Fluoxetine is a strong antidepressant intended for drug therapy for obsessive and depressive conditions, which are accompanied by the presence of fears.
Systematic use of this drug helps patients overcome apathy, improve mood, normalize appetite and sleep, and reduce feelings of fear and tension.
First acquaintance with the medicine
The active ingredient of the drug is fluoxetine hydrochloride.
The pharmacological property is based on its ability to inhibit the reuptake of serotonin into the central nervous system, the main neurotransmitter called the hormone of pleasure (or happiness).
It is he who is responsible for a good mood, the absence of tearfulness, pickiness, and boredom. The therapeutic effect of the drug improves the patient’s psycho-emotional activity and does not affect blood pressure, functional activity of the heart, and does not cause drowsiness or lethargy.
The drug is prescribed for:
- obsessive states;
- various depressions;
- premenstrual dysphoria;
- alcoholism.
Pros and cons of the drug
The main advantages of the drug are:
- lack of hypnotic effect and cardiotoxic effect;
- availability in the pharmacy network;
- democratic price.
The disadvantages of the drug include the following side effects:
- allergic reaction to the main component of the drug;
- pregnancy;
- breastfeeding a baby;
- pathological processes in the liver and kidneys;
- diabetes mellitus;
- epileptic conditions.
This predominance of “cons” over “pros” is a consequence of the fact that this drug is already outdated. Today, the pharmacological industry provides patients with modern analogs of Fluoxetine, which have the ability to selectively affect the human body.
Why are people looking for fluoxetine analogs?
Price issue
Fluoxetine is not the cheapest drug (its price is about 300 rubles) and in order to save money you have to look for more affordable analogues.
Among them are Framex and Flunat - these are more affordable medications that cost from 100 to 150 rubles, and their low price is due to their less famous name.
By-effect
A high-quality and proven drug, but it has certain disadvantages, or rather a number of side effects:
- bowel dysfunction;
- infrequent headaches that appear an hour after administration;
- increased heart rate, which can lead to tachycardia;
- overdrying of the mucous membrane;
- blurred vision;
- increased sweat secretions;
- general malaise;
- Women who took the drug experienced pain in the mammary glands and menstrual irregularities (up to several weeks);
- nausea and vomiting;
- noise in ears;
- constant feeling of fatigue;
- sleep disorders;
- depression;
- acne and allergic irritations;
- broken bones;
- sexual apathy (loss of interest in sex).
The list of contraindications is quite long and that is why most people are looking for more harmless analogues. For example, it could be Flunat or Deprex. The drugs have a natural composition and a less aggressive effect on the patient’s body.
No choice
Of course, the last reason why people turn to analogues of this drug is simply its absence on the shelves in pharmacies, since Fluoxetine is a sought-after medication.
If this medicine is not available in the pharmacy, then you should turn your attention to Profluzac and Fluval, which are identical in their action and composition.
Analogues in terms of active substance, composition, action
The active substance fluoxetine hydrochloride has the following analogues:
- Apo-Fluoxetine;
- Bioxetine;
- Deprex;
- Deprenon;
- Flunate;
- Fluval;
- Fluoxetine-Canon;
- Fluoxetine-Nycomed.
Similar medications in composition and effect on the body: 
- Portal, composition: fluoxetine and vitamin supplements;
- Prodep, composition: fluoxetine and calcium;
- Prozac, composition: fluoxetine and sedatives.
Unlike Fluoxetine, almost all similar drugs contain fewer impurities, which means they are more harmless.
TOP - 15 best analogues
Popular analogues:
A question of price and free access
Cheap analogues of the antidepressant Fluoxetine: 
- Floxet – 150 rubles;
- Profluzak – 75 rubles.
Over-the-counter analogues of Fluoxetine:
- Portal;
- Bioxetine.
Domestic analogues:
- Portal;
Release form
Hard gelatin capsules, No. 4, with a white body and a blue cap; the contents of the capsules are white or almost white granules.
Compound
fluoxetine hydrochloride 11.2 mg, which corresponds to the content of fluoxetine 10 mg
Excipients: lactose monohydrate (milk sugar) - 30.8 mg, microcrystalline cellulose - 16.1 mg, colloidal silicon dioxide (aerosil) - 150 mcg, magnesium stearate - 600 mcg, talc - 1.15 mg.
Composition of the capsule shell: gelatin - 36.44 mg, titanium dioxide - 1.52 mg, indigo carmine - 40 mcg.
Package
10 pieces. - contour cell packaging (2) - cardboard packs.
pharmachologic effect
An antidepressant from the group of selective serotonin reuptake inhibitors. It has a thymoanaleptic and stimulating effect.
Selectively blocks the reverse neuronal uptake of serotonin (5HT) at the synapses of neurons in the central nervous system. Inhibition of serotonin reuptake leads to an increase in the concentration of this neurotransmitter in the synaptic cleft, enhancing and prolonging its effect on postsynaptic receptor sites. By increasing serotonergic transmission, fluoxetine inhibits neurotransmitter metabolism through the negative membrane binding mechanism. With long-term use, fluoxetine inhibits the activity of 5-HT1 receptors. 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. It has an anorexigenic effect and can cause weight loss. Does not cause orthostatic hypotension, sedation, and is noncardiotoxic. A lasting clinical effect occurs after 1-2 weeks of treatment.
Pharmacokinetics
When taken orally, the drug is well absorbed from the gastrointestinal tract (up to 95% of the dose taken); administration with food slightly inhibits the absorption of fluoxetine. Cmax in blood plasma is reached after 6-8 hours. The bioavailability of fluoxetine after oral administration is more than 60%. The drug accumulates well in tissues, easily penetrates the blood-brain barrier, binding to blood plasma proteins is more than 90%. Metabolized in the liver by demethylation to the active metabolite norfluoxetine and a number of unidentified metabolites. It is excreted by the kidneys in the form of metabolites (80%) and the intestines (15%), mainly in the form of glucuronides. T1/2 of fluoxetine after reaching equilibrium concentration in the blood plasma is about 4-6 days. T1/2 of the active metabolite of norfluoxetine with a single dose and after reaching equilibrium concentration in the blood plasma ranges from 4 to 16 days. In patients with liver failure, the half-life of fluoxetine and norfluoxetine is prolonged.
