Fluoxetine - instructions for use, analogs, reviews and release forms (10 mg capsules and 20 mg Lannacher, Canon and other trademarks) drugs for the treatment of bulimia and weight loss in adults, children and pregnancy. Interaction with alcohol

In this article, you can read the instructions for using the drug Fluoxetine. There are reviews of visitors to the site - consumers of this medication, as well as opinions of specialists on the use of Fluoxetine in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of fluoxetine in the presence of existing structural analogues.Use to treat bulimia and weight loss in adults, children, as well as during pregnancy and lactation. Interaction of the drug with alcohol.

Fluoxetine - an antidepressant group of selective serotonin reuptake inhibitors. Has a timoanaleptic and stimulating effect.

Selectively blocks the reverse neuronal capture of serotonin (5HT) in the synapses of neurons of the central nervous system. Inhibition of serotonin reuptake leads to an increase in the concentration of this neurotransmitter in the synaptic cleft, enhances and retorts its effect on the post-synaptic peptopter regions. Increasing serotonergic transmission, by the mechanism of negative membrane binding, fluoxetine inhibits the exchange of the neurotransmitter. With prolonged use, fluoxetine inhibits the activity of 5-HT1 receptors. Poorly affects the re-uptake of norepinephrine and dopamine. It has no direct effect on serotonin, m-cholinergic, H1-histamine and alpha-adrenergic receptors. Unlike most antidepressants, there is no decrease in activity of postsynaptic beta-adrenergic receptors.

Effective with endogenous depression and obsessive-compulsive disorders.Has an anorexigenic effect, can cause weight loss. Does not cause orthostatic hypotension, sedation, non-cardiotoxic. A persistent clinical effect occurs after 1-2 weeks of treatment.

Composition

Fluoxetine hydrochloride + excipients.

Pharmacokinetics

When ingested, the drug is well absorbed from the digestive tract (up to 95% of the dose taken), use with food slightly inhibits absorption of fluoxetine. The drug is well accumulated in tissues, easily penetrates the blood-brain barrier, binding to plasma proteins is more than 90%. Metabolised in the liver by demethylation to the active metabolite of norfluoxetine and a number of unidentified metabolites. It is excreted by the kidneys in the form of metabolites (80%) and intestine (15%), mainly in the form of glucuronides.

Indications

• depression of different genesis;
• obsessive-compulsive disorder;
• premenstrual dysphoria;
• bulimic neurosis.

Forms of release

Capsules 10 mg and 20 mg (Lannacher, Kanon and others trademarks, sometimes mistakenly referred to as tablets).

Instructions for use and reception scheme

The drug is taken orally, at any time, regardless of food intake.

Depressive state

The initial dose is 20 mg once a day in the morning, regardless of food intake. If necessary, the dose can be increased to 40-60 mg per day, divided into 2-3 doses (20 mg per day weekly). The maximum daily dose is 80 mg in 2-3 divided doses.

The clinical effect develops 1-2 weeks after the start of treatment, in some patients it can be achieved later.

Obsessive-compulsive disorder

The recommended dose is 20-60 mg per day.

Bulimic neurosis

The drug is used in a daily dose of 60 mg divided into 2-3 doses.

In premenstrual dysphoric disorders, the recommended dose is 20 mg per day.

The use of the drug by patients of different ages

There are no data on dose changes depending on age. Begin the treatment of elderly patients with a dose of 20 mg per day.

Side effect

• atrial flutter;
• hot flushes;
• hypotension;
• vasculitis;
• diarrhea;
• nausea, vomiting;
• dry mouth;
• dyspepsia;
• dysphagia;
• perversion of taste;
• pain along the esophagus;
• anaphylactic reactions;
• serum sickness;
• anorexia (including weight loss) of the body;
• muscle twitching;
• headache;
• violation of attention;
• dizziness;
• lethargy;
• drowsiness (including hypersensitivity, sedation);
• tremor;
• psychomotor agitation;
• hyperactivity;
• ataxia;
• lack of coordination;
• convulsions;
• insomnia (including early morning awakening, primary and secondary insomnia);
• unusual dreams (including nightmares);
• nervousness;
• tension;
• decreased libido (including lack of libido);
• euphoria;
• violation of orgasm (including anorgasmia);
• disturbance of thinking;
• manic disorders;
• itching;
• polymorphous skin rash;
• hives;
• cold sweat;
• blurred vision;
• increased urination (including pollakiuria);
• violation of ejaculation (including lack of ejaculation, dysfunctional ejaculation, early ejaculation, ejaculation delay, retrograde ejaculation);
• erectile disfunction;
• gynecological bleeding (including bleeding from the cervix, dysfunctional uterine bleeding, bleeding from the genital tract, menometrorrhagia, menorrhagia, metrorrhagia, polymenorrhoea, postmenopausal bleeding, uterine bleeding, vaginal bleeding);
• sexual dysfunction;
• priapism.

