Presentation

Overview

Fluoxetine is a selective serotonin reuptake inhibitors (SSRI) antidepressant. Fluoxetine affects chemicals in the brain that may become unbalanced and cause depression, panic, anxiety, or obsessive-compulsive symptoms.
Fluoxetine is used to treat major depressive disorder, bulimia nervosa (an eating disorder) obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD).
Fluoxetine is sometimes used together with another medication called olanzapine (Zyprexa). to treat depression caused by bipolar disorder (manic depression). This combination is also used to treat depression after at least 2 other medications have been tried without successful treatment of symptoms.

WHAT IS ATMOFLIN USED FOR ?

Fluoxetine Tablets are used to treat the following conditions:

In adults:
•major depressive episodes
•obsessive-compulsive disorder (OCD)
•bulimia nervosa: fluoxetine is used alongside psycho-therapy for the reduction of binge-eating and purging.

In children and adolescents aged 8 years and above:
moderate to severe major depressive disorder, if the depression does not respond to psychological therapy after 4-6 sessions. Fluoxetine should be offered to a child or young person with moderate to severe major depressive disorder only in combination with psychological therapy. Ask your doctor or pharmacist if you need additional information.

Warnings

Do not take Fluoxetine and tell your doctor or pharmacist if the following apply:

if you are allergic (hypersensitive) to fluoxetine or any of the other ingredients in the medicine, listed above. An allergy may include rash, itching, swollen face or lips or shortness of breath.

if you are taking medicines known as non-selective monoamine oxidase inhibitors or reversible monoamine oxidase inhibitors type A (also called MAOIs, which are also used to treat depression), since serious or even fatal reactions can occur.

Treatment with fluoxetine should only be started 2 weeks after discontinuation of an irreversible MAOI (for instance tranylcypromine).
However, treatment with Fluoxetine can be started the following day after discontinuation of certain MAOIs called reversible MAOI-A (for instance moclobemide).
Do not take any MAOIs for at least five weeks after you stop taking Fluoxetine. If Fluoxetine has been prescribed for a long period and/or at a high dose, a longer interval needs to be considered by your doctor. Examples 0of MAOIs include nialamide, iproniazide, selegiline, moclobemide, phenelzine, tranylcypromine, isocarboxazid and toloxatone.

Contraindications

Fluoxetine hydrochloride is contraindicated in patients known to be hypersensitive to it.

Side Effects

insomnia, headache, dizziness, vision changes, tremors or shaking, feeling anxious or nervous, pain, weakness, yawning, tired feeling, upset stomach, loss of appetite, nausea, vomiting, diarrhea, dry mouth, sweating, hot flashes

Dosage

Oral

Disclaimer:To be taken only after consulting with the doctor.

Storage

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

For Professionals

PHARMACOLOGY

Pharmacodynamics

The antidepressant, antiobsessive-compulsive, and antibulimic actions of Fluoxetine are presumed to be linked to its inhibition of CNS neuronal uptake of serotonin. Studies at clinically relevant doses in man have demonstrated that Fluoxetine blocks the uptake of serotonin into human platelets. Studies in animals also suggest that Fluoxetine is a much more potent uptake inhibitor of serotonin than of norepinephrine.
Antagonism of muscarinic, histaminergic, and α1-adrenergic receptors has been hypothesized to be associated with various anticholinergic, sedative, and cardiovascular effects of classical tricyclic antidepressant (TCA) drugs. Fluoxetine binds to these and other membrane receptors from brain tissue much less potently in vitro than do the tricyclic drugs.

Absorption, Distribution, Metabolism, and Excretion
Protein Binding: Over the concentration range from 200 to 1000 ng/mL, approximately 94.5% of Fluoxetine is bound in vitro to human serum proteins, including albumin and α1-glycoprotein. The interaction between Fluoxetine and other highly protein-bound drugs has not been fully evaluated, but may be important.
Enantiomers: Fluoxetine is a racemic mixture (50/50) of R-Fluoxetine and S-Fluoxetine enantiomers. In animal models, both enantiomers are specific and potent serotonin uptake inhibitors with essentially equivalent pharmacologic activity. The S-Fluoxetine enantiomer is eliminated more slowly and is the predominant enantiomer present in plasma at steady state.
Metabolism: Fluoxetine is extensively metabolized in the liver to norFluoxetine and a number of other unidentified metabolites. The only identified active metabolite, norFluoxetine, is formed by demethylation of Fluoxetine. In animal models, S-norFluoxetine is a potent and selective inhibitor of serotonin uptake and has activity essentially equivalent to R- or S-Fluoxetine. R-norFluoxetine is significantly less potent than the parent drug in the inhibition of serotonin uptake. The primary route of elimination appears to be hepatic metabolism to inactive metabolites excreted by the kidney.
Clinical issues related to metabolism/elimination: The complexity of the metabolism of Fluoxetine has several consequences that may potentially affect Fluoxetine's clinical use.