Fluoxetine, indications for use
- depression of various origins;
- obsessive-compulsive disorders;
- bulimic neurosis.
Contraindications
- simultaneous use with MAO inhibitors (and within 14 days after their withdrawal);
- simultaneous use of thioridazine (and for 5 weeks after discontinuation of fluoxetine), pimozide;
- pregnancy;
- period of breastfeeding;
- severe renal dysfunction (creatinine clearance less than 10 ml/min);
- liver failure;
- lactase deficiency, lactose intolerance, glucose-galactose malabsorption;
- age up to 18 years;
- increased sensitivity to the drug.
Carefully
Suicidal risk: with depression, there is a possibility of suicide attempts, which may persist until stable remission occurs. Isolated cases of suicidal thoughts and suicidal behavior have been described during therapy or shortly after its completion, similar to the effects of other drugs with similar pharmacological action (antidepressants). Careful monitoring of patients at risk is necessary. Clinicians should encourage patients to promptly report any distressing thoughts or feelings.
Epileptic seizures: Floxetine should be prescribed with caution to patients who have had epileptic seizures.
Hyponatremia: Cases of hyponatremia have been reported. Mostly, such cases were observed in elderly patients and in patients taking diuretics, due to a decrease in circulating blood volume.
Diabetes mellitus: glycemic control in diabetic patients during treatment with fluoxetine showed hypoglycemia; after discontinuation of the drug, hyperglycemia developed. Doses of insulin and/or oral hypoglycemic agents may need to be adjusted at the start or after treatment with fluoxetine.
Renal/liver failure: Fluoxetine is metabolized by the liver and excreted by the kidneys and gastrointestinal tract. In patients with severe liver dysfunction, it is recommended to prescribe lower doses of fluoxetine, or prescribe the drug every other day. When taking fluoxetine at a dose of 20 mg/day for two months, there were no differences in the concentrations of fluoxetine and norfluoxetine in the blood plasma of healthy individuals with normal renal function and patients with severely impaired renal function (creatinine clearance 10 ml/min) requiring hemodialysis.
Directions for use and doses
The drug is taken orally, at any time, regardless of meals.
Depressive state
The initial dose is 20 mg 1 time / day in the first half of the day, regardless of meals. If necessary, the dose can be increased to 40-60 mg/day, divided into 2-3 doses (by 20 mg/day weekly). The maximum daily dose is 80 mg in 2-3 doses.
The clinical effect develops 1-2 weeks after the start of treatment; in some patients it may be achieved later.
Obsessive-compulsive disorders
The recommended dose is 20-60 mg/day.
Bulimic neurosis
The drug is used in a daily dose of 60 mg, divided into 2-3 doses.
Use of the drug in patients of different ages
There are no data on changes in doses depending on age. Treatment of elderly patients should begin with a dose of 20 mg/day.
Accompanying illnesses
It is recommended to prescribe fluoxetine to patients with impaired liver or kidney function using low doses and lengthening the interval between doses.
Use during pregnancy and breastfeeding
Contraindicated during pregnancy and lactation.
Side effects
When using fluoxetine, as in cases of using drugs from the group of selective serotonin reuptake inhibitors, the following adverse events are noted.
From the cardiovascular system: often (≥ 1% - ≤10%) - atrial flutter, hot flashes; uncommon (≥ 0.1% - ≤1%) - hypotension; rarely (≤ 0.1%) - vasculitis, vasolidation.
From the digestive system: very often (≥ 10%) - diarrhea, nausea; often (≥ 1% - ≤10%) - dry mouth, dyspepsia, vomiting; infrequently (≥ 0.1% - ≤1%) - dysphagia, taste perversion; rarely (≤ 0.1%) - pain along the esophagus.
From the hepatobiliary system: rarely (≤ 0.1%) - idiosyncratic hepatitis.
From the immune system: very rarely (≤ 0.1%) - anaphylactic reactions, serum sickness.
Metabolic and nutritional disorders: often (≥ 1% - ≤10%) - anorexia (including weight loss) of the body.
From the musculoskeletal system: infrequently (≥ 0.1% - ≤1%) - muscle twitching.
From the central nervous system: very often (≥ 10%) - headache; often (≥ 1% - ≤10%) - impaired attention, dizziness, lethargy, drowsiness (including hypersomnolence, sedation), tremor; infrequently (≥ 0.1% - ≤1%) - psychomotor agitation, hyperactivity, ataxia, incoordination, bruxism, dyskinesia, myoclonus; rarely (≤ 0.1%) - bucco-glossal syndrome, seizures, serotonin syndrome.
Mental disorders: very often (≥ 10%) - insomnia (including early morning awakening, initial and moderate insomnia); often (≥ 1% - ≤ 10%) - unusual dreams (including nightmares), nervousness, tension, decreased libido (including lack of libido), euphoria, sleep disorder; infrequently (≥ 0.1% - ≤1%) - depersonalization, hyperthymia, impaired orgasm (including anorgasmia), thinking disorders; rarely (≤ 0.1%) - manic disorders.
From the skin: often (≥ 1% - ≤10%) - hyperhidrosis, itching, polymorphic skin rash, urticaria; uncommon (≥ 0.1% - ≤1%) - ecchymosis, tendency to bruise, alopecia, cold sweat; rarely (≤ 0.1%) - angioedema, photosensitivity reactions.
From the senses: often (≥ 1% - ≤10%) - blurred vision; uncommon (≥ 0.1% - ≤1%) - mydriasis.
From the genitourinary system: often (≥ 1% - ≤10%) - frequent urination (including pollakiuria), ejaculation disorders (including lack of ejaculation, dysfunctional ejaculation, early ejaculation, delayed ejaculation, retrograde ejaculation), erectile dysfunction, gynecological bleeding (including bleeding from the cervix, dysfunctional uterine bleeding, bleeding from the genital tract, menometrorrhagia, menorrhagia, metrorrhagia, polymenorrhea, postmenopausal bleeding, uterine bleeding, vaginal bleeding); uncommon (≥ 0.1% - ≤1%) - dysuria; rarely (≤ 0.1%) - sexual dysfunction, priapism.
Post-marketing messages
On the part of the endocrine system, cases of antidiuretic hormone deficiency have been reported.
