COMMON BRAND NAME(S):
Prozac

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Uses: Treats (1) major forms of depression (including depression in HIV-positive patients and in geriatric depression); (2) obsessive-compulsive disorder; (3) bulimia; (4) approved for use in severe PMS (PMDS either every day or for the 14 days before menstruation is expected to start).

Other (unlabeled) generally accepted uses: (1) Refractory diabetic neuropathy; (2) may help control kleptomania; (3) can be of help in treating obesity, especially when obesity is accompanied by depression; (4) eases symptoms of panic attacks; (5) used to treat seasonal affective disorder (such as depression limited to winter months); (6) treats some forms of sexual problems; (7) some data for use of childhood anxiety disorder: (8) may ease ringing in the ears (tinnitus) that has not responded to other medicines; (9) may reduce the severity and frequency of hot flashes (by about half) in cancer survivors; (10) could have a role after a stroke in decreasing emotionalism and improving motor performance; (11) may have a role in anorexia nervosa when weight is returned to prior levels in order to help prevent relapse; (12) improved some measures of thinking in a small trial of patients with traumatic brain injury.

How This Drug Works: It restores normal levels of a nerve transmitter (serotonin). May work to stimulate Brain Derived Neurotrophic Factor (BDNF) and a specific receptor (tyrosine kinase receptor) resulting in remodeling of nerves. While this mechanism is derived from rat data, early clinical trials show improved performance in some small studies where fluoxetine gained improvements in thinking in adults who had suffered traumatic injuries.

Available Dosage Forms and Strengths

Capsules - 10 mg, 20 mg, 40 mg
Capsules - 90 mg (Prozac Weekly form)

Capsules - 10 mg and 20 mg (28-pill blister packs Sarafem form)
Oral solution - 20 mg/5 ml
Tablet - 10 mg

Usual Adult Dosage Ranges:

Depression: Starts with 20 mg in the morning; if no improvement after several weeks, dose may be increased by 20 mg/day. Doses over 20 mg/day should be divided into two equal doses and taken twice daily. Maximum daily dose is 80 mg. Prozac Weekly form is intended for people who are already stabilized on the daily 20 mg form. The once weekly form is started seven days after the last 20 mg dose was given and is continued at 90 mg per week.
Bulimia: 60 mg once daily in the morning.
PMDS (severe PMS): A 28-pill blister pack is available (Sarafem form). In clinical studies, some patients used 20-60 mg during the entire month to check sign and symptom decreases (this is the recommended dose in current labeling). One part of the clinical study group obtained an 86% symptom reduction using 20 mg a day on days 14-28 of each menstrual cycle. Your doctor may adjust dosing strategies to the severity of your symptoms. This drug is now approved in PMDS for use only in the 14 days (luteal phase) BEFORE menstruation is expected to start.
Hot flashes in cancer survivors: 20 mg per day. Obsessive-compulsive disorder: 20 to 80 mg daily.
Note: Actual dose and schedule must be determined for each patient individually.

Conditions Requiring Dosing Adjustments

Liver Function: The dose should be decreased or the dosing interval lengthened for patients with liver compromise. Some clinicians decrease the dose by 50% in compensated cirrhosis. This drug is also a rare cause of liver toxicity and should be used with caution by this patient population.
Kidney Function: Dosing changes are needed for severely impaired kidney function. Patients should be closely watched for adverse effects.

Dosing Instructions: The capsule may be opened and the contents mixed with any convenient food. To make smaller doses, the contents may be mixed with orange juice or apple juice (NOT GRAPEFRUIT JUICE) and refrigerated; doses of 5-10 mg may prove effective and better tolerated. If you forget a dose: take the dose you missed as soon as you remember it, unless it is nearly time for your next dose-if that is the case, skip the missed dose and take the next dose right on schedule. DO NOT DOUBLE DOSES. If you find yourself missing doses, talk to your doctor.

Please Note: The information contained on this page is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs or following any treatment or regimen. Only your doctor, nurse or pharmacist can provide you with advice on what is safe and effective for you.

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