Fluoxetine

When ATH:
N06AB03

Characteristic.

Bicyclic antidepressant, propylamine derivative.

Fluoxetine hydrochloride - white or off-white crystalline powder, it is soluble in water (14 mg / ml). Molecular weight 345,79.

Pharmacological action.
Antidepressant, anoreksigennoe.

Application.

Depression (especially accompanied by fear), incl. after failure of other antidepressants, obsessive-compulsive disorder, nervnaya bulimia.

Contraindications.

Hypersensitivity, MAO inhibitors (in the previous 2 Sun), liver and kidney failure (creatinine clearance less than 10 ml / min), Epilepsy and convulsive conditions (history), suicidal thoughts, diabetes, atonic bladder, zakrыtougolynaya glaucoma, prostatauxe.

Restrictions apply.

Childhood (Safety and efficacy have not been established), myocardial infarction, incl. history, cirrhosis of the liver.

Pregnancy and breast-feeding.

If pregnancy should be used only when absolutely necessary. When using fluoxetine during pregnancy have a higher risk of preterm birth, malformations and low neonatal adaptation (incl. difficulty breathing, cyanosis, excitability).

Category actions result in FDA - C. (The study of reproduction in animals has revealed adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not held, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk.)

At the time of treatment should abandon breastfeeding (Fluoxetine passes into breast milk of nursing women).

Side effects.

From the nervous system and sensory organs: headache, dizziness, anxiety, nervousness, slackness, fatiguability, asthenic syndrome, emotional lability, sleep disorders (insomnia, drowsiness), nightmares, restlessness, vellication, myoclonus, tremor, giperkineziya, convulsive status, Hypo- or hyperreflexia, extrapyramidal syndrome, carpal tunnel syndrome, ataxia, akathisia, dysarthria, Hyper- or hypoesthesia, paraesthesia, neuralgia, Neuropathy, neuritis, neurosis, thought disorder, difficulty concentrating, amnesia, euphoria, mania or gipomaniya, hallucinations, depersonalization, paranoid reaction, psychosis, suicidal tendencies, EEG changes, stupor, coma, decrease in visual acuity, amblyopia, strabismus, diplopia, exophthalmos, midriaz, conjunctivitis, Irit, scleritis, .Aloe, xerophthalmia, photophobia, glaucoma, dysgeusia, parosmija, noise and ear pain, hyperacusis.

Cardio-vascular system and blood (hematopoiesis, hemostasis): Rituals- or bradycardia, arrythmia, Atrial fibrillation or ventricular, cardiac arrest, myocardial infarction, congestive heart failure, Hyper- or hypotension, phlebarteriectasia, phlebitis, tromboflebit, thrombosis vessels, vasculitis gemorragicheskoy sыpyyu, cerebral ischemia, cerebral embolism, anemia, leukocytosis or leukopenia, Lymphocytosis, thrombocythemia, thrombocytopenia, pancytopenia.

From the respiratory system: nasal congestion, nose bleed, sinusitis, laryngeal edema, labored breathing, stridor, Hyper- or hypoventilation, Ikotech, cough, respiratory distress syndrome, inflammatory changes in the lungs or the fibrous nature, atelectasis, эmfizema, pulmonary edema, gipoksiya, apnea, chest pain.

From the digestive tract: reduction (rarely increase) Appetite, anorexia, dry mouth, increased salivation, salivary gland enlargement, thrush, glossitis, dysphagia, esophagitis, gastritis, dyspepsia, nausea, vomiting, incl. gematemezis, abdominal pain, syndrome of "acute abdomen", peptic ulcer, gastrointestinal bleeding, flatulence, diarrhea, constipation, ground, colitis, bowel obstruction, increased liver transaminases, creatinphosphokinase and alkaline phosphatase in the blood, hepatitis, cholelithiasis, cholestatic jaundice, hepatic failure, hepatic necrosis, pancreatitis.

Metabolism: violation of secretion of ADH, giponatriemiya, Hypo- or hyperkalemia, hypocalcemia, hyperuricemia, gout, hypercholesterolemia, diabetes, gipoglikemiâ, diabetic acidosis, gipotireoz, swelling, degidratatsiya.