These side effects more often occur at the beginning of fluoxetine therapy or when the dose of the drug is increased.
special instructions
Careful monitoring of patients with suicidal tendencies is required, especially at the beginning of treatment. The risk of suicide is highest in patients who have previously taken other antidepressants and in patients who experience excessive fatigue, hypersomnia, or restlessness during treatment with fluoxetine. Until significant improvement in treatment occurs, such patients should be under medical supervision.
In children, adolescents and young adults (under 24 years of age) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and suicidal behavior. Therefore, when prescribing fluoxetine or any other antidepressants in children, adolescents and young adults (under 24 years of age), the risk of suicide should be weighed against the benefits of their use. In short-term studies, the risk of suicide did not increase in people over 24 years of age, but it decreased slightly in people over 65 years of age. Any depressive disorder itself increases the risk of suicide. Therefore, during treatment with antidepressants, all patients should be monitored for early detection of disturbances or changes in behavior, as well as suicidality.
During electroconvulsive therapy, prolonged epileptic seizures may develop.
The interval between the end of therapy with MAO inhibitors and the start of treatment with fluoxetine should be at least 14 days; between the end of treatment with fluoxetine and the start of therapy with MAO inhibitors - at least 5 weeks.
After discontinuation of the drug, its therapeutic concentration in the blood serum may remain for several weeks.
In patients with diabetes mellitus, hypoglycemia may develop during fluoxetine therapy and hyperglycemia after its discontinuation. Doses of insulin and/or oral hypoglycemic agents may need to be adjusted at the start or after treatment with fluoxetine.
When treating patients with underweight, anorexigenic effects should be taken into account (progressive weight loss is possible).
While taking fluoxetine, you should refrain from drinking alcohol, because. the drug enhances the effect of alcohol.
Impact on the ability to drive vehicles and operate machinery
Taking fluoxetine may negatively affect the performance of work that requires a high speed of mental and physical reactions.
Drug interactions
Fluoxetine and its main metabolite, norfluoxetine, have long half-lives, which must be taken into account when combining fluoxetine with other drugs, as well as when replacing it with another antidepressant.
The drug should not be used simultaneously with MAO inhibitors, incl. antidepressants - MAO inhibitors; furazolidone, procarbazine, selegiline, as well as tryptophan (a precursor of serotonin), since the development of serotonergic syndrome is possible, manifested in confusion, hypomanic state, psychomotor agitation, convulsions, dysarthria, hypertensive crises, chills, tremor, nausea, vomiting, diarrhea.
After using MAO inhibitors, fluoxetine should be prescribed no earlier than 14 days. MAO inhibitors should not be used earlier than 5 weeks after stopping fluoxetine.
Concomitant use of drugs metabolized by the CYP2D6 isoenzyme (carbamazepine, diazepam, propafenone) with fluoxetine should be carried out using minimal therapeutic doses. Fluoxetine blocks the metabolism of the tricyclic and tetracyclic anti-depressive drugs trazodone, metoprolol, terfenadine, which leads to an increase in their concentration in the blood serum, enhancing their effect and increasing the frequency of complications.
In patients stable on maintenance doses of phenytoin, plasma phenytoin concentrations increased significantly and symptoms of phenytoin toxicity (nystagmus, diplopia, ataxia, and CNS depression) appeared after initiation of concomitant treatment with fluoxetine.
The combined use of fluoxetine and lithium salts requires careful monitoring of the concentration of lithium in the blood, because it is possible to increase it.
Fluoxetine enhances the effect of hypoglycemic drugs.
When used simultaneously with drugs that are highly protein bound, especially with anticoagulants and digitoxin, plasma concentrations of free (unbound) drugs may increase and the risk of adverse effects may increase.
Overdose
Symptoms: psychomotor agitation, seizures, drowsiness, heart rhythm disturbances, tachycardia, nausea, vomiting.
Other serious symptoms of fluoxetine overdose (both when fluoxetine was taken alone and when taken concomitantly with other drugs) included coma, delirium, QT prolongation and ventricular tachyarrhythmia, including atrial fibrillation and cardiac arrest, decreased blood pressure, syncope, mania, pyrexia, stupor and neuroleptic malignant syndrome-like state
Treatment: specific antagonists to fluoxetine have not been found. Symptomatic therapy is carried out, gastric lavage with the administration of activated charcoal, for convulsions - diazepam, maintenance of breathing, cardiac activity, body temperature.
Storage conditions
In a dry place, protected from light, at a temperature not exceeding 25°C. Keep out of the reach of children.
Best before date
3 years.
Yellow film-coated tablets in blisters of 10 pieces, 1 or 2 blisters per package.
pharmachologic effect
The drug has an anorexigenic effect, eliminates depression and relieves feelings of depression.
Pharmacodynamics and pharmacokinetics
The substance fluoxetine - what is it?
The active substance of the drug fluoxetine hydrochloride is a white (or almost white) crystalline powder, sparingly soluble in water.
What is Fluoxetine?
Fluoxetine is a selective serotonin reuptake inhibitor (SNRS). The drug belongs to the pharmacotherapeutic group “Antidepressants”.
Pharmacodynamics
The medicine is intended for oral administration. The mechanism of its action is associated with the ability to selectively (selectively) and reversibly inhibit ONZS.
The antidepressant Fluoxetine has little effect on the uptake of dopamine and norepinephrine and has a weak effect on acetylcholine receptors and H1-type histamine receptors.
Along with antidepressant, it also has a stimulating effect. After taking the tablets/capsules, the patient’s feelings of fear, anxiety and mental tension decrease, mood improves, and symptoms of dysphoria are eliminated.
Wikipedia notes that the drug does not cause orthostatic hypotension, does not have a sedative effect, and is not cardiotoxic.
It takes 3 to 4 weeks to achieve a lasting clinical effect with regular use of the drug.
Pharmacokinetic parameters:
- absorption in the digestive canal is good;
- bioavailability - 60% (orally);
- TSmax - from 6 to 8 hours;
- binding to plasma proteins (including alpha (α)-1-glycoprotein and albumin) - 94.5%;
- T½hour.
The liver is involved in the metabolism of the substance. As a result of its biotransformation, a number of unidentified metabolites are formed, as well as norfluoxetine, the selectivity and activity of which are equivalent to those of fluoxetine.
Pharmacologically inactive metabolic products are eliminated by the kidneys.
Due to the fact that the substance is excreted from the body rather slowly, the plasma concentration necessary to maintain the therapeutic effect is maintained for several weeks.
