Fluoxetine

Administration

• Type: Antidepressant
• Dosage Forms: 10mg, 20mg, 40mg
• Routes of Administration: Oral
• Common Trade Names: Prozac

Adult Dosing

Major depressive disorder

• 20-80mg PO qAM
  • Start 20mg PO qAM

Obsessive-Compulsive Disorder

• 20-60mg PO qAM
  • Start 20mg PO qAM

Bulimia nervosa

• 60mg PO qAM

Panic Disorder

• 20mg PO qAM

Bipolar disorder, Type I

• 20-50mg PO qPM

Cataplexy

• 20-60mg PO qAM

Pediatric Dosing

Major depressive disorder

• 6-7 yo
  • 10 mg PO qd
• 8-18 yo
  • 10-20 mg PO qd

Obsessive-Compulsive Disorder

• 7-17 yo
  • 20-60 mg PO qd

Bipolar disorder, type I

• 10-17 yo
  • 20-50 mg PO qd

Bulimia nervosa

• 12+ yo
  • 20-60 mg PO qd

Insomnia

• 10-17 yo
  • 10-20 mg PO qd

PTSD

• 7-17 yo
  • 10-20 mg PO qd

Social Anxiety Disorder

• 5+ yo
  • 20 mg PO qd

Cataplexy

• 5+ yo
  • 10-40 mg PO qd

Special Populations

• Pregnancy Rating: C; Caution advised in 3rd trimester
• Lactation risk: Consider alternative while breastfeeding

Renal Dosing

• Adult:
  • No adjustment
• Pediatric:
  • No adjustment

Hepatic Dosing

• Adult:
  • Decrease dose or frequency
• Pediatric:
  • Decrease dose or frequency

Contraindications

• Allergy to class/drug
• Caution:
  • Concurrent CNS depressant use
  • Alcohol use
  • Pts < 25 yo
  • Elderly
  • Pregnancy 3rd trimester
  • Hepatic impairment
  • Poor CYP2D6 metabolizer
  • Bleeding risk
  • QT prolongation
  • CHF
  • Hypomania or mania history
• Avoid abrupt withdrawal

Adverse Reactions

Serious

• Suicidality
• Depression exacerbation
• Hypomania/mania
• QT prolongation, torsades de pointes
• Serotonin syndrome
• Anaphylaxis, Stevens-Johnson Syndrome, Erythema multiforme
• Serum sickness
• Vasculitis, Pulmonary fibrosis
• Glaucoma, angle-closure
• Seizures, Hyponatremia, SIADH
• Hypoglycemia
• Priapism, Extrapyramidal symptoms

Common

• Insomnia
• Nausea, vomiting, diarrhea
• Headache, dizziness
• Anorexia, anxiety, nervousness
• Asthenia, somnolence
• Sexual dysfunction
• Dyspepsia
• Abnormal dreams
• Rash
• Weight loss

Pharmacology

• Half-life: 4-6 day (parent drug) and 9.3 days (active metabolite)
• Metabolism: Liver, CYP2C19 and CYP2D6 (primary)
• Excretion: Urine 80% (11.6% unchanged), Feces 15%

Mechanism of Action

• Selectively inhibits serotonin reuptake