Prozac - instructions for use, reviews, analogs and forms of release (capsules or soluble tablets 20 mg) antidepressant medications for the treatment of depression and bulimia nervosa (for weight loss) in adults, children and in pregnancy

In this article, you can read the instructions for using the drug Prozac. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of antidepressant Prozac 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 Prozac in the presence of existing structural analogues. Use to treat depression and bulimia nervosa (for weight loss) in adults, children, as well as during pregnancy and lactation.

Prozac antidepressant.It is a selective inhibitor of serotonin reuptake, which determines the mechanism of its action. Fluoxetine (Prozac's active ingredient) has little or no affinity for other receptors, for example, alpha1, alpha2 and beta adrenoreceptors, serotonin receptors, dopamine receptors, histamine H1 receptors, m-cholinergic receptors and GABA receptors.

Composition

Fluoxetine (in the form of hydrochloride) + auxiliary substances.

Pharmacokinetics

After oral administration, it is well absorbed from the digestive tract. Bioavailability when ingested - more than 60%. Medicinal forms of fluoxetine for oral administration are bioequivalent. Binding to blood plasma proteins - more than 90%. It is distributed throughout the body. Intensively metabolized in the liver to norfluoxetine and a number of other unidentified metabolites. It is excreted in the urine in the form of metabolites.

Indications

• depression of different etiology;
• nervous bulimia (for weight loss);
• obsessive-compulsive disorder;
• premenstrual dysphoric disorder.

Forms of release

Capsules 20 mg.

Tablets are soluble 20 mg.

Instructions for use and dosing regimen

With depression, the initial recommended dose is 20 mg per day.

With bulimia nervosa, the recommended dose is 60 mg per day.

In obsessive-compulsive disorders, the recommended dose is 20-60 mg per day.

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

The recommended doses can be increased or decreased, but the use of the drug in a dose of more than 80 mg per day has not been studied.

The drug can be taken regardless of food intake.

There is no data on the need to change the dose depending on age.

In patients with impaired hepatic function, concomitant diseases or taking other drugs, the dose should be reduced and the frequency of administration reduced.

Side effect

• diarrhea;
• nausea, vomiting;
• dysphagia;
• dyspepsia;
• perversion of taste;
• idiosyncratic hepatitis;
• convulsions;
• ataxia;
• tremor;
• anorexia (up to weight loss);
• anxiety, accompanied by palpitation, anxiety, nervousness, agitation;
• dizziness;
• fatigue (drowsiness, asthenia);
• the violation of concentration and thinking;
• manic reaction;
• sleep disturbances (unusual dreams, insomnia);
• visual impairment (mydriasis, blurred vision);
• disorders of the autonomic nervous system (dry mouth, sweating, vasodilatation, chills);
• serotonin syndrome (complex clinical manifestations of mental status changes and neuromuscular activity in combination with impaired autonomic nervous system);
• urination disorders (including frequent urination);
• priapism / prolonged erection;
• sexual disorders (decreased libido, delay or lack of ejaculation, lack of orgasm, impotence);
• itching;
• skin rash;
• hives;
• anaphylactic reactions;
• vasculitis;
• photosensitivity;
• alopecia;
• yawn;
• ecchymosis.

Contraindications

• established hypersensitivity to fluoxetine.

Application in pregnancy and lactation

In experimental studies on animals revealed no direct or indirect adverse effects of fluoxetine on the development of the embryo or fetus, or the course of pregnancy. In studies and animals no evidence of mutagenicity and impaired fertility has been obtained.Since animal reproduction studies do not always allow predicting a person's reaction, Prozac should be used during pregnancy only in cases of extreme necessity.

Prozac is excreted in breast milk, so the drug should be cautiously prescribed to nursing mothers.

The effect of fluoxetine on the process of childbirth in humans is unknown.

Use in children

Prozac's safety and effectiveness in children are not established.

special instructions

There are reports of skin rash, anaphylactic reactions and progressive systemic disorders involving the skin, lungs, liver, kidneys in the pathological process of patients taking Prozac. When skin rashes or other possible allergic reactions occur, the etiology of which can not be determined, Prozac's intake should be discarded.

As with other antidepressants, Prozac should be administered with caution to patients who have a history of epileptic seizures.