Indications for use: why are tablets and Fluoxetine prescribed?
Indications for use of Fluoxetine:
- depression (especially accompanied by fears), including when other antidepressants are ineffective;
- obsessive-compulsive disorder (OCD);
- kinorexia (to reduce uncontrollable cravings for food, the drug is used as part of complex psychotherapy).
Contraindications
The drug is not prescribed for:
* After using MAO inhibitors, Fluoxetine can be used no earlier than 14 days later; MAO inhibitors after completion of treatment with Fluoxetine are prescribed no earlier than 5 weeks later.
Side effects of Fluoxetine
General disorders that occur during the use of the drug can manifest themselves in the form of hyperhidrosis, chills, fever or sensation of cold, photosensitivity, neuroleptic syndrome, alopecia, lymphadenopathy, anorexia, erythema multiforme, which can progress to malignant exudative or develop into Lyell's syndrome.
Some patients experience symptoms of serotonin toxicity, including:
From the digestive system of organs, the following are possible: diarrhea, nausea, loss of appetite, vomiting, dysphagia, dyspepsia, change in taste, pain in the esophagus, dry mouth, dyskinesia, liver dysfunction. In isolated cases, idiosyncratic hepatitis may develop.
CNS reactions to taking pills manifest themselves in the form of: bruxism, headache, weakness, sleep disturbances (night delirium, pathological dreams, insomnia), dizziness, fatigue (hypersomnia, drowsiness); disturbances of attention, processes and concentration of thinking, memory; anxiety and associated psychovegetative syndrome, dysphemia, panic attacks, suicidal thoughts and/or attempts to take one’s own life.
The possibility of developing:
Discontinuation of drug treatment may provoke withdrawal syndrome, the main symptoms of which are: sensitivity disorders, dizziness, sleep disorders, asthenia, nausea and/or vomiting, agitation, headache, tremor.
Reviews of side effects indicate that the drug is addictive when taken uncontrolled. In some cases, the addiction is so strong that a person requires professional help to treat it.
Other adverse reactions that patients mention in reviews are severe drowsiness, tremors, convulsions, loss of appetite, and nausea. However, there are people who did not experience any unwanted effects at all during treatment.
Instructions for use of Fluoxetine
The tablets are taken orally. Eating does not affect the absorption of the drug.
To relieve depressive symptoms, the medicine should be taken once a day, in the morning, at a dose of 20 mg. If clinically necessary, 3-4 weeks after the start of therapy, the frequency of doses is increased to 2 times per day. (tablets are taken morning and evening).
For patients with an insufficient response to treatment at a dosage of 20 mg/day, in some cases the daily dose is gradually increased. In this case, it should be divided into 3-4 doses. The highest dose for elderly and senile people is 60 mg/day.
Dosage for bulimic neurosis - 60 mg/day. (take one tablet 3 times a day), for OCD - depending on the severity of clinical symptoms - from 20 to 60 mg/day.
It must be taken into account that increasing the dose may increase the severity of side effects.
Maintenance dose - 20 mg/day.
When does the drug start working?
A significant improvement in the condition is usually observed after about 2 weeks of systematic use of the medicine.
How long should I take Fluoxetine?
It takes six months to eliminate depressive symptoms.
For obsessive manic disorders (OMD), the drug is given to the patient for 10 weeks. Further recommendations depend on the results of treatment. If there is no clinical effect, the fluoxetine treatment regimen is reviewed.
If there are positive dynamics, therapy is continued using an individually selected minimum maintenance dose. The patient's need for further treatment should be reassessed periodically.
Long-term - more than 24 weeks in patients with NMR and more than 3 months in patients with bulimia nervosa - has not been studied.
After completion of treatment with Fluoxetine, the active substance circulates in the body for another 2 weeks, which should be taken into account when stopping treatment or prescribing other medications.
Patients with liver/renal insufficiency, elderly people with concomitant diseases, and patients taking other medications are prescribed half the dose of the drug. In some cases, it is advisable to transfer the patient to intermittent treatment.
If, after reducing the dose/discontinuing the drug, the patient's condition worsens, it is necessary to return to treatment with the previous effective therapeutic dose. A gradual dose reduction is resumed after positive dynamics appear.
If we compare Fluoxetine and Fluoxetine Lannacher or Fluoxetine and Fluoxetine OZONE, we can conclude that the instructions for use of Fluoxetine Lannacher and Fluoxetine OZONE contain recommendations similar to those listed above.
Overdose
An overdose of Fluoxetine is accompanied by: nausea/vomiting, convulsions, hypomania, anxiety, agitation, grand mal seizures.
A victim of an overdose should rinse the stomach, give sorbitol, enterosorbent and, for convulsions, diazepam. Monitoring of respiratory activity and parameters characterizing the functional state of the heart is also important. Subsequently, symptomatic and supportive therapy is carried out.
Interaction
Doubles the plasma concentration of tricyclic antidepressants, phenytoin, trazodone, maprotiline. When prescribing Fluoxetine in combination with tricyclic antidepressants, the dose of the latter should be reduced by 50%.
It may provoke an increase in the plasma concentration of Li+, which in turn increases the likelihood of developing its toxic effects. In case of simultaneous use, it is recommended to monitor the concentration of Li+ in the blood.
Use as an adjunct to electroconvulsive therapy may cause the development of prolonged epileptic seizures.
The serotonergic effects of the drug are enhanced in combination with tryptophan. The likelihood of developing serotonin intoxication increases if taken simultaneously with drugs that inhibit the MAO enzyme.
The likelihood of adverse reactions and increased depressant effects on the central nervous system increases in combination with drugs that depress the central nervous system.
Taking with drugs that are characterized by a high degree of protein binding may provoke an increase in the plasma concentration of unbound (free) drugs, as well as an increase in the likelihood of developing undesirable effects.
Terms of sale: how is Fluoxetine dispensed - with a prescription or not?
Fluoxetine cannot be purchased without a prescription.
Storage conditions
Tablets should be stored at temperatures below 25°C.
Best before date
special instructions
When treating patients with low body weight, anorexigenic effects should be taken into account when prescribing the drug.
Diabetics may develop hypoglycemia during treatment with Fluoxetine, and hyperglycemia after discontinuation of the drug. Taking this into account, it is recommended to make changes to the dosage regimen of insulin and/or oral hypoglycemic agents. Until the clinical picture improves, patients with diabetes mellitus should be under constant medical supervision.
