Class: SSRI Antidepressant
Dosage Forms. Capsule: 10 mg, 20 mg, 40 mg; Capsule (Delayed Release): 90 mg; Tablet: 10 mg, 20 mg, 60 mg; Solution, Syrup: 20 mg/5 mL
Common FDA Label Indication, Dosing, and Titration.
1. Depression: Adults and Children 8 y of age and older, 20 mg po daily; may titrate to 80 mg po daily
2. OCD: Adults, 20 mg po daily, may titrate to 80 mg po daily; Children 7 y and older, 10 mg po daily, may titrate to 30 mg po daily
3. Panic disorder: 10 mg po daily, may increase to 60 mg po daily
4. Premenstrual dysphoric disorder: 20 mg po daily or for 14 d prior to expected start of menses; may titrate to 80 mg po daily
1. Posttraumatic stress disorder: 20-80 mg po daily
MOA. Fluoxetine is a bicyclic antidepressant that is a selective and potent inhibitor of presynaptic reuptake of serotonin (an SSRI).
Drug Characteristics: Fluoxetine
Medication Safety Issues: Fluoxetine
Drug Interactions: Fluoxetine
Adverse Reactions: Fluoxetine
Efficacy Monitoring Parameters. Improvement in symptoms of depression, panic disorder, OCD, premenstrual syndrome.
Toxicity Monitoring Parameters. Worsening of depression, suicidality, or unusual changes in behavior, especially at the initiation of therapy or with dosage increases or decreases; signs/symptoms of abnormal bleeding.
Key Patient Counseling Points. Avoid activities requiring mental alertness or coordination until drug effects are realized. Symptomatic improvement may not be seen for several weeks. Report worsening depression, suicidal ideation, unusual changes in behavior, or unusual bleeding. Do not drink alcohol or use NSAIDs or aspirin while taking this drug.
Clinical Pearls. If intolerable withdrawal symptoms occur following a decrease in dose or therapy discontinuation, may need to resume the previous dose and taper at a more gradual rate. Must be dispensed with medication guide. Weekly dosage form with more pharmacokinetic variability than daily dosing.