When fluoxetine was used, there were cases of development of hyponatremia (in some cases, the sodium level in the blood was less than 110 mmol / l).Basically, similar cases were observed in elderly patients and in patients receiving diuretics, due to a decrease in BCC.

In patients with diabetes mellitus, during treatment with Prozac, hypoglycemia was noted, and after discontinuation of the drug - hyperglycemia. At the beginning and after the end of treatment with fluoxetine, a correction of insulin doses and / or hypoglycemic drugs for oral administration may be required.

Results of experimental studies

In studies and animals no evidence of carcinogenicity has been obtained.

Impact on the ability to drive vehicles and manage mechanisms

Drugs that affect mental activity can affect the ability to make decisions and the driving skills of a car. Patients should be advised to avoid driving the car or managing dangerous mechanisms until it is determined that the drug has no effect on the ability to perform these activities.

Drug Interactions

Prozac should not be administered simultaneously with MAO inhibitors and for at least 14 days after discontinuation of treatment with MAO inhibitors. After the abolition of fluoxetine and the beginning of treatment with MAO inhibitors, there should be an interval of at least 5 weeks.If long-term fluoxetine treatment was used and / or the drug was used in high doses, then this interval should be increased. Among patients who had previously taken fluoxetine, and started taking MAO inhibitors through a shorter interval, there were serious cases of the development of serotonin syndrome (manifestations of which may be similar to ZNS), up to a lethal outcome.

Fluoxetine has the ability to inhibit the isoenzyme CYP2D6. Therefore, treatment with drugs that are metabolized by this system and which have a narrow therapeutic index should start with the lowest doses if the patient simultaneously receives fluoxetine or has taken it within the previous 5 weeks. If fluoxetine is included in the treatment regimen of a patient already taking such a drug, a dose reduction of the first drug should be provided.

With the simultaneous use with Prozac, the changes in blood concentrations of phenytoin, carbamazepine, haloperidol, clozapine, diazepam, alprazolam, lithium, imipramine and desipramine are noted, and in some cases toxic effects have been observed.When taking fluoxetine in combination with these drugs should provide for a conservative dose selection and monitor the patient.

Fluoxetine binds strongly to plasma proteins. Therefore, with the appointment of fluoxetine against the background of the use of another drug that binds firmly to plasma proteins, changes in the plasma concentrations of both drugs are possible.

With the simultaneous use of fluoxetine with warfarin, there was an increase in bleeding time. Changes in anticoagulant activity (laboratory indicators and / or clinical signs and symptoms) were unstable. As in the case of treatment with Warfarin in combination with many other drugs at the beginning of the application or in the event of discontinuation of fluoxetine treatment with warfarin therapy, careful monitoring of blood coagulation should be carried out.

If it is necessary to prescribe other drugs after Prozac's withdrawal, a long half-life of fluoxetine and its active metabolite of norfluoxetine should be taken into account and, in this connection, the possibility of drug interaction development.

Rarely have there been cases of prolonged seizures in patients taking fluoxetine during electroconvulsive therapy.

Analogues of the drug Prozac

Structural analogs for the active substance:

• Depres;
• Depenone;
• Portal;
• Prodep;
• Profluzak;
• Floxet;
• Fluval;
• Fluxonil;
• Flunisan;
• Fluoxetine;
• Framex.

Analogues for the pharmacological group (antidepressants):

• Agomelatine;
• Adress;
• Azafen;
• Azona;
• Alventa;
• Amizole;
• Amide;
• Amirol;
• Amitriptyline;
• Anaphranil;
• Asentra;
• Aurorix;
• Valdoxane;
• Velaxin;
• Velafax;
• Wellbutrin;
• Venlaksor;
• Heptor;
• Daplex;
• Depres;
• Deprim;
• Doxepine;
• Zoloft;
• Ixelles;
• Kaliksta;
• Clominal;
• Coaxyl;
• Life 600;
• Life 900;
• Maprotiline;
• Mirzaten;
• Mirtazapine (hemihydrate);
• Mirtazonal;
• Nerustin;
• Oprah;
• Paxil;
• Paroxetine;
• Pirazidol;
• Plizil;
• Rexetin;
• Seralin;
• The Siozam;
• Sierestill;
• Stimuloton;
• Trittico;
• Umorap;
• Févarine;
• Fluorocycin;
• Cipralex;
• Cipramyl;
• Citol;
• Elivel;
• Ephevelone;
• Epevelon retard.

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