Welcome to this video tutorial on Prozac!
Prozac Overview
What Prozac Is Used For
Prozac (fluoxetine) is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class of drugs. It is given to treat major depressive disorder, panic attacks, obsessive-compulsive disorder, bulimia, and premenstrual dysphoric disorder (a severe form of premenstrual syndrome). It also has some off-label uses including fibromyalgia, migraines, and Raynaud’s phenomenon.
Prozac is usually started at 20 mg/day orally in the morning. The dose may be increased after several weeks if improvement is not observed, but not to exceed 80 mg/day.
Common Adverse Effects
Adverse effects of Prozac include the following:
- GI symptoms (nausea, diarrhea, loss of appetite, weight loss)
- Sexual dysfunction
- CNS stimulation (anxiety, nervousness, insomnia)
- Headache
- Drowsiness
- Weakness
- Dizziness
- Sweating
- Increased risk of GI bleeding (worsened by the use of NSAID, aspirin, or warfarin)
There is a black box warning for Prozac and all antidepressants. When given for depression, Prozac has been shown to cause an increase in the incidence of suicidal thoughts in patients under age 24. Therefore, children and young adults should be closely observed if drug therapy is started.
Pregnancy and Lactation Considerations
When considering Prozac use during pregnancy, several things should be kept in mind. Prozac falls in pregnancy category C (animal studies show adverse effects on the fetus, and there are no adequate, well-controlled studies in humans, but benefits may account for use of the drug despite the risks). Some studies have shown heart malformations in newborns and prolonged hospitalization with respiratory support needed.
Prozac is in the lactation category of L3 for neonates and L2 for older infants, which means it is probably compatible, but there are no controlled studies, and unforeseen effects to the breastfed infant are possible. The benefits of the drug have to be weighed against the risks.
Drug Interactions and Serotonin Syndrome
Switching Between Prozac and MAOIs
If the patient will be switching from an MAOI (monoamine oxidase inhibitor) to Prozac (or any SSRI), there should be at least a 14-day lapse between the drugs. When switching from Prozac to an MAOI, Prozac should be discontinued at least five weeks before starting the MAO inhibitor.
Signs of Serotonin Syndrome
Serotonin syndrome is a serious and sometimes fatal reaction that may occur when an SSRI and an MAO inhibitor are combined. It is characterized by the following symptoms:
- Mental status changes (agitation, delirium, coma)
- Autonomic instability (tachycardia, labile BP, dizziness, hyperthermia)
- Neuromuscular symptoms (tremor, muscle rigidity, incoordination, seizures)
- GI symptoms (nausea, vomiting, diarrhea)
Other Serotonin-Increasing Drugs and Supplements
The risk of serotonin syndrome increases if other drugs are taken that also increase serotonin, including other antidepressants, street drugs such as ecstasy, St. John’s wort, and tryptophan, among others.
Patient Education
When educating the patient taking Prozac, be sure to tell them the following:
- Inform the doctor right away if you notice worsening depression or other psychiatric conditions, unusual changes in behavior or mood, or suicidal thoughts.
- Some improvement should be seen within 1 to 2 weeks, but it may take 4 or 5 weeks before feeling the full benefit of the medication.
- If diabetic, Prozac may affect blood sugar levels; therefore, regularly monitor your blood sugar. The doctor may need to make adjustments to medication or diet.
- The drug may cause dizziness or drowsiness, so avoid driving or using machinery until you are sure such activities can be performed safely.
- Avoid alcoholic beverages.
- Inform the doctor or pharmacist if you are taking other products that cause drowsiness, including antihistamines, drugs for sleep or anxiety, muscle relaxants, narcotic pain relievers, or alcohol.
- Do not stop taking Prozac without first consulting your healthcare provider. Some conditions may become worse or even severe when the drug is stopped abruptly. It is best if the dose is gradually decreased under the doctor’s supervision. The effects of the drug decrease slowly, over 2 to 3 months.
- Prozac can stay in the body for many weeks after the last dose and may still interact with other medications. It is important to tell your healthcare provider if Prozac has been taken in the previous five weeks before taking any other medication.
- Medication should be stored away from light and moisture. Do not store in the bathroom.
- Do not flush medications down the toilet or pour them in a drain.
- Keep all medications away from children and pets.
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