During the treatment period, it is necessary to refrain from engaging in activities that require a high speed of psychomotor reactions and increased attention.
The tablets contain lactose, so they should not be taken if you have galactosemia, lactase deficiency, or glucose/galactose malabsorption syndrome.
Like other antidepressants, fluoxetine can cause mood disorders (mania or hypomania).
The central organ of drug metabolism is the liver; the kidneys are responsible for excreting metabolites. Patients with liver pathologies should be prescribed low or alternative daily doses.
In case of renal failure (with Clcr less than 10 ml/min.) after 2 months of treatment using a dose of 20 mg/day. plasma concentrations of fluoxetine/norfluoxetine are the same as in patients with healthy kidneys.
Depression is associated with an increased risk of suicidal ideation and suicide attempts. The risk remains until complete remission. Clinical experience with the drug shows that the risk of suicide increases, as a rule, in the early stages of recovery.
Patients with mental illness and depressive syndrome should be under constant supervision. In placebo-controlled studies in a group of patients receiving antidepressants, it was found that the risk of suicidal behavior is highest in people under 25 years of age.
Patients who have been switched to a lower/higher dose also require special monitoring.
The use of Fluoxetine is associated with the development of akathisia, the subjective symptoms of which are a constant need to be in motion, as well as the inability to sit or stand. These phenomena are especially pronounced in the first weeks of treatment. For patients who have developed such symptoms, the drug is prescribed in the minimum effective dose.
If discontinued suddenly, approximately 60% of patients develop withdrawal symptoms. The likelihood of their occurrence depends on the dose used, the duration of the course, and the level of dose reduction. It is recommended to reduce the dose by titration over 7-14 days.
There are reports of subcutaneous hemorrhages, such as purpura or ecchymosis, occurring during treatment with the drug. Therefore, for patients taking oral anticoagulants that affect platelet function and increase the likelihood of bleeding, as well as for patients with a history of bleeding, Fluoxetine is prescribed taking into account the possible risks.
Fluoxetine analogs
Which is better: Prozac or Fluoxetine?
The active ingredient in Prozac is fluoxetine. Therefore, when choosing one or another product, the decisive factors are price and subjective feelings. The cost of Fluoxetine is significantly lower than the cost of its analogue.
For children
Not used to treat patients under 18 years of age.
A nineteen-week clinical study showed that in depressed children aged 8-18 years, fluoxetine caused a decrease in height and body weight. The effect of the drug on achieving normal growth in adulthood has not been studied.
However, the possibility of growth retardation during puberty cannot be ruled out.
Fluoxetine and alcohol
Drinking alcohol during treatment with Fluoxetine is contraindicated.
Fluoxetine for weight loss
Fluoxetine is often prescribed for bulimic syndrome, a mental syndrome that is accompanied by a lack of satiety and uncontrolled overeating.
The use of the drug reduces appetite and relieves the constant feeling of hunger.
Thus, we can conclude that Fluoxetine can only get rid of excess weight if the reason for its gain is appetite.
However, the drug is not intended for weight loss; its main purpose is to treat depression. Decreased appetite and weight loss are side effects.
The medicine is quite powerful, and the body often reacts to its use with anaphylactic reactions and systemic disorders involving the lungs, skin, kidneys and liver in the pathological process.
How to take Fluoxetine for weight loss?
At the initial stage, diet pills are taken in a minimal dosage - one once a day. If well tolerated, you can switch to taking two tablets - one is taken in the morning, the second in the evening.
The maximum permissible dose is 4 tablets/day.
The drug begins to act after 4-8 hours; it takes about a week to remove fluoxetine from the body.
Reviews on forums confirm the effectiveness of the product - in 1-3 months people got rid of 5-13 kg without much effort. At the same time, all patients who took Fluoxetine note that it is still not worth drinking it just for the sake of losing weight, like Phenibut or Phenotropil, in the absence of indications.
During pregnancy
The safety of the drug in pregnant women has been poorly studied, and the results of some published epidemiological studies are contradictory. Some randomized and cohort studies have found no increase in the likelihood of congenital anomalies.
A prospective study conducted by ENTIS suggests an increased likelihood of developing congenital anomalies in the structure of large vessels or the heart in children whose mothers took fluoxetine in the 1st trimester of pregnancy, compared with children whose mothers did not receive this drug.
A reliable connection between taking the drug in early pregnancy and the formation of malformations in the fetus could not be established. The specific group of CVS anomalies has also not been defined.
The use of SSRIs in the last weeks of pregnancy contributes to the development of complications in newborns, in particular, an increase in the duration of mechanical ventilation and tube feeding and the duration of hospitalization.
There are references to the development of apnea, respiratory distress syndrome, convulsions, hypoglycemia, lability of body temperature and blood pressure, tremor, hyperreflexia, vomiting, cyanosis, difficulties with adequate nutrition, constant crying, excitability, nervous irritability.
The listed pathological conditions may be a consequence of SSRI withdrawal syndrome or a manifestation of their toxic effects.
Reviews of Fluoxetine
Reviews from patients taking Fluoxetine (APO, Lannacher, Kanon) leave the impression of the effectiveness of this drug for depression, bulimic neuroses and OCD.
The forums also often discuss the possibility of using the drug to control appetite and correct weight.
Reviews from doctors about Fluoxetine for weight loss are clear: the medicine can be used to combat extra pounds only if the cause of weight gain is a mental disorder.
When excess weight is a consequence of overeating caused by depression or stress, the drug allows you to completely get rid of bouts of gluttony in 2-3 weeks and remove up to 5 kg in just the first month.
Reviews of those losing weight about Fluoxetine (Lannacher, OZONE, etc.) allow us to conclude that not everyone succeeds in losing weight on this drug: for some, their appetite disappears completely (even to the point of disgust in food), for others it remains the same.
However, in most cases, the drug has quite serious side effects: many people who took it noted a decrease in libido and a deterioration in sex life, a feeling of lethargy, severe pain, drowsiness, increased aggression, and the appearance of suicidal thoughts.
In addition, for many losing weight, the disadvantages of the drug are the need to stop driving and drinking alcohol, as well as the fact that Fluoxetine is highly addictive.
