Fluoxetine is eliminated from the body. Fluoxetine: detailed instructions for use. Indications and contraindications

Gross formula

C 17 H 18 F 3 NO

Pharmacological group of the substance Fluoxetine

Nosological classification (ICD-10)

CAS code

54910-89-3

Characteristics of the substance Fluoxetine

Bicyclic antidepressant, SSRI.

Fluoxetine hydrochloride is a white or off-white crystalline powder, sparingly soluble in water (14 mg/ml). Molecular weight 345.79.

Pharmacology

pharmachologic effect- antidepressant, anorexigenic.

Selectively inhibits the reuptake of serotonin, which leads to an increase in its concentration in the synaptic cleft, strengthening and prolonging its effect on postsynaptic receptors. By increasing serotonergic transmission, it inhibits neurotransmitter exchange through a negative feedback mechanism. With long-term use, it reduces the activity of 5-HT 1 receptors. It also blocks the reuptake of serotonin in platelets. Weakly affects the reuptake of norepinephrine and dopamine. It has no direct effect on serotonin, m-cholinergic, H1-histamine and alpha-adrenergic receptors. Unlike most antidepressants, it does not cause a decrease in the activity of postsynaptic beta-adrenergic receptors.

Effective for endogenous depression and obsessive-compulsive disorders. Improves mood, reduces tension, anxiety and fear, eliminates dysphoria. It has an anorexigenic effect and can cause weight loss. In patients with diabetes mellitus it can cause hypoglycemia, and when fluoxetine is discontinued, it can cause hyperglycemia. A pronounced clinical effect for depression occurs after 1-4 weeks of treatment, for obsessive-compulsive disorders - after 5 weeks or more.

Well absorbed from the gastrointestinal tract. The “first pass” effect through the liver is weakly expressed. Capsules and water solution fluoxetine are equivalent in effectiveness. After a single dose of 40 mg, Cmax of fluoxetine is achieved after 4-8 hours and is 15-55 ng/ml; when taken at the same dose for 30 days, Cmax of fluoxetine is 91-302 ng/ml, norfluoxetine - 72- 258 ng/ml. At concentrations up to 200-1000 ng/ml, fluoxetine is 94.5% bound to blood proteins, including albumin and alpha 1-glycoprotein. The enantiomers are equally effective, but S-fluoxetine is excreted more slowly and predominates over the R-form at steady state concentration. Easily penetrates the BBB. In the liver, enantiomers are demethylated with the participation of the isoenzyme CYP2D6 cytochrome P450 to norfluoxetine and other unidentified metabolites, and S-norfluoxetine is equal in activity to R- and S-fluoxetine and superior to R-norfluoxetine. T1/2 of fluoxetine is 1-3 days after a single dose and 4-6 days with long-term administration. T1/2 of norfluoxetine is 4-16 days in both cases, which causes significant accumulation of substances, slow achievement of their equilibrium level in plasma and prolonged presence in the body after withdrawal. In patients with liver cirrhosis, T1/2 of fluoxetine and its metabolites is prolonged. Excreted within 1 week mainly by the kidneys (80%): unchanged - 11.6%, in the form of fluoxetine glucuronide - 7.4%, norfluoxetine - 6.8%, norfluoxetine glucuronide - 8.2%, more than 20% - hippuric acid, 46% - other compounds; 15% is excreted by the intestines. If renal function is impaired, the elimination of fluoxetine and its metabolites slows down. It is not excreted during dialysis (due to the large volume of distribution and high degree of binding to plasma proteins).

There is evidence of the effectiveness of fluoxetine in eating disorders (anorexia nervosa), alcoholism, anxiety disorders, including social phobia; diabetic neuropathy, affective, incl. bipolar disorders; dysthymia, autism, panic attacks, premenstrual syndrome, narcolepsy, catalepsy, obstructive sleep apnea syndrome, kleptomania, schizophrenia, schizoaffective disorders, etc.

Use of the substance Fluoxetine

Depression (especially accompanied by fear), incl. when other antidepressants are ineffective, obsessive-compulsive disorder, bulimia nervosa.

Contraindications

Hypersensitivity, use of MAO inhibitors (in the previous 2 weeks), liver and kidney failure (creatinine clearance less than 10 ml/min), epilepsy and convulsive conditions (history), suicidal ideation, diabetes mellitus, atony Bladder, angle-closure glaucoma, prostatic hypertrophy.

Restrictions on use

Children's age (safety and effectiveness have not been established), myocardial infarction, incl. history of liver cirrhosis.

Use during pregnancy and breastfeeding

During pregnancy, it should be prescribed only if absolutely necessary. When using fluoxetine during pregnancy, an increased risk of premature birth, developmental abnormalities and low adaptation of newborns (including difficulty breathing, cyanosis, excitability) were noted.

During treatment you should avoid breastfeeding(fluoxetine penetrates into breast milk lactating women).

