Fluoxetine: Effective SSRI Treatment for Depression and Anxiety
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Synonyms
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Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) widely prescribed for the management of major depressive disorder, obsessive-compulsive disorder, panic disorder, and bulimia nervosa. As one of the most extensively studied antidepressants, it offers a favorable balance of efficacy and tolerability. Its mechanism of action involves increasing serotonin levels in the brain, which helps regulate mood, emotion, and behavior. Clinical evidence supports its use in both acute treatment and long-term maintenance therapy.
Features
- Active ingredient: Fluoxetine hydrochloride
- Available in 10 mg, 20 mg, and 40 mg capsules; 20 mg/5 mL liquid formulation
- Selective serotonin reuptake inhibitor (SSRI) class
- FDA-approved for multiple psychiatric and eating disorders
- Once-daily dosing convenience
- Generic and brand-name (Prozac) formulations available
Benefits
- Significantly reduces symptoms of depression and anxiety disorders
- Helps restore emotional balance and improves overall quality of life
- Reduces frequency and intensity of obsessive thoughts and compulsive behaviors
- Effective in decreasing binge-eating and purging behaviors in bulimia nervosa
- Lower risk of cardiovascular effects compared to older antidepressants
- Suitable for long-term maintenance therapy to prevent relapse
Common use
Fluoxetine is primarily indicated for the treatment of major depressive disorder (MDD) in adults and pediatric patients aged 8 years and older. It is also approved for obsessive-compulsive disorder (OCD), panic disorder with or without agoraphobia, and bulimia nervosa. Off-label uses include treatment of premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder (PTSD), and certain anxiety spectrum disorders. Healthcare providers may also prescribe it as part of combination therapy for treatment-resistant depression.
Dosage and direction
The recommended starting dose for depression in adults is 20 mg once daily in the morning. Dosage may be increased after several weeks if insufficient clinical improvement is observed, with maximum recommended dose of 80 mg daily. For OCD, initial adult dose is 20 mg daily, with possible titration to 60 mg maximum. Pediatric dosing for MDD (ages 8-18) starts at 10 mg daily, increasing to 20 mg after one week if tolerated. Administration with food may minimize gastrointestinal upset. Full therapeutic effect typically requires 4-6 weeks of consistent use.
Precautions
Patients should be monitored for emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, and mania, particularly during initial treatment and dose adjustments. Caution is advised in patients with history of seizures, as fluoxetine may lower seizure threshold. Use with caution in patients with hepatic impairment, requiring dosage adjustment or alternative therapy. Elderly patients may require lower initial doses due to increased sensitivity to side effects. Regular monitoring of weight and growth parameters is recommended in pediatric patients.
Contraindications
Fluoxetine is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy due to risk of serotonin syndrome. Contraindicated in patients taking pimozide or thioridazine due to potential for serious cardiac arrhythmias. Should not be used in patients with known hypersensitivity to fluoxetine or any component of the formulation. Avoid use in patients with uncontrolled narrow-angle glaucoma.
Possible side effect
Common side effects (≥10%) include headache, nausea, insomnia, fatigue, drowsiness, anxiety, nervousness, and dizziness. Less frequent effects (1-10%) include diarrhea, dry mouth, dyspepsia, decreased libido, sweating, rash, and tremor. Sexual dysfunction including anorgasmia, delayed ejaculation, and impotence may occur. Rare but serious adverse effects include serotonin syndrome, abnormal bleeding, hyponatremia, angle-closure glaucoma, and QT interval prolongation. Sudden discontinuation may cause withdrawal symptoms including dizziness, sensory disturbances, agitation, and anxiety.
Drug interaction
Fluoxetine is a strong inhibitor of CYP2D6 and moderate inhibitor of CYP2C9/19, potentially increasing levels of drugs metabolized by these enzymes. Significant interactions occur with MAOIs (serotonin syndrome risk), other serotonergic drugs, drugs that prolong QT interval, warfarin (increased bleeding risk), and tricyclic antidepressants (increased TCA levels). Use with NSAIDs, aspirin, or other anticoagulants may increase bleeding risk. May decrease efficacy of tamoxifen through CYP2D6 inhibition. Carefully monitor patients taking multiple medications.
Missed dose
If a dose is missed, take it as soon as remembered unless it is close to the time for the next scheduled dose. In that case, skip the missed dose and resume regular dosing schedule. Do not double the dose to make up for a missed one. Consistent daily administration is important for maintaining steady state concentrations and therapeutic effect. Patients should contact their healthcare provider if multiple doses are missed or if uncertainty exists about proper dosing.
Overdose
Symptoms of overdose may include nausea, vomiting, agitation, restlessness, hypomania, seizures, and cardiovascular effects. Serotonin syndrome manifestations including hyperthermia, rigidity, myoclonus, autonomic instability, and mental status changes may occur. Fatalities have been reported with mixed overdoses involving multiple drugs. There is no specific antidote; treatment involves supportive care and symptomatic management. Gastric lavage may be considered if presented early. Activated charcoal may be administered. ECG monitoring is recommended due to potential QT prolongation.
Storage
Store at controlled room temperature (20-25°C or 68-77°F). Keep container tightly closed and protect from moisture. Dispense in original container with child-resistant closure. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Oral solution should be used within 14 days after opening when stored at room temperature, or within 7 weeks if refrigerated. Do not freeze the liquid formulation.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Individual response to fluoxetine may vary based on genetic factors, concomitant medications, and underlying health conditions. Treatment decisions should be made in consultation with a qualified healthcare professional who can assess individual patient needs and monitor treatment response. Never initiate, adjust, or discontinue medication without professional medical supervision.
Reviews
Clinical studies demonstrate fluoxetine’s efficacy with response rates of 50-70% in major depression and significant improvement in anxiety symptoms. Meta-analyses confirm its position as a first-line antidepressant with established safety profile. Many patients report substantial improvement in mood, energy levels, and overall functioning after 4-8 weeks of treatment. Some users note initial side effects that often diminish with continued use. Healthcare providers appreciate its predictable pharmacokinetics and well-characterized drug interaction profile. Long-term studies support its effectiveness in maintenance therapy and relapse prevention.