Summarizing the reviews, we can draw the following conclusions: Fluoxetine is primarily a medicine for depression and can be taken only if indicated and only under the supervision of a doctor.
How much does Fluoxetine cost?
The price in Ukraine for Fluoxetine tablets is from 11 UAH per package No. 10. The price of Fluoxetine in package No. 20 is from 18 UAH.
The price of Fluoxetine in Russian pharmacies depends on which company produced the drug and varies from 27 to 255 rubles. For example, the price of Fluoxetine Lannacher in St. Petersburg is from 112 to 145 rubles per package No. 20, and the price of the drug produced by OZON LLC is rubles.
You can buy Apo-Fluoxetine in Moscow or St. Petersburg for rubles.
The cost of the drug in Belarus is about 120 thousand rubles.
Do I need a prescription for the drug? Undoubtedly it is needed. After all, Fluoxetine is far from a harmless pill. Side effects from uncontrolled use of the drug can be quite serious.
Due to the fact that the drug is not available without a prescription, many are interested in the question of how to buy Fluoxetine online. The attitude towards prescription drugs in online pharmacies is no less strict than in regular ones.
In most cases, when receiving pills, it is enough to show the courier a prescription written by a doctor, but some pharmacies do not deliver prescription drugs, so you need to go in person to pick up the medicine.
- Online pharmacies in Russia Russia
- Online pharmacies in Ukraine Ukraine
- Online pharmacies in Kazakhstan Kazakhstan
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BIOSPHERE
An excellent drug, I lost more than 10 kg in the first two months with its help. and I feel great. There is no depression or excessive hunger.
Vita: I am very grateful to Anna (Anna, Anulya is her nickname on VKontakte) for helping.
Dana: The drug is good, it takes a long time to take, but due to this you are cured as needed.
Ekaterina: Hello, I have the same problem, a purulent chic was cut out on my buttock a month ago! All .
Valeria: Zerkalin helps relieve even severe inflammation. It may not completely remove acne (this.
All materials presented on the site are for reference and informational purposes only and cannot be considered a treatment method prescribed by a doctor or sufficient advice.
We choose fluoxetine analogues depending on the goal
Fluoxetine is a strong antidepressant intended for drug therapy for obsessive and depressive conditions, which are accompanied by anxiety and fear.
Systematic use of this drug helps patients overcome apathy, improve mood, normalize appetite and sleep, and reduce feelings of fear and tension.
First acquaintance with the medicine
The active ingredient of the drug is fluoxetine hydrochloride.
The pharmacological properties of Fluoxetine are based on its ability to inhibit the reuptake of serotonin into the central nervous system, the main neurotransmitter called the hormone of pleasure (or happiness).
It is he who is responsible for a good mood, the absence of tearfulness, pickiness, and boredom. The therapeutic effect of the drug improves the patient’s psycho-emotional activity and does not affect blood pressure, functional activity of the heart, and does not cause drowsiness or lethargy.
The drug is prescribed for:
Pros and cons of the drug
The main advantages of the drug are:
- lack of hypnotic effect and cardiotoxic effect;
- availability in the pharmacy network;
- democratic price.
The disadvantages of the drug include the following side effects:
- dizziness and headache;
- asthenia;
- increased sweating;
- decreased libido;
- the appearance of pain in the bones and mammary glands;
- noise in ears;
- stool instability;
- rashes on the skin;
- dry mouth;
- disturbances of taste and olfactory sensations;
- decreased vision.
- allergic reaction to the main component of the drug;
- pregnancy;
- breastfeeding a baby;
- pathological processes in the liver and kidneys;
- diabetes mellitus;
- epileptic conditions.
This predominance of “cons” over “pros” is a consequence of the fact that this drug is already outdated. Today, the pharmacological industry provides patients with modern analogs of Fluoxetine, which have the ability to selectively affect the human body.
Why are people looking for fluoxetine analogs?
Price issue
Fluoxetine is not the cheapest drug (its price is about 300 rubles) and in order to save money you have to look for more affordable analogues.
Among them are Framex and Flunat - these are more affordable medications that cost from 100 to 150 rubles, and their low price is due to their less famous name.
By-effect
Fluoxetine is a high-quality and proven drug, but it has certain disadvantages, or rather a number of side effects:
- bowel dysfunction;
- infrequent headaches that appear an hour after administration;
- increased heart rate, which can lead to tachycardia;
- overdrying of the mucous membrane;
- blurred vision;
- increased sweat secretions;
- general malaise;
- Women who took the drug experienced pain in the mammary glands and menstrual irregularities (up to several weeks);
- nausea and vomiting;
- noise in ears;
- constant feeling of fatigue;
- sleep disorders;
- depression;
- acne and allergic irritations;
- broken bones;
- sexual apathy (loss of interest in sex).
The list of contraindications is quite long and that is why most people are looking for more harmless analogues. For example, it could be Flunat or Deprex. The drugs have a natural composition and a less aggressive effect on the patient’s body.
No choice
Of course, the last reason why people turn to analogues of this drug is simply its absence on the shelves in pharmacies, since Fluoxetine is a sought-after medication.
If this medicine is not available in the pharmacy, then you should turn your attention to Profluzac and Fluval, which are identical in their action and composition.
Analogues in terms of active substance, composition, action
The active substance fluoxetine hydrochloride has the following analogues:
Similar medications in composition and effect on the body:
- Portal, composition: fluoxetine and vitamin supplements;
- Prodep, composition: fluoxetine and calcium;
- Prozac, composition: fluoxetine and sedatives.
Unlike Fluoxetine, almost all similar drugs contain fewer impurities, which means they are more harmless.