Updating information

Use of fluoxetine in the first trimester of pregnancy

There are not enough controlled studies examining the safety of fluoxetine in women during the first trimester of pregnancy, and the results of some published epidemiological studies are conflicting. More than 10 cohort and case-control studies have found no increase in the likelihood of developing birth defects development. At the same time, a prospective cohort study conducted European Network of Teratology Information Services, suggests an increased risk of developing birth defects of cardio-vascular system in newborns whose mothers (n=253) used fluoxetine during the first trimester of pregnancy compared with newborns whose mothers (n=1359) did not take fluoxetine. At the same time, a specific group of malformations of the cardiovascular system was not determined and it was not possible to establish a reliable cause-and-effect relationship between taking fluoxetine during the first trimester of pregnancy and an increased risk of fetal developmental anomalies.

[Updated 24.02.2012 ]

Use of fluoxetine in the third trimester of pregnancy

The use of serotonin and norepinephrine reuptake inhibitors (SNRIs), as well as SSRIs, including fluoxetine, at the end of the third trimester of pregnancy led to the development of complications in newborns (increased length of hospitalization, duration of artificial ventilation and tube feeding). There are reports of the development of such pathological conditions How respiratory distress syndrome newborns, apnea, convulsions, lability of body temperature, hypoglycemia, decrease or increase blood pressure, vomiting, difficulty in adequate nutrition, cyanosis, hyperreflexia, tremor, nervous irritability, excitability, constant crying. The listed disorders may be a manifestation of the toxic effects of SNRIs and SSRIs, or be a consequence of their withdrawal syndrome.

[Updated 24.02.2012 ]

Data from fluoxetine teratogenicity studies in animals

When fluoxetine is administered in doses exceeding 12.5 mg/kg per day to pregnant female rats, as well as in doses exceeding 15 mg/kg per day to pregnant female rabbits (1.5 and 3.6 times higher, respectively) maximum dose, recommended for humans - 80 mg/m2), no reliable data have been identified indicating the teratogenicity of fluoxetine during the process of organogenesis. However, data from other studies in rats indicate an increase in stillbirths, a decrease in neonatal weight and an increase in neonatal mortality within 7 days after birth when fluoxetine was administered at a dose of 12 mg/kg per day (1.5 times the maximum dose recommended for humans) during pregnancy and at a dose of 7.5 mg/kg per day (90% of the maximum dose recommended for humans) during pregnancy and lactation. However, no signs of neurotoxicity were detected in surviving newborn female rats that received 12 mg/kg fluoxetine per day during pregnancy. A fluoxetine dose of 5 mg/kg per day (60% of the maximum recommended dose for humans) was determined not to increase mortality in neonatal animals.

[Updated 24.02.2012 ]

Side effects of the substance Fluoxetine

From the outside nervous system and sense organs: headache, dizziness, anxiety, nervousness, lethargy, fatigue, asthenic syndrome, emotional lability, sleep disorders (insomnia, drowsiness), nightmares, motor restlessness, muscle twitching, myoclonus, tremor, hyperkinesia, convulsive states, hypo- or hyperreflexia, extrapyramidal syndrome, carpal tunnel syndrome, ataxia, akathisia, dysarthria, hyper- or hypoesthesia, paresthesia, neuralgia, neuropathy, neuritis, neurosis, thinking disorders, difficulty concentration, amnesia, euphoria, mania or hypomania, hallucinations, depersonalization, paranoid reactions, psychosis, suicidal tendencies, EEG changes, stupor, coma, decreased visual acuity, amblyopia, strabismus, diplopia, exophthalmos, mydriasis, conjunctivitis, iritis, scleritis , blepharitis, xerophthalmia, photophobia, glaucoma, disorder taste sensations, parosmia, noise and pain in the ears, hyperacusis.

From the cardiovascular system and blood (hematopoiesis, hemostasis): tachy- or bradycardia, extrasystole, atrial or ventricular fibrillation, cardiac arrest, myocardial infarction, congestive heart failure, hyper- or hypotension, vascular dilatation, phlebitis, thrombophlebitis, vascular thrombosis, vasculitis with hemorrhagic rash, cerebral ischemia, cerebral embolism, anemia, leukocytosis or leukopenia, lymphocytosis, thrombocythemia, thrombocytopenia, pancytopenia.

From the respiratory system: nasal congestion, nose bleed, sinusitis, laryngeal edema, difficulty breathing, stridor, hyper- or hypoventilation, hiccups, cough, respiratory distress syndrome, inflammatory or pulmonary changes fibrous in nature, atelectasis, emphysema, pulmonary edema, hypoxia, apnea, chest pain.

From the gastrointestinal tract: decreased (rarely increased) appetite, anorexia, dry mouth, increased salivation, increased salivary glands, aphthous stomatitis, glossitis, dysphagia, esophagitis, gastritis, dyspepsia, nausea, vomiting, incl. hematemesis, abdominal pain, " acute abdomen", stomach ulcer and duodenum, gastrointestinal bleeding, flatulence, diarrhea, constipation, melena, colitis, intestinal obstruction, increased levels of liver transaminases, creatine phosphokinase and alkaline phosphatase in the blood, hepatitis, cholelithiasis, cholestatic jaundice, liver failure, liver necrosis, pancreatitis.

