of treatment, and 7 weeks after stopping taking norfluoxetine is still can be found in the blood. The PET study compared the effects of a single dose of fluoxetine on exclusively heterosexual and exclusively homosexual men who reported that their past and present sexual behaviors, desires and fantasies were directed exclusively at women or at men, respectively. The study showed that in some areas of the brain, the metabolic response in these two groups proceeded differently. "Both groups, however, show similar broadly lateralized metabolic responses to fluoxetine (compared to placebo), with most brain areas in these groups responding similarly." These groups "did not differ in behavioral characteristics or blood levels of fluoxetine." Fluoxetine is a selective serotonin reuptake inhibitor and to some extent inhibits the reuptake of norepinephrine and dopamine. However, Eli Lilly researchers found that a single high dose of fluoxetine in rats also showed a significant increase in norepinephrine and dopamine concentrations in the brain. This effect may be mediated by 5HT2a and in particular 5HT2 receptors, which are inhibited by higher concentrations of fluoxetine. Scientists at Eli Lilly also suggested that the effects on dopamine and norepinephrine receptors may contribute to enhancing the antidepressant effects of fluoxetine. According to other researchers, the strength of this effect, however, remains undetermined. When taking fluoxetine in smaller, more clinically significant doses, no increase in dopamine and norepinephrine levels was observed. In addition, in electrophysiological studies, it was shown that only when taking high doses of fluoxetine, changes in the activity of norepinephrine neurons in rats were observed. Some authors, however, argue that these data may still be of clinical relevance for the treatment of severe illness when fluoxetine is taken at doses higher than therapeutic (60-80 mg). Compared to other SSRIs, "Fluoxetine is the least selective," and exhibits a 10-fold difference in binding capacity between first and second neural targets (eg, to the serotonin and norepinephrine pumps, respectively). All values ​​greater than 10-fold difference result in insignificant activation of secondary neural targets. In addition to its known effects on serotonin, fluoxetine also increases the density of endogenous opioid receptors in the rat brain. It's not yet clear if the same thing happens in humans, but if it does, it could explain some of the antidepressant or side effects of fluoxetine.

Measurements in body fluids

For monitoring during treatment, confirming the diagnosis of poisoning in hospitalized patients, or assisting in the course of a forensic examination, the amount of fluoxetine and norfluoxetine can be quantified in blood, plasma or serum. Fluoxetine concentrations in blood or plasma are typically 50-500 µg/L in individuals taking the drug as an antidepressant, 900-3000 µg/L in acute overdose survivors, and 1000-7000 µg/L in fatal overdose victims. Norfluoxetine concentrations are approximately equal to those of the parent drug in long-term therapy, but may be significantly lower in acute overdose, as it takes at least 1-2 weeks for the metabolite to reach equilibrium.

Mechanism of action

Fluoxetine acts primarily as a serotonin reuptake inhibitor. Fluoxetine inhibits the reuptake of serotonin, causing serotonin to be released for a longer time when released. Some of the effects of fluoxetine also depend on its weak 5-HT2C receptor antagonism. In addition, fluoxetine acts as a sigma-1 receptor agonist, stronger than citalopram, but weaker than fluvoxamine. However, the meaning of this property is not entirely clear.

Story

In 1970, Eli Lilly and Company began the work that eventually led to the discovery of fluoxetine as part of a collaboration between Brian Molloy and Robert Rathbun. At that time it was known that antihistamine Diphenhydramine has some antidepressant properties. The compound 3-phenoxy-3-phenylpropylamine, structurally similar to diphenhydramine, was taken as the basis. Molloy synthesized dozens of derivatives of this compound. Testing the physiological effects of these compounds in mice led to the discovery of nisoxetine, a selective norepinephrine reuptake inhibitor currently widely used in biochemical experiments. Later, hoping to find a derivative that only inhibits serotonin reuptake, another Eli Lilly scientist, David T. Wong, proposed retesting the compounds in the laboratory for serotonin, norepinephrine, and dopamine reuptake. This test by Jong-Sir Horng in May 1972 showed that the compound later named Fluoxetine was the most potent and selective serotonin reuptake inhibitor of all the compounds tested. In 1974, Wong published the first paper on fluoxetine. A year later, the compound was given the official chemical name "Fluoxetine", and Eli Lilly and Company launched it under the trade name "Prozac". In February 1977, Dista Products Company, a division of Eli Lilly and Co, submitted a new request to the US FDA for fluoxetine. In May 1984, the German Regulatory Agency (BGA) rejected Prozac as "completely unsuitable for the treatment of depression." In May 1985, the FDA's then Chief Safety Investigator, Dr. Richard Karit, wrote: "In contrast to the profile of a traditional tricyclic antidepressant, the side effects of fluoxetine are closer to those of stimulants than to sedatives." According to him, “fluoxetine’s specific adverse side effect profile may in the future lead to great clinical interference in the use of this drug for the treatment of depression.” Fluoxetine entered the Belgian market in 1986. More than ten years later, in December 1987, the FDA finally approved Fluoxetine, and a month later Eli Lilly began marketing Prozac, which reached $350 million in annual sales in the United States within a year. Shortly after publication Researchers from a Lilly paper titled "Prozac (Fluoxetine, Lilly 110140), the first selective serotonin reuptake inhibitor and antidepressant", which claimed that fluoxetine was the first selective serotonin reuptake inhibitor (SSRI), controversy ensued. Two years later, the authors were forced to publish an amendment acknowledging that the first SSRI, called Zimelidine, had been developed by Arvid Karlsson and colleagues. Eli Lilly's US patent on Prozac (Fluoxetine) expired in August 2001, prompting an influx of generics into the market. In an attempt to stem the declining sales of Fluoxetine by Eli Lilly after the patent expired, Prozac was rebranded as "Sarafem" for the treatment of PMS. A meta-analysis published in February 2008 collected data from 35 clinical trials of four new antidepressants (fluoxetine, paroxetine (Paxil), nefazodone (Serzone), and venlafaxine (Effexor)). These antidepressants, belonging to three different pharmacological groups, were considered together, that is, the authors did not analyze them separately. The authors concluded that "although the difference [between placebo and antidepressants] easily reaches statistical significance", it does not meet the UK National Institutes of Health and Clinical Standards criteria for clinical significance "in all but the most severely depressed patients". . Articles began to appear in the press under the titles "Myth-Making Prozac" and "Prozac Doesn't Help Most Depressed Patients" in which the authors concluded that fluoxetine was ineffective from general conclusions about the relative effectiveness of antidepressants and placebo. In the following article, the authors of the meta-analysis noted that "unfortunately, the media often portrays the results of our work in the form of such headlines as" antidepressants do not work "and the like, which fundamentally distorts the more subtle structural conclusions of our report." As of April 2, 2010, fluoxetine is one of four antidepressants that the FAA (US Federal Aviation Administration) allows pilots to carry on board a ship. The other three include sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro).