Contraindications

• simultaneous administration with MAO inhibitors (and within 14 days after their cancellation);
• simultaneous administration of thioridazine (and within 5 weeks after the abolition of fluoxetine), pimozide;
• pregnancy;
• the period of breastfeeding;
• severe renal dysfunction (creatinine clearance less than 10 ml / min);
• liver failure;
• deficiency of lactase, lactose intolerance, glucose-galactose malabsorption;
• age to 18 years;
• hypersensitivity to the drug.

Application in pregnancy and lactation

Contraindicated in pregnancy and lactation.

Use in children

In children and adolescents with depression, other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and suicidal behavior. Therefore, the prescription of the drug in childhood refers to contraindications to admission.

special instructions

It requires careful monitoring of patients with suicidal tendencies, especially at the beginning of treatment. The highest risk of suicide in patients who have previously taken other antidepressants, and patients who have excessive fatigue, hypersomnia or motor anxiety in the presence of fluoxetine.Before the onset of significant improvement in treatment, such patients should be under the supervision of a physician.

In children, adolescents and young people (under 24 years) with depression, other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and suicidal behavior. Therefore, when prescribing fluoxetine or any other antidepressants in children, adolescents and young people (under 24 years of age), the risk of suicide and the benefits of using them should be correlated. In short-term studies in people over 24 years of age, the risk of suicide did not increase, but in people older than 65 years, it declined slightly. Any depressive disorder in itself increases the risk of suicide. Therefore, during treatment with antidepressants, all patients should be monitored for early detection of abnormalities or behavioral changes, as well as suicidal tendencies.

Against the background of electroconvulsive therapy, it is possible to develop long-term epileptic seizures.

The interval between the end of therapy with MAO inhibitors and the initiation of treatment with fluoxetine should be at least 14 days; between the end of fluoxetine treatment and the initiation of therapy with MAO inhibitors - at least 5 weeks.

After the drug is withdrawn, its therapeutic concentration in the blood serum may persist for several weeks.

Patients with diabetes mellitus may develop hypoglycemia during fluoxetine and hyperglycaemia therapy after withdrawal. At the beginning or after treatment with fluoxetine, you may need to adjust the dosages of insulin and / or hypoglycemic drugs for oral administration.

In the treatment of patients with body weight deficiency, anorexigenic effects should be considered (a progressive loss of body weight is possible).

When taking fluoxetine, you should refrain from drinking alcohol. the drug enhances the effect of alcohol.

Impact on the ability to drive vehicles and manage mechanisms

Taking fluoxetine can adversely affect the performance of work that requires a high rate of mental and physical reactions.

Drug Interactions

Fluoxetine and its main metabolite, norfluoxetine, have long half-lives, which must be considered when fluoxetine is combined with other drugs, and when it is replaced with another antidepressant.

It is impossible to apply the drug simultaneously with MAO inhibitors, incl.antidepressants - MAO inhibitors; furozolidone, procarbazine, selegiline, as well as tryptophan (a precursor of serotonin), since it is possible to develop a serotonergic syndrome manifested in confusion, hypomania, psychomotor agitation, convulsions, dysarthria, hypertensive crises, chills, tremor, nausea, vomiting, diarrhea.

After using MAO inhibitors, administration of fluoxetine is allowed no earlier than 14 days. Do not use MAO inhibitors earlier than 5 weeks after fluoxetine withdrawal.

In patients who regularly took maintenance doses of phenytoin, plasma phenytoin concentrations increased significantly and symptoms of phenytoin intoxication appeared (nystagmus, diplopia, ataxia and CNS depression) after the onset of concomitant fluoxetine treatment.

The combined use of fluoxetine and lithium salts requires careful monitoring of the concentration of lithium in the blood. it is possible to increase it.

Fluoxetine enhances the action of hypoglycemic drugs.

When used simultaneously with drugs that have a high degree of binding to proteins, especially with anticoagulants and digitoxin,it is possible to increase the concentration in the plasma of free (unbound) drugs and increase the risk of developing adverse effects.

Analogues of the drug Fluoxetine

Structural analogs for the active substance:

• Apo Fluoxetine;
• Depres;
• Depenone;
• Portal;
• Prodep;
• Prozac;
• Profluzak;
• Floxet;
• Fluval;
• Fluxonil;
• Flunisan;
• Fluoxetine HEXAL;
• Fluoxetine Lannacher;
• Fluoxetine Nycomed;
• Fluoxetine OBL;
• Fluoxetine Canon;
• Fluoxetine hydrochloride;
• Framex.

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