From the side of metabolism: impaired ADH secretion, hyponatremia, hypo- or hyperkalemia, hypocalcemia, hyperuricemia, gout, hypercholesterolemia, diabetes mellitus, hypoglycemia, diabetic acidosis, hypothyroidism, edema, dehydration.

From the outside genitourinary system: dysuria, frequent urination, nocturia, poly- or oliguria, albumin and proteinuria, glucosuria, hematuria, infections urinary tract, cystitis, renal failure, hyperprolactinemia, enlargement and pain in the mammary glands, decreased libido, ejaculation disorders, priapism, impotence, anorgasmia, painful menstruation, menopause and metrorrhagia.

From the musculoskeletal system: myasthenia gravis, myopathy, myalgia, myositis, arthralgia, arthritis, rheumatoid arthritis, bursitis, tenosynovitis, chondrodystrophy, osteomyelitis, osteoporosis, bone pain.

From the outside skin: polymorphic rash, incl. hemorrhagic, ulcerative skin lesions, acne, alopecia, contact dermatitis, photosensitivity, skin discoloration, furunculosis, herpes zoster, hirsutism, eczema, psoriasis, seborrhea, epidermal necrosis, exfoliative dermatitis.

Allergic reactions: rash, itching, urticaria, Quincke's edema, reactions such as serum sickness, anaphylactic and anaphylactoid reactions.

Others: weight loss, sweating, flushing of the face and neck with a feeling of heat, neuroleptic malignant syndrome, yawning, chills, fever, flu-like syndrome, hypothermia, lymphadenopathy, incl. enlarged tonsils, pharyngitis. Deaths have been described.

Interaction

Incompatible with MAO inhibitors, other antidepressants, furazolidone, procarbazine, because causes serotonergic syndrome (chills, hyperthermia, muscle rigidity, myoclonus, autonomic lability, hypertensive crisis, agitation, tremor, restlessness, convulsions, diarrhea, hypomanic state, delirium, coma; death is possible. When taken simultaneously with drugs that have a high degree of binding to plasma proteins (oral anticoagulants, oral hypoglycemic agents, cardiac glycosides, etc.), possible mutual displacement from protein binding with a change in the concentration of the free fraction in the blood, risk of developing side effects increases. The risk of bleeding increases while taking warfarin. Inhibits the biotransformation of drugs metabolized with the participation of the isoenzyme CYP2D6 cytochrome P450 (tricyclic antidepressants, dextromethorphan, etc.). Extends half-life of diazepam, potentiates the effects of alprazolam. When taken simultaneously, it changes (increases or decreases) the concentration of lithium in the blood plasma, increases the content of phenytoin (up to clinical manifestations its overdose); the level of tricyclic antidepressants (imipramine, desipramine) increases 2-10 times. Tryptophan enhances the serotonergic properties of fluoxetine (agitation, motor restlessness, and gastrointestinal dysfunction are possible). Incompatible with ethanol.

Updating information

More information about drug interactions fluoxetine

The use of fluoxetine in combination with MAO inhibitors, as well as within 14 days after their discontinuation, is contraindicated to avoid the risk of interaction. Prescription of MAO inhibitors is possible only 5 weeks after discontinuation of fluoxetine.

[Updated 24.02.2012 ]

The simultaneous use of fluoxetine and pimozide is not recommended. Clinical researches safety studies of pimozide in combination with other antidepressants have shown that their simultaneous use may lead to a prolongation of the corrected QT interval (QTc). Although special studies While the safety of simultaneous use of pimozide and fluoxetine has not been studied, the potential for drug interactions, mainly prolongation of the QTc interval, is a sufficient basis for limiting the combined use of these drugs.

[Updated 24.02.2012 ]

A study was conducted with the participation of 19 healthy volunteers - 6 slow and 13 rapid metabolizers of the enzyme debrisoquine hydroxylase, who took 25 mg of thioridazine orally once. Cmax in slow metabolizers was 2.4 times higher, AUC - 4.5 times higher compared to fast metabolizers. It is known that the activity of debrisoquine hydroxylase depends on the level of activity of the isoenzyme of the cytochrome P450 system CYP2D6. Thus, this study demonstrated that drugs that inhibit the isoenzyme CYP2D6 drugs such as selective serotonin reuptake inhibitors, in particular fluoxetine, may increase plasma concentrations of thioridazine. Thioridazine has the ability to dose-dependently prolong QTc, which causes the risk of developing life-threatening forms of ventricular arrhythmias, such as torsades de pointes, and sudden death, the likelihood of which increases when taking thioridazine concomitantly with fluoxetine.

Taking into account the risk of developing life-threatening forms of ventricular arrhythmias and sudden death while taking thioridazine and fluoxetine, it should be noted that such a therapeutic combination is contraindicated, and thioridazine can be taken after 5 weeks from the last dose of fluoxetine.

