What Meds

Psychiatric Medications


Fluoxetine
Brand Name: Prozac, Prozac Weekly, Sarafem

Overview
Prozac is the brand name for Fluoxetine hydrochloride, an antidepressant. Prozac is an SSRI – a Selective Serotonin Reuptake Inhibitor which increases and restores levels of the neurotransmitter serotonin to relieve depression.

Prozac usually starts relieving symptoms within one to four weeks.

Why is this drug prescribed?
Prozac is FDA-labeled in adults for treatment of bulimia nervous, major depressive disorder, obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder. It is FDA-labeled in adolescents and children above age 8 in major depressive disorder. And it is FDA-labeled in children above age 7 in obsessive-compulsive disorder

How much of this drug is typically used?
Capsule: 10 mg, 20 mg, 40 mg
  Sarafem: 10 mg, 20 mg
Capsule, delayed release:
  Prozac Weekly: 90 mg
Solution, oral: 20 mg/5 mL
Tablet: 10 mg, 20 mg

Warnings and Precautions
There have been limited studies concerning the use of Prozac on children 7 to 18 years of age. These studies indicate that Prozac may help to treat depression and obsessive-compulsive disorder in children. Certain side effects such as unusual excitement, restlessness, irritability, and trouble in sleeping are especially frequent in children. In general, children are more sensitive than adults are to the effects of Prozac.

For Pregnant or Nursing Mothers: Prozac is passed into breast milk and is not recommended for nursing mothers. Some studies indicate that taking Prozac during pregnancy may cause problems in the baby, though other studies did not find any adverse effects due to Prozac.

Contraindications
Prozac should Not be used for people with the following medical conditions:

Adverse Reactions
Prozac may cause the following reactions:

Rarely:

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Prozac are:

Research Studies and Use in Child Psychiatry
Fluoxetine was effective in the treatment of overanxious disorder, social phobia, or separation anxiety disorder in an analysis of twenty-one patients ages 11 to 17 years of age (Birmaher et al, 1994). Open-label trials with fluoxetine revealed improvement in behavior, social skills, language and adaptive skills with autistic children (DeLong GR, Teague LA & Kamran MM, 1998). Likewise, two open label study showed anorexic/bulimics maintaining weight at least 85% of body weight and other outcome measures while on fluoxetine.

In an 8-week, placebo-controlled study, fluoxetine was more effective than placebo for treating major depressive disorder in children and adolescents (Emslie et al, 1997a). Another study showed comparisons with fluoxetine alone, cognitive-behavioral therapy (CBT) alone, combined fluoxetine and CBT, or placebo. This showed that fluoxetine combined with CBT improved outcome and reduced suicidal thinking in a randomized controlled trial involving 439 patients between the ages of 12 to 17 years with a primary diagnosis of major depressive disorder (Treatment for Adolescents With Depression Study (TADS) Team, 2004). Fluoxetine is the only SSRI with FDA-labeling for treatment of depression in children and adolescents. However, it is not clear if it is actually superior to the other SSRIs in this regard. Of not, this medication has a longer half life, and thus stays in the body much longer than other SSRIs. The medication does carry a special warning, as with other antidepressants, of increased suicidal thinking and behavior in children, adolescents and young adults.

A retrospective evaluation of 20 children and 18 adolescents with obsessive compulsive disorder (OCD), showed that fluoxetine 1 mg/kg/day effectively improved symptoms of OCD in 74% of patients; clinical response was maintained over a follow up period averaging 19 months (Geller et al, 1995). Studies have also shown improvement of OCD symptoms in association with Tourette’s syndrome with fluoxetine (Kurlan et al, 1993). These studies indicate that fluoxetine may help to treat depression and obsessive-compulsive disorder in children.

There are some signs of efficacy in body dysmorphic disorder, depression in cancer, depression in diabetes, dysthymia, fibromyalgia, hot sweats, posttraumatic stress disorder, and Raynaud’s phenomenon in adults.

There have also been off-label uses for selective mutism in children and adolescents

Sources

Stanford Medicine Resources:

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