Philozac (Egypt)

Biozac, Deprexetin, Fluval, Biflox, Deprexit, Sofluxen, Floxet, Ranflutin - (Bulgaria)

Flunisan, Orthon, Refloksetin, Fluoxetine - (Macedonia)

Motivest (Philippines)

Seronil (Finland)

Lorien (South Africa)

Affectine (Israel)

Proxetin (Thailand)

Flow (Pakistan)

Fluxil (Singapore)

Prozac in popular culture

Mention of the drug Prozac is found in many books, films and songs of popular culture. These include: Listening to Prozac, written in 1993 by psychiatrist Peter D. Kramer. The 1994 memoir Prozac Nation by Elisabeth Werzel, as well as the 2001 film of the same name, starring Christina Ricci as Werzel. The 1995 Blur song "Country House" ("House in the Village") contains the following lines: "He" s reading Balzac and knocking back Prozac / It "s the helping hand that makes you feel wonderfully bland" ("He reads Balzac and sips Prozac in one gulp / It's like a helping hand, bringing amazing calmness"). A well-known book critical of the drug is Prozac Commentary, written by psychiatrist Peter Breggin and published in 1994 (ISBN 0312114869). Prozac is mentioned in the Superman graphic novel Red Son, where the Nerd uses it to control the mood of the people in Superman's empire. In Alison Bechdel's comic book series "Dykes to Watch Out For", Lois takes Prozac in the 1997 book "Hot, Trobbibg Dykes to Watch Out For". Prozac Diary 1998, confessional memoir by Lauren Slater. "Plato, not Prozac!" is the title of a 1999 self-help book by Lou Marinoff that proposes using classical philosophy as an alternative to the usual pro-pharmaceutical approach to psychotherapy. The song "1985" by The Bowling For Soup describes the breakdown/crisis of a suburban middle-aged housewife. It begins with "Debbie just hit the wall/she never had it all/One Prozac a day/husband"s a CPA..." - senior accountant…") "Pets on Prozac" is the name of a UK underground house band formed in 2010. Prosac is one of the most notable works of the progressive house musician Tomcraft. The main lyrics of the song are read from pharmacological description and indications for the use of the drug. Bernard Sumner (musician from New Order and Joy Division) chronicled his experience with Prozac and its impact on creativity for the BBC documentary The Prozac Diaries. Prozac is often referenced in the hit sitcom Ally McBeal, where in Season 3 the eponymous character (played by Calista Flockheart) takes Prozac at the behest of his psychiatrist, Dr. Shirley Flott (played by Betty White). Flott describes the miraculous benefits of Prozac on an almost eucharistic scale, telling Ellie that she "will not find happiness in love or God, happiness is in pills." Flott also claims that she herself takes Prozac in the form of suppositories. Although Ellie initially begins taking Prozac to combat her hallucinations, she is later discouraged by a friend and colleague and ends up flushing the pills down the toilet. In the HBO series The Sopranos, gangster Tony Soprano (James Gandolfini) has a tendency to have panic attacks. His psychiatrist Dr. Jennifer Melfi (Lorraine Bracco) prescribes him Prozac. Prozac takes place in the movie Love and Other Drugs, starring Jake Gyllenhaal, who plays a Pfizer drug salesman who is trying to promote Zoloft. He discards most of the Prozac shipment, which is subsequently picked up by vagrants and the drug is thus distributed throughout the country. "ProzaKc Blues" is a song by progressive rock band King Crimson from their 2000 album ConstruKction of Light. Prozac+ is the name of an Italian punk band.

Availability:

Fluoxetine is a fairly common drug on the domestic market used to treat various depressive conditions, which are accompanied by a feeling of fear and anxiety. The drug has a strong effect with many adverse reactions. Most often, people taking fluoxetine note a feeling of increased fatigue, a complete absence of an emotional factor, a lack of desire. With extreme caution, this drug can be taken by people with diabetes, as it can change the level of glucose in blood, as well as people with cardiovascular disease and people doing potentially hazardous work. Fluoxetine is available only by prescription and is in a low price category, being affordable for most citizens of the country.