[Updated 24.02.2012 ]

Fluoxetine inhibits the activity of the isoenzyme of the cytochrome P450 system CYP2D6 and thus alters the normal metabolic activity of the isoenzyme to a level similar to that of poor metabolizers. Other drugs whose metabolism is carried out with the participation of the isoenzyme CYP2D6, such as tricyclic antidepressants (TCAs), antipsychotics (including phenothiazines and most atypical antipsychotics), antiarrhythmics (propafenone, flecainide, etc.) should be used together with fluoxetine with caution. If the patient is taking fluoxetine or has taken it within the last 5 weeks, therapy with drugs primarily metabolized CYP2D6 and having a narrow therapeutic range (for example, flecainide, propafenone, vinblastine and TCAs), should begin with the lowest possible doses (dose selection should be the same as in the case of prescription of slow metabolizers for this isoenzyme of the cytochrome P450 system). When prescribing fluoxetine to a patient already receiving drugs metabolized by the isoenzyme CYP2D6, the need to adjust the dose of these drugs towards its reduction should be considered.

[Updated 24.02.2012 ]

In some patients, T1/2 of diazepam may be prolonged while taking fluoxetine. The combined use of alprazolam and fluoxetine was accompanied by an increase in serum concentrations of alprazolam, leading to depression of psychomotor activity.

[Updated 24.02.2012 ]

Some clinical data suggest a possible drug interaction between antipsychotics and selective serotonin reuptake inhibitors. In particular, increased concentrations of haloperidol and clozapine were observed in patients receiving fluoxetine as concomitant therapy.

[Updated 24.02.2012 ]

Both decreases and increases in serum lithium concentrations have been reported with concomitant use of fluoxetine. In the latter case, the likelihood of developing toxic effects of both mood stabilizers and selective serotonin reuptake inhibitors increases. When taking lithium and fluoxetine simultaneously, it is necessary to constantly monitor lithium concentrations in the blood plasma.

[Updated 24.02.2012 ]

Fluoxetine, when taken at a dose of 60 mg once or for 8 days, leads to a slight (about 16%) decrease in olanzapine clearance and an increase in Cmax.

In patients receiving fixed doses of phenytoin and carbamazepine, an increase in their plasma concentrations was observed with the development of clinical manifestations of toxic effects when fluoxetine was added as concomitant therapy.

[Updated 24.02.2012 ]

In the study in vivo It has been shown that a single administration of terfenadine (CYP3A4 substrate) during fluoxetine therapy is not accompanied by an increase in serum concentrations of terfenadine.

During research in vitro Data have been obtained indicating that ketoconazole, an effective inhibitor of the cytochrome P450 system isoenzyme CYP3A4, is at least 100 times more active than fluoxetine and norfluoxetine in preventing the metabolism of CYP3A4 substrates (such as astemizole, cisapride, midazolam). Thus, the inhibitory ability of fluoxetine in relation to the isoenzyme of the cytochrome P450 system CYP3A4 is not clinically significant.

[Updated 24.02.2012 ]

Overdose

Symptoms: nausea, vomiting, agitation, anxiety, hypomania, convulsions, large epileptic seizures. Two described fatalities from acute overdose of fluoxetine (in combination with maprotiline, codeine, temazepam).

Treatment: gastric lavage, taking activated charcoal, sorbitol, ECG monitoring, symptomatic and supportive therapy, for convulsions - diazepam. There is no specific antidote. Forced diuresis, peritoneal dialysis, hemodialysis, and blood transfusion are ineffective.

Routes of administration

Inside.

Precautions for the substance Fluoxetine

Prescribe with caution in the elderly, with cardiovascular diseases, liver and/or kidney failure. Careful monitoring of patients with suicidal tendencies is required, especially at the beginning of treatment. The risk of suicide is greatest in patients who have previously taken other antidepressants and in patients who experience excessive fatigue, hypersomnia, or restlessness during treatment with fluoxetine. When treating patients with low body weight, the anorexigenic properties of fluoxetine should be taken into account. When carrying out electroconvulsive therapy while taking fluoxetine, prolonged epileptic seizures are possible. The interval between stopping MAO inhibitors and starting to take fluoxetine should be more than 2 weeks, and between stopping fluoxetine and taking MAO inhibitors - at least 5 weeks.

But this connection is still visible. Some types of psychoneurotic disorders affect eating behavior person. These are neurotic bulimia and compulsive overeating. Some people cannot swallow even a piece of food when they are stressed or depressed, while others, on the contrary, eat everything they can get their hands on. If bouts of compulsive overeating accompany a stressful life, excess weight appears, which can develop into obesity. It is in such a situation that the inexpensive, but effective and well-proven drug “Fluoxetine” will come to the rescue.

The role of the drug in weight loss

The antidepressant Fluoxetine is a selective serotonin reuptake inhibitor. Medicinal substance slows down and prevents the physiological inactivation of the neurotransmitter, increasing its concentration in the synaptic connections of nerve fibers. The action develops predominantly in the central nervous system, and the characteristics selective inhibitor assigned to “Fluoxetine” due to its indifference to other neurotransmitters - dopamine and norepinephrine. Although they have a structure similar to serotonin, they are outside the zone of influence of the drug. This makes Fluoxetine safer and has fewer side effects than other antidepressants.

