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Fluoxetine

Fluoxetine hydrochloride is an antidepressant drug used medically in the treatment of depression, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder and panic disorder. Fluoxetine is also used (off-label) to treat many other conditions, such as ADHD. more...

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It is sold under the brand names Prozac®, Symbyax® (compounded with olanzapine), Sarafem®, Fontex® (Sweden), Foxetin® (Argentina), Ladose® (Greece), Fluctin® (Austria, Germany), Prodep® (India), Fludac*® (India) and Lovan® (Australia). Fluoxetine was derived from diphenhydramine, an antihistamine found to inhibit reuptake of the neurotransmitter serotonin.

Compared to other popular selective serotonin reuptake inhibitors, fluoxetine has a strong energizing effect. This makes fluoxetine highly effective in treatment of clinical depression cases where symptoms like depressed mood and lack of energy prevail. Although stimulating, it is also approved for a variety of anxiety disorders, including panic disorder and obsessive compulsive disorder.

Eli Lilly's Prozac was approved by the FDA on December 29, 1987 and introduced in the US at the beginning of 1988. The drug became very popular, with millions around the world having taken the medication. In the fall of 2001, Eli Lilly lost a patent dispute with Barr Laboratories and now fluoxetine hydrochloride is manufactured by many companies.

Uses

Approved

Fluoxetine hydrochloride is approved in the United States to treat depression, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder and panic disorder. In the United Kingdom, it is approved to treat depression with or without anxiety, bulimia nervosa, and obsessive-compulsive disorder.

In December 2003 the FDA approved Symbyax® to treat bipolar depression. Symbyax is a combination of fluoxetine and olanzapine. (However, the pure form of fluoxetine can cause mania, mixed-states, rapid cycling and psychosis in bipolar patients, particularly if the patient is not also taking a mood stabilizer.)

Unapproved/Off-label/Investigational

In 2003, Michel Harper, Fukodome Takayasu, and Andrew G. Engel reported that fluoxetine given over a period of three years at doses of up to 80-120 mg/day to two patients with slow-channel congenital myasthenic syndrome who were allergic to quinidine resulted in substantial subjective and objective improvement in muscle strength.

Mechanism of action

Recent research indicates that fluoxetine may increase the production of new neurons (brain cells) in adult brain (adult neurogenesis)^, and that it interacts with the system of "clock genes", the transcription factors involved in drug abuse and possibly obesity ^,.

Read more at Wikipedia.org

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Fluoxetine for Depression in Patients with Diabetes
From American Family Physician, 11/15/00 by Jim Nuovo

Up to 20 percent of patients with diabetes have a major depressive disorder. Depression in patients with diabetes may be associated with poor compliance with therapy, poor glycemic control and an increased risk of complications. An important question is whether antidepressant therapy improves diabetes control. Lustman and associates assessed the efficacy of fluoxetine in the treatment of depression in patients with diabetes.

The 60 patients in the double-blind placebo-controlled study were 21 to 65 years of age and met the diagnostic criteria for major depression. Each had a score of 14 or greater on the Beck Depression Inventory (BDI) or the Hamilton Rating Scale for Depression (HAMD). Patients were randomly assigned to receive fluoxetine, which was initiated at a dosage of 20 mg per day and increased up to 40 mg daily as required by the clinical response. Depression and glycemic control were evaluated during the third, fifth and eighth weeks of treatment.

Fifty-four of the 60 patients (27 in each group) completed the study. Treatment and placebo groups were comparable with respect to median age (45.0 and 47.7 years, respectively), mean glycosylated hemoglobin (HbA1c) level at baseline (8.4 and 8.6 percent, respectively) and duration of diabetes (12.2 and 14.1 years, respectively). Patients were equally distributed among those with type 1 (formerly known as insulin-dependent) and type 2 (formerly known as non-insulin-dependent) diabetes.

After eight weeks of fluoxetine therapy, mean BDI and HAMD scores had dropped significantly, from a mean BDI score of 23.6 to 9.6 and from a mean HAMD score of 20.1 to 9.4. In the placebo group, the mean BDI scores were 22.4 and 13.6 at baseline and after treatment, respectively, and the mean HAMD scores were 19.5 and 14.3 at baseline and after treatment.

Improvement in HbA1c level was greater in the fluoxetine group than in the placebo group, but the difference was not statistically significant. The mean decrease in HbA1c was 0.40 percent in the fluoxetine group and 0.07 percent in the placebo group.

The authors conclude that fluoxetine is superior to placebo in the treatment of major depression in patients with diabetes. The trend toward greater improvement in glycemic control in these patients could not be attributed to the effects of treatment on weight or depression. While the long-term benefits of fluoxetine on glycemic control are unclear, the results of this study are promising. Identification and treatment of depression in patients with diabetes will likely improve their quality of life and clinical outcomes.

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