Fluoxetine
The Good, The Bad & The Ugly
Today we will review fluoxetine & we will do so from the perspective of what is good, what is bad and what is ugly about this drug.
The Good:
Fluoxetine, sold under the brand name Prozac, is a selective serotonin reuptake inhibitor (SSRI) that is widely used for the treatment of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder, and bulimia nervosa. It works by increasing the levels of serotonin in the brain, which can improve mood and reduce symptoms of anxiety.
Fluoxetine is generally well-tolerated, and it has a lower risk of side effects compared to other antidepressants. It has a long half-life, which means it stays in the body for a longer period of time, allowing for once-daily dosing. It can also be used in children and adolescents with MDD, OCD, and bulimia nervosa.
The Bad:
Despite its benefits, fluoxetine can cause a range of side effects. The most common side effects include nausea, headache, insomnia, and sexual dysfunction. It can also cause agitation, anxiety, and suicidal thoughts, particularly in young adults and adolescents. Therefore, it is important to closely monitor patients who are taking fluoxetine, especially during the first few weeks of treatment.
Fluoxetine can also interact with other medications, including monoamine oxidase inhibitors (MAOIs), blood thinners, and nonsteroidal anti-inflammatory drugs (NSAIDs). Therefore, patients should inform their healthcare provider of all medications they are taking before starting fluoxetine.
The Ugly:
One of the potential risks associated with fluoxetine is the development of serotonin syndrome, a potentially life-threatening condition that occurs when there is an excess of serotonin in the brain. Symptoms of serotonin syndrome can include agitation, hallucinations, rapid heart rate, and high blood pressure. Therefore, patients should seek immediate medical attention if they experience any of these symptoms while taking fluoxetine.
**this is highly unusual when administered within standard dosage ranges, but be on the look out for additional serotonergic medications on their med list, including tryptans, which may have been started by the patient’s PCP.
Fluoxetine has also been associated with an increased risk of suicidal thoughts and behaviors, particularly in children, adolescents, and young adults. Because of this association, it has a black box warning for risk of suicidal ideation. Patients and caregivers should be aware of the signs of suicidal thoughts, such as talking about wanting to harm oneself or feeling hopeless, and should seek medical attention if these symptoms occur.
DISCLAIMER
This is not Medical Advice and while the writer believes what he has shared, substack dot com does not equate to strong evidence. Please do not treat patients based on what is read in this post, these are opinions of an internet stranger. Instead use these posts as a starting point for furthering your own study & education.