Indications for use of the drug include:

• depressive states of various origins;
• obsessive-compulsive disorders;
• premenstrual dysphoria;
• panic attacks and phobias;
• schizophrenia;
• neurosis in alcoholism;
• bulimia neurotic type.

The drug can be prescribed for prolonged depression, accompanied by regular overeating and stable weight gain. In some cases, Fluoxetine is prescribed to athletes recovering from injuries. This is due to the activation of energy release under the influence of serotonin, as well as improved mood and increased endurance of the patient.

An increase in serotonin concentration under the influence of an antidepressant helps stabilize the patient’s psycho-emotional state, improve sleep, and increase physical activity. The anorexigenic effect of the drug is concomitant. Doctors classify it as one of the side effects of the drug, which manifest themselves so clearly that in some cases, Fluoxetine is prescribed specifically to reduce appetite.

An additional advantage of the product is the activation of heat transfer under its action, which accelerates combustion subcutaneous fat and further stimulates the reset process excess weight. Also, with Fluoxetine, there is an improvement in the synthesis and discharge of bile, urine output, and increased intestinal motility.

Types and instructions for use of "Fluoxetine"

Fluoxetine hydrochloride is the active ingredient of drugs of the same name, as well as analogues. It is a fine crystalline powder of almost white, slightly soluble in water. To improve absorption, it can be produced in enteric-coated tablets or in capsulated form. Standard dosage active substance is 20 mg. There are 10 mg release forms (for ease of selection and dose adjustment). The list of fluoxetine hydrochloride drugs includes:

• "Fluoxetine Lannacher";
• "Fluoxetine Canon";
• "Prozac";
• "Profluzak";
• "Fluxen".

The use of Fluoxetine Lannacher and its analogues is always the same in composition. The minimum therapeutic dose is 20 mg. It is taken once a day, regardless of food intake. The maximum concentration in the blood, as well as the active onset of action of the drug, occurs in the sixth to seventh hour after internal administration. It is correct to take Fluoxetine in the first half of the day. Taking it at night can lead to insomnia and nightmares.

If efficiency minimum dose the drug is satisfactory, treatment continues without increasing the dosage. If efficiency is insufficient, it is gradually increased in increments of 10-20 mg. It is considered optimal to select the dose in a hospital setting under the close supervision of a doctor. The maximum daily dose for an adult is 80 mg, for older people - 60 mg.

If it is necessary to use an increased daily dose of the drug, it is divided into several doses (up to three per day). The last part should be drunk no later than a couple of hours before going to bed. Rules for fluoxetine therapy:

• regularity of taking the drug;
• strict adherence to specialist recommendations;
• reception outside the meal;
• smooth exit from therapy.

With the effectiveness of the product and rapid achievement required result The fluoxetine dosage regimen is established for a period of up to five weeks. For serious psychoneurotic disorders, the course of treatment can be extended to three months. Exit from therapy involves a gradual reduction to zero of the dose consumed over the course of last week treatment.

Rules for safe treatment

Before using Fluoxetine for weight loss, a woman must make sure that she is not pregnant. Taking the drug during pregnancy is strictly contraindicated due to an increased risk of fetal abnormalities, miscarriage and premature birth. The drug penetrates well into breast milk, so a combination of treatment with Fluoxetine and breastfeeding is impossible. The drug is not prescribed to children under 18 years of age, unless there are special indications.

Who shouldn't

Treatment with Fluoxetine, even if it is necessary to get rid of depression, is impossible if the patient has contraindications to the use of the drug. Their list includes the following states:

• anorexia;
• renal failure;
• liver failure;
• heart failure;
• status epilepticus;
• glaucoma;
• tendency to seizures;
• prostatitis;
• severe depression;
• suicidal mood;
• taking other antidepressants.

A special contraindication is suicidal thoughts. According to statistics collected in America, 3% of suicides occur due to the use of Fluoxetine and other antidepressants with similar effects.

What to Expect

Like all drugs that affect the functioning of the central nervous system, Fluoxetine can cause side effects. According to reviews of those losing weight, they appear singly or several at a time. They weaken as the drug is taken and the body adapts to it. Doctors explain such conditions by the body’s individual reaction to increased serotonin levels. Side effects appear as follows:

• feeling of heat and hot flashes, as if during menopause;
• increased sweating;
• febrile conditions;
• anorexia;
• loss of appetite;
• attacks of nausea;
• diarrhea;
• dry mouth, thirst;
• headache;
• night sleep disturbances;
• decreased libido;
• decrease in pressure;
• increased heart rate;
• panic attacks;
• blurred vision;
• joint pain;
• small hemorrhages on the skin;
• nosebleeds.

Side effects may also include allergic reactions delayed type, anaphylactic shock, shortness of breath. Fluoxetine is not a drug, but it can be addictive and even dependent. That is why, when the desired result is achieved, the drug is stopped as soon as possible, and the selection of the minimum effective dose should be done exclusively by a specialist.