With the genitourinary system: dizurija, frequent urination, nocturia, foot- or oliguria, albumin- and proteinuria, glycosuria, hematuria, urinary tract infections, cystitis, renal failure, hyperprolactinemia, magnification and breast pain, decreased libido, ejaculation disorders, priapism, impotence, anorgazmija, painful menstruation, Menno- and metrorrhagia.

On the part of the musculoskeletal system: myasthenia, myopathy, myalgia, myositis, arthralgia, arthritis, rheumatoid arthritis, ʙursit, tendosinoviit, xondrodistrofija, osteomyelitis, osteoporosis, bone pain.

For the skin: polymorphic rash, incl. haemorrhagic, ulcerative skin lesions, acne, alopecia, contact dermatitis, photosensitivity, livor, furunculosis, shingles, girsutizm, eczema, psoriasis, seborrhea, epidermal necrosis, exfoliative dermatitis.

Allergic reactions: rash, itch, hives, angioedema, type reaction serum sickness, anaphylactic and anaphylactoid reactions.

Other: weight loss, Sweating, flushing of the face and neck with a feeling of heat, neuroleptic malignant syndrome, zevota, chills, fever, flu-like symptoms, gipotermiя, lymphadenopathy, incl. enlarged tonsils, pharyngitis. Described deaths.

Cooperation.

Incompatible with MAO inhibitors, other antidepressants, furazolidonom, procarbazine, tk. cause serotonergic syndrome (chills, hyperthermia, muscle stiffness, myoclonus, vegetative lability, hypertensive crisis, excitation, tremor, restlessness, convulsions, diarrhea, elated state, delirium, coma; possible death. When concomitantly with drugs, having a high degree of binding to plasma proteins (oral anticoagulants, oral hypoglycemics, cardiac glycosides, and others.), possible mutual displacement of the connection with the concentration of the protein-free fraction of blood, the risk of side effects increases. Increased risk of bleeding in patients receiving warfarin. Inhibits biotransformation of drugs, метаболизирующихся с участием изофермента CYP2D6 цитохрома P450 (tricyclic antidepressants, dextromethorphan, vynblastyn, Carbamazepine). Lengthens T_1/2 diazepama, potentiates the effects of alprazolam. At simultaneous reception changes (increases or decreases) lithium concentration in blood plasma, increases the concentration of phenytoin (to the clinical manifestations of overdose); levels of tricyclic antidepressants (imipramine, desipramine) increases 2-10 times. Tryptophan enhances the serotonergic properties of fluoxetine (possible agitation, restlessness, dysfunction of the gastrointestinal tract). Incompatible with ethanol.

Overdose.

Symptoms: nausea, vomiting, excitation, anxiety, hypomania, convulsions, grand mal seizures. Described two deaths from acute overdose of fluoxetine (in combination with maprotilinom, Codeine, temazepamom).

Treatment: gastric lavage, administration of activated charcoal, sorʙita, ECG monitoring, symptomatic and supportive therapy, if convulsions - diazepam. No specific antidote. Forced diuresis, pyeritonyealinyi dialysis, hemodialysis, blood transfusions are ineffective.

Dosing and Administration.

Inside, while eating, 1-2 reception (mainly in the first half of the day). Starting and maintenance doses 20 mg / day. If necessary, increase the dose weekly in the 20 mg / day. The maximum daily dose - 80 mg, Patient elderly - 60 mg. The course of treatment - 3-4 weeks, at obsessivno-kompulʹsivnyh condition - 5 weeks or more, bulimia nervosa - 1 Sun.

Precautions.

With care given to the elderly, cardiovascular diseases, failure of the liver and / or kidney. Careful monitoring of patients with suicidal tendencies, especially at the beginning of treatment. Most high risk of suicide in patients, previously treated with other antidepressants, and patients, who during treatment with fluoxetine noted excessive fatigue, hypersomnia, or restlessness. In the treatment of patients with low body weight should be considered anorectic properties of fluoxetine. During the electroconvulsive therapy in patients receiving fluoxetine possible prolonged seizures. The interval between the cancellation and the beginning of MAO inhibitors fluoxetine should be more 2 Sun, and between the cancellation of fluoxetine and MAO inhibitors intake - at least 5 Sun. Be wary of the drivers of vehicles and people, activities which require high concentration and speed of psychomotor reactions. During treatment should avoid alcohol.

Cooperation