TOP - 15 best analogues
- Apo-Fluoxetine is an antidepressant that has a calming effect and improves mood;
- Bioxetine is a fairly effective selective inhibitor; it is often prescribed for neuroses, since it has practically no side effects;
- Deprex is a product that contains the active substance fluoxetine, which has a sedative and invigorating effect for neuralgia;
- Deprenon is a potent depressant (prescribed for serious mental disorders);
- Portal is an antidepressant in capsule form, which, thanks to its natural composition, has proven itself well as a medicine in the fight against bulimia nervosa;
- Prodep is an antidepressant, a selective serotonin reuptake inhibitor, which improves mood, reduces tension, anxiety and fear;
- Prozac is a natural medicine used for depression (regardless of the degree of depressive disorder - mild, moderate, severe), bulimia, anorexia, alcoholism, obsessive-compulsive disorder;
- Profluzak is a strong antidepressant used in the fight against psychological and nervous conditions;
- Flunate is an adjuvant drug based on fluoxetine, which enhances the effects of Alprazolam, Diazepam and ethanol;
- Fluval is not the most popular, but nevertheless a worthy analogue of Fluoxetine, which is used in conjunction with electroconvulsive therapy;
- Framex is an antidepressant that should only be taken under medical supervision, since when used together with other medications it can increase blood concentration, which can lead to adverse consequences;
- Fluoxetine-Canon is a potent sedative used for violent nervous disorders;
- Floxet is a complete analogue of Fluoxetine, which is used for depression and other disorders;
- Fluoxetine-Lannacher is a selective inhibitor that is used for bulimia nervosa and anorexia;
- Fluoxetine - Nycomed is a sedative based on the parent medication.
A question of price and free access
Cheap analogues of the antidepressant Fluoxetine:
Over-the-counter analogues of Fluoxetine:
This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.
This page provides a list of all fluoxetine analogues by composition and indication for use. A list of cheap analogues, and you can also compare prices in pharmacies.
- The cheapest analogue of Fluoxetine:
- The most popular analogue of Fluoxetine:
- ATX classification: Fluoxetine
- Active ingredients/composition: fluoxetine
Cheap analogs of Fluoxetine
| # | Name | Price in Russia | Price in Ukraine |
|---|---|---|---|
| 1 | paroxetine | 250 rub. | -- |
| 2 | sertraline Similar in indication and method of use | 268 RUR | 109 UAH |
| 3 | paroxetine Similar in indication and method of use | 289 RUR | 192 UAH |
| 4 | sertraline Similar in indication and method of use | 350 rub. | 148 UAH |
| 5 | sertraline Similar in indication and method of use | 383 RUR | 81 UAH |
When calculating the cost cheap analogs of Fluoxetine the minimum price was taken into account, which was found in the price lists provided by pharmacies
Popular analogs of Fluoxetine
| # | Name | Price in Russia | Price in Ukraine |
|---|---|---|---|
| 1 | fluvoxamine Similar in indication and method of use | 544 RUR | 74 UAH |
| 2 | escitalopram Similar in indication and method of use | RUR 396 | -- |
| 3 | escitalopram Similar in indication and method of use | 651 RUR | 700 UAH |
| 4 | citalopram Similar in indication and method of use | 1211 RUR | 93 UAH |
| 5 | escitalopram Similar in indication and method of use | 516 RUR | 960 UAH |
The list of drug analogues based on statistics of the most requested drugs
All analogues of Fluoxetine
The above list of drug analogues, which indicates fluoxetine substitutes, is the most suitable because they have the same composition of active ingredients and coincide in indications for use
Analogues by indication and method of use
| Name | Price in Russia | Price in Ukraine |
|---|---|---|
| citalopram | 1211 RUR | 93 UAH |
| citalopram | -- | 884 UAH |
| -- | 1100 UAH | |
| -- | -- | |
| -- | -- | |
| -- | -- | |
| citalopram | -- | -- |
| paroxetine | 579 RUR | 323 UAH |
| paroxetine | -- | 49 UAH |
| paroxetine | 665 RUR | 156 UAH |
| paroxetine | -- | -- |
| paroxetine | -- | -- |
| paroxetine | -- | -- |
| paroxetine | 289 RUR | 192 UAH |
| paroxetine | 250 rub. | -- |
| -- | 285 UAH | |
| sertraline | 383 RUR | 81 UAH |
| sertraline | 350 rub. | 148 UAH |
| sertraline | 268 RUR | 109 UAH |
| sertraline | -- | -- |
| sertraline | -- | 87 UAH |
| sertraline | -- | -- |
| sertraline | -- | 57 UAH |
| sertraline | -- | 212 UAH |
| -- | -- | |
| -- | -- | |
| fluvoxamine | 544 RUR | 74 UAH |
| fluvoxamine | -- | -- |
| escitalopram | -- | 81 UAH |
| escitalopram | 980 rub. | 221 UAH |
| escitalopram | -- | -- |
| escitalopram | -- | 108 UAH |
| escitalopram | 516 RUR | 960 UAH |
| escitalopram | -- | 235 UAH |
| escitalopram | -- | -- |
| escitalopram | -- | 94 UAH |
| 466 RUR | 1200 UAH | |
| escitalopram | 651 RUR | 700 UAH |
| escitalopram | RUR 396 | -- |
| escitalopram | -- | 75 UAH |
| escitalopram | -- | 185 UAH |
| escitalopram | -- | 98 UAH |
| escitalopram | -- | 151 UAH |
Different composition, may have the same indication and method of use
| Name | Price in Russia | Price in Ukraine |
|---|---|---|
| imipramine | 320 rub. | 98 UAH |
| clomipramine | -- | 75 UAH |
| 261 RUR | 88 UAH | |
| amitriptyline | -- | 160 UAH |
| amitriptyline | 20 rub | 10 UAH |
| -- | 13 UAH | |
| -- | 44 UAH | |
| -- | 82 UAH | |
| amitriptyline hydrochloride | 38 rub. | -- |
| amitriptyline | 47 RUR | -- |
| doxepin | -- | 40 UAH |
| moclobemide | -- | 250 UAH |
| pipofezin | 151 RUR | 370 UAH |
| azafen | 1296 RUR | -- |
| mianserin | -- | 141 UAH |
| mianserin | 918 RUR | 280 UAH |
| trazodone | 516 RUR | 186 UAH |
| -- | -- | |
| -- | 319 UAH | |
| mirtazapine | -- | 236 UAH |
| mirtazapine | -- | 136 UAH |
| mirtazapine | -- | -- |
| mirtazapine | -- | 172 UAH |
| mirtazapine | -- | 656 UAH |
| mirtazapine | -- | -- |
| -- | -- | |
| mirtazapine | 1250 rub. | 550 UAH |
| -- | 742 UAH | |
| tianeptine | -- | -- |
| venlafaxine | 666 RUR | 150 UAH |
| venlafaxine | 157 RUR | 175 UAH |
| venlafaxine | 499 RUR | 110 UAH |
| venlafaxine | -- | 152 UAH |
| venlafaxine | -- | -- |
| venlafaxine | -- | 500 UAH |
| venlafaxine | -- | -- |
| -- | -- | |
| -- | -- | |
| venlafaxine | 1166 RUR | 1000 UAH |
| milnacipran | 1454 RUR | 1690 UAH |
| duloxetine | 1100 rub. | 500 UAH |
| -- | -- | |
| duloxetine | 820 rub. | -- |
| agomelatine | -- | 173 UAH |
| desvenlafaxine | -- | 337 UAH |
| St. John's wort | 2000 rub | -- |
| St. John's wort | 228 rub. | 156 UAH |
| St. John's wort | 12 rub. | 450 UAH |
| vortioxetine | 1909 RUR | 452 UAH |
To compile a list of cheap analogues of expensive drugs, we use prices that are provided to us by more than 10,000 pharmacies throughout Russia. The database of drugs and their analogues is updated daily, so the information provided on our website is always up to date as of the current day. If you have not found the analogue you are interested in, please use the search above and select the medicine you are interested in from the list. On the page of each of them you will find all possible analogues of the drug you are looking for, as well as prices and addresses of pharmacies where it is available.
How to find a cheap analogue of an expensive medicine?
To find an inexpensive analogue of a medicine, a generic or a synonym, first of all we recommend paying attention to the composition, namely the same active ingredients and indications for use. The same active ingredients of a drug will indicate that the drug is a synonym for the drug, pharmaceutically equivalent or a pharmaceutical alternative. However, we should not forget about the inactive components of similar drugs, which may affect safety and effectiveness. Do not forget about the instructions of doctors; self-medication can harm your health, so always consult a doctor before using any medication.Fluoxetine price
Use the websites below to find prices for Fluoxetine and find out availability at your local pharmacy.Fluoxetine instructions
INSTRUCTIONS
on the use of the product
Fluoxetine
Release form
Hard gelatin capsules, No. 4, with a white body and a blue cap; the contents of the capsules are white or almost white granules.
Compound
fluoxetine hydrochloride 11.2 mg, which corresponds to the content of fluoxetine 10 mg
Excipients: lactose monohydrate (milk sugar) - 30.8 mg, microcrystalline cellulose - 16.1 mg, colloidal silicon dioxide (aerosil) - 150 mcg, magnesium stearate - 600 mcg, talc - 1.15 mg.
Composition of the capsule shell: gelatin - 36.44 mg, titanium dioxide - 1.52 mg, indigo carmine - 40 mcg.
Package
10 pieces. - contour cell packaging (2) - cardboard packs.
pharmachologic effect
An antidepressant from the group of selective serotonin reuptake inhibitors. It has a thymoanaleptic and stimulating effect.
Selectively blocks the reverse neuronal uptake of serotonin (5HT) at the synapses of neurons in the central nervous system. Inhibition of serotonin reuptake leads to an increase in the concentration of this neurotransmitter in the synaptic cleft, enhancing and prolonging its effect on postsynaptic receptor sites. By increasing serotonergic transmission, fluoxetine inhibits neurotransmitter metabolism through the negative membrane binding mechanism. With long-term use, fluoxetine inhibits the activity of 5-HT1 receptors. 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. It has an anorexigenic effect and can cause weight loss. Does not cause orthostatic hypotension, sedation, and is noncardiotoxic. A lasting clinical effect occurs after 1-2 weeks of treatment.
Pharmacokinetics
When taken orally, the drug is well absorbed from the gastrointestinal tract (up to 95% of the dose taken); administration with food slightly inhibits the absorption of fluoxetine. Cmax in blood plasma is reached after 6-8 hours. The bioavailability of fluoxetine after oral administration is more than 60%. The drug accumulates well in tissues, easily penetrates the blood-brain barrier, binding to blood plasma proteins is more than 90%. Metabolized in the liver by demethylation to the active metabolite norfluoxetine and a number of unidentified metabolites. It is excreted by the kidneys in the form of metabolites (80%) and the intestines (15%), mainly in the form of glucuronides. T1/2 of fluoxetine after reaching equilibrium concentration in the blood plasma is about 4-6 days. T1/2 of the active metabolite of norfluoxetine with a single dose and after reaching equilibrium concentration in the blood plasma ranges from 4 to 16 days. In patients with liver failure, the half-life of fluoxetine and norfluoxetine is prolonged.
Fluoxetine, indications for use
- depression of various origins;
- obsessive-compulsive disorders;
- bulimic neurosis.
Contraindications
- simultaneous use with MAO inhibitors (and within 14 days after their withdrawal);
- simultaneous use of thioridazine (and for 5 weeks after discontinuation of fluoxetine), pimozide;
- pregnancy;
- period of breastfeeding;
- severe renal dysfunction (creatinine clearance less than 10 ml/min);
- liver failure;
- lactase deficiency, lactose intolerance, glucose-galactose malabsorption;
- age up to 18 years;
- increased sensitivity to the drug.
Carefully
Suicidal risk: with depression, there is a possibility of suicide attempts, which may persist until stable remission occurs. Isolated cases of suicidal thoughts and suicidal behavior have been described during therapy or shortly after its completion, similar to the effects of other drugs with similar pharmacological action (antidepressants). Careful monitoring of patients at risk is necessary. Clinicians should encourage patients to promptly report any distressing thoughts or feelings.
Epileptic seizures: Floxetine should be prescribed with caution to patients who have had epileptic seizures.
Hyponatremia: Cases of hyponatremia have been reported. Mostly, such cases were observed in elderly patients and in patients taking diuretics, due to a decrease in circulating blood volume.
Diabetes mellitus: glycemic control in diabetic patients during treatment with fluoxetine showed hypoglycemia; after discontinuation of the drug, hyperglycemia developed. Doses of insulin and/or oral hypoglycemic agents may need to be adjusted at the start or after treatment with fluoxetine.
Renal/liver failure: Fluoxetine is metabolized by the liver and excreted by the kidneys and gastrointestinal tract. In patients with severe liver dysfunction, it is recommended to prescribe lower doses of fluoxetine, or prescribe the drug every other day. When taking fluoxetine at a dose of 20 mg/day for two months, there were no differences in the concentrations of fluoxetine and norfluoxetine in the blood plasma of healthy individuals with normal renal function and patients with severely impaired