Dangerous combinations

To prevent the occurrence of unpleasant consequences of taking Fluoxetine, the doctor must be fully aware of the patient’s lifestyle and habits. Individual medications also play a role in determining whether antidepressant treatment is appropriate.

For example, the popular natural antidepressant St. John's wort activates the development of side effects of the drug. Simultaneous use with the anticoagulant Warfarin increases the risk of internal bleeding. The use of fluoxetine increases toxicity anticonvulsants. And its combination with MAO inhibitors increases the risk of developing acute life-threatening states.

Hypoglycemic drugs can enhance their effect under the influence of Fluoxetine, which is very important to control for diabetics. Concomitant use with tryptophan increases the likelihood of developing serotonin syndrome. Its symptoms:

• tachycardia;
• hyperthermia;
• tremor;
• hypertension.

The poor compatibility of Fluoxetine tablets with alcohol puts a veto on alcoholic beverages for the entire period of treatment with the drug. This “duet” increases the load on the liver, kidneys and heart. In addition, apathetic states and suicidal tendencies often accompany the simultaneous use of alcohol and medication. Taking the drug while intoxicated significantly increases the possibility of uncontrolled use of pills and overdose, which manifests itself:

• manic attacks;
• nausea and vomiting;
• heart rhythm disturbances;
• breathing problems;
• state of overexcitation;
• muscle cramps.

If the listed symptoms are present, it is necessary to provide first aid: induce vomiting in the patient, give him an adsorbent. After this, it is important to take the patient to the hospital for symptomatic therapy and monitoring vital signs.

What's the result?

The supposed positive effects of taking Fluoxetine for weight loss are:

• weight loss due to decreased appetite;
• acquiring new eating habits;
• reducing food portions;
• stabilization of the nervous system;
• eliminating bouts of compulsive overeating;
• getting rid of various psycho-emotional disorders and phobias.

It is impossible to buy the product and select an adequate dosage without a doctor’s prescription. Remember that taking incorrect doses is associated with an increase in the amount negative effects medicinal substance.

Doctors say that losing weight on Fluoxetine often ends in failure due to an incorrect treatment regimen or lack of adequate indications for the use of the drug. Customer reviews of Fluoxetine tablets for weight loss are different. Some people managed to get rid of the tendency to overeat, and some did not lose weight at all, and also noticed apathy, drowsiness, and anxiety. In any case, a serious antidepressant is an effective adjuvant only if its use is supervised by an experienced specialist.

Reviews: “I don’t feel like eating, but at the same time I don’t want anything at all”

I took fluoxetine as an anorexigenic drug. I took 4 tablets a day for a week. not for treatment, but for weight loss. I lost weight, but my mood was not elevated. I’ve been sitting in depression for three years now. aminotreptilline is a great treatment for apathy and depression. But in general, amino and Prozac (namely American Prozac) are dangerous things. Have you heard about withdrawal syndrome? It was he who forced me to make 2 suicide attempts, one after the other. Here's an antidepressant for you)))) by the way, aminotrep. Unlike Prozac, you can’t just buy it. I was treated with amine for anorexia. I walked around there all the time as if I was high, laughing for no reason))) and when I stopped taking it... I felt bad, I was poisoned.

Charlie, http://www.woman.ru/relations/medley4/thread/3998884/

My wife and I took fluoxetine. Three or four attempts, about two months each. In the very first days, my health improved noticeably (placebo effect?). Then fierce irritation, embitterment, even rage grew. They endured it as best they could, expecting that adaptation to the drug would occur, the side effects would disappear and a therapeutic effect would appear. It never came. We're not trying anymore.

Vitaly, http://psy-ru.org/viewtopic.php?f=28&t=30

Author, I took fluoxetine for a long time. If you have questions, ask. I'll tell you about myself. Yes, I lost weight with it. The appetite really disappears, sometimes it’s sickening to look at food in the literal sense of the word. The effect occurs after approximately 5-7 days of administration at a rate of 60 mg per day (3 capsules). Side effects include constant dry mouth, decreased vision (after discontinuation, vision returns to normal), dilated pupils and bulging eyes, tremor of the hands and head. The heads - especially, they just shake on their own. And one of the most unpleasant things is that sexual desire disappears and it is often impossible to achieve orgasm. On the plus side, your mood improves and your appetite disappears.

Instructions for use:

Fluoxetine is a drug belonging to the group of antidepressants.

Pharmacological action of Fluoxetine

Fluoxetine is a propylamine derivative. The mechanism of its action is due to the selective (selective) ability to suppress the reuptake of serotonin in the central nervous system. At the same time, the drug has a minimal effect on the metabolism of dopamine, acetylcholine and norepinephrine.

The instructions for Fluoxetine indicate that it is medicine reduces feelings of tension and fear, relieves anxiety, improves mood. Fluoxetine does not cause orthostatic hypotension, does not have negative influence to the myocardium.

According to reviews, fluoxetine should be taken for at least one to two weeks to achieve the full therapeutic effect.

Fluoxetine is well absorbed from gastrointestinal tract. Food intake has no noticeable effect on its bioavailability.

Indications for use of Fluoxetine

The drug is taken in the following cases:

• Treatment of depressive conditions of varying severity;
• Obsessive states;
• Appetite disorders (anorexia, bulimia);
• Complex therapy of alcoholism.

How to use Fluoxetine

For the treatment of depressive conditions, the drug is usually prescribed 1 tablet (20 mg) once a day, preferably in the morning. If the effectiveness is insufficient, the dose can be increased to two tablets (40 mg) per day. Maximum permissible daily dose is 4 tablets (80 mg), and for elderly patients - 3 tablets (60 mg).

According to the instructions, Fluoxetine for the treatment of bulimia is prescribed one tablet three times a day.

For the treatment of obsessive states, 1 to 3 tablets (20-60 mg) per day are prescribed.

The duration of treatment depends on the severity of the disease and the effectiveness of the therapy. The minimum duration of the course is at least 3 weeks, and the maximum is several years.

Side effects

Therapy with this drug may cause side effects:

• From the nervous system – headache, asthenia, dizziness, weakness, increased excitability, mania, anxiety, increased risk of suicide;
• From the digestive tract - loss of appetite, dyspepsia, dry mouth or, conversely, increased salivation (salivation);
• On the part of other organs - decreased libido, increased sweating, weight loss, allergic reactions.

When using Fluoxetine, side effects from the therapy often require its discontinuation.

Contraindications

According to the instructions, Fluoxetine is contraindicated in the following cases:

• Individual intolerance to the drug;
• Atony of the bladder;
• Angle-closure glaucoma;
• Severe liver or kidney failure;
• Treatment with MAO inhibitors;
• Pregnancy and lactation;
• Increased tendency to commit suicide;
• Prostate hypertrophy.

The use of Fluoxetine in patients suffering from Parkinson's syndrome, epilepsy, diabetes mellitus or severe malnutrition requires special caution.

Interaction of Fluoxetine with other drugs

This medicine enhances the effects of alcohol, Diazempam and medications that lower blood glucose levels.

Fluoxetine, when taken simultaneously with tricyclic antidepressants, increases the concentration of the latter in the blood plasma by almost two times.

According to reviews, Fluoxetine should not be prescribed to patients undergoing electroconvulsive therapy, because in this case, the severity of epileptic seizures is possible.

Overdose

If a large dose of Fluoxetine is accidentally or intentionally taken, the patient requires urgent assistance. medical care. There is no specific antidote, so symptomatic treatment is carried out. To speed up the removal of the drug from the body, gastric lavage is performed and sorbents are given orally.

Release form

Fluoxetine is available in capsules containing 20 mg of active substance.

Storage conditions

The drug is dispensed from pharmacies only with a doctor's prescription. Store at room temperature out of the reach of children. Shelf life – three years. Fluoxetine should not be used after the expiration date stated on the box.

Fluoxetine is a popular antidepressant with a stimulating effect that reduces tension, improves mood, removes anxiety and fear, and eliminates dysphoria. Its undoubted advantages include the fact that it does not cause a sedative effect, orthostatic hypotension, does not harm the functioning of the heart and blood vessels. While taking this remedy, appetite is significantly reduced, which has made it popular among those losing weight. Perhaps this is why the medicine has maintained its leading position in the market for a long time.

Fluoxetine: indications for use

If we consider official testimony for use, you will not find the line “for weight loss” in them. All testimony is of a purely mental nature. The list includes the following items:

• depression of any severity;
• uncontrollable feeling of fear;
• depression against the background of any other mental disorders;
• bulimia nervosa;
• obsessive states;
• headache.

It is known that the use of fluoxetine for obesity will not only not give the desired result, but can also be harmful to health. The fact is that with obesity, all internal organs bear an excessive load, and this drug increases it even more. As a result, the most various diseases internal organs or vessels.

Fluoxetine: contraindications

Like any medicine, fluoxetine has a whole list of contraindications for which it is prohibited to take it:

• hypersensitivity to the components of the drug;
• severe liver failure;
• chronic renal failure;
• suicidal ideation;
• any manic states;
• pregnancy;
• lactation period.

In addition, taking fluoxetine during diabetes mellitus, epileptic syndrome and epilepsy, cachexia, compensated renal and liver failure. For these diseases, the drug is used with caution, under the strict supervision of a doctor.

Fluoxetine: tablet dosage

For depression, fluoxetine should be taken only in the morning, 20 mg per day. If necessary, increase the dose once a week by 20 mg per day. The maximum possible dose is 80 mg, and it must be divided into 2-3 doses. In any case, the course should last 3-4 weeks.

Fluoxetine: overdose

In case of overdose, nausea, vomiting, convulsions and agitation occur. Treatment is based on symptoms, but gastric lavage and activated charcoal are always necessary.

Fluoxetine: side effects

There is a possibility of a number of side effects, in which case it is possible to discontinue the medication and replace it with another.

The list is quite long:

A deadly side effect, neuroleptic malignant syndrome, is also possible. However, it occurs most often when taking antipsychotics. That is why, if you are taking fluoxetine for depression or for any other purpose, it is important not to do it uncontrollably, but to consult a doctor.

Fluoxetine belongs to the group of antidepressants. It is produced by a Russian pharmaceutical company, unlike its foreign analogue- Prozac. The latter is the brainchild of a British pharmaceutical industrial corporation. That’s why it costs an order of magnitude more, but its effectiveness is comparable to the domestic drug.

How does Fluoxetine work?

Fluoxetine (Prozac) blocks the flow of serotonin back into neuronal synapses (junctions nerve cells together). As a result, the content of this mediator (a substance involved in the transmission of nerve impulses) in connecting elements increases significantly, so over a long period of time it manages to influence postsynaptic areas, causing characteristic changes. This shows up:

• Stimulating effect on the nervous system
• Improved mood
• Activation of mental processes
• Suppressing anxiety and worry
• Decreased appetite, ultimately leading to weight loss.

In addition to inhibiting serotonin uptake in nervous tissue, Fluoxetine has a similar effect on platelets, reducing their aggregation (gluing) ability. This positive effect helps prevent thrombosis in patients at risk. But this property is not used as the main therapeutic effect; it is a “pleasant” addition to antipsychotic effects.

An important advantage of this antidepressant is the lack of sedation. Therefore, Fluoxetine (Prozac) can be used by persons engaged in precise work that requires care:

• Drivers
• Jewelers
• Aviation industry, etc.

Consequences of Fluoxetine - existing risks of taking

Taking the drug may cause side effects. They are polysystemic, i.e. can affect any system of the body. Clinically expressed by the following conditions:

• Manic stalking
• Suicidal tendencies
• Dizziness
• Shiver
• Convulsions
• Poor appetite
• Diarrhea
• Increased salivation
• Heart rhythm disturbance
• Urinary retention or incontinence
• Sexual dysfunction
• Allergic rashes.

Therefore, any discomfort and deviations in habitual behavior during treatment with Fluoxetine require consultation with a doctor. Such patients may need to adjust the dose of the antidepressant or replace it with another drug.

Allergic rashes are a common side effect of the drug fluoxetine.

Indications for use

Indications for taking Fluoxetine (Prozac) should only be determined by a doctor. Self-treatment These antidepressants are prohibited, because they have a number of contraindications and side effects. The need to use Fluoxetine and its substitutes exists when a person suffers from certain mental disorders, namely:

• Depression (regardless of its cause)
• Neurosis, manifested by a strong increase in appetite, leading to obesity
• Obsessive states with constant checking of what has been done.

Symptoms of fluoxetine overdose

Exceeding the dose of the drug recommended by the doctor and the frequency of its administration leads to the appearance of a number of symptoms indicating an overdose. In this case, immediate contact with a specialist is required, because the likelihood of death due to complications is high. The main signs indicating fluoxetine poisoning are:

• Mental excitement
• Increased motor activity that does not have any purpose
• Convulsions resembling epileptic seizures
• Arrhythmias of various types
• Cardiopalmus
• Nausea, the climax of which is repeated vomiting.

Nausea and vomiting are signs of fluoxetine overdose

Patients should know that they cannot exceed the recommended dose, much less prescribe the drug themselves, because There is no effective specific antidote. In case of overdose, it is possible to carry out only symptomatic therapy - this is the fight against clinical signs poisoning, and not eliminating its cause (binding of Fluoxetine molecules). Required components are:

• gastric lavage
• administration of enterosorbents ( Activated carbon, Enterosgel and others), anticonvulsants and antiarrhythmic drugs.

Scandal around Fluoxetine (Prozac)

Recently, the press discussed the possibility of prescribing fluoxetine in psychiatry. In Europe, a scandal erupted in connection with this, which resulted in a ban on treatment with this drug and withdrawal from the pharmacy chain. IN Russian Federation similar actions did not follow - he remained in the Register medicines approved for use in medicine.

To avoid negative consequences treatment with Fluoxetine, it should be used only on the advice of a doctor.

Therefore in modern conditions This antidepressant can be purchased in the pharmacy chain only with a prescription. But there is also the other side of the coin - online pharmacies prohibited by law. In them, the drug is sold illegally - over the counter. It should be remembered that if you purchase the drug without consulting a doctor, the risk of developing fluoxetine addiction is very high. It manifests itself with serious symptoms that a person cannot cope with on his own. An overdose can result in cardiac arrest and death.

Efficacy of the drug

Considering the existing risks of treatment with Fluoxetine, a number of studies have been conducted to evaluate the therapeutic effectiveness of this drug and the validity of its prescription. They showed that it exhibits good cupping ability anxiety states and depression. Therefore, fluoxetine is widely used in complex therapy many psychoneurological disorders. However, there are also conflicting data indicating high danger means and low effectiveness, comparable to placebo (dummy). Therefore, the drug should be taken seriously and not taken without a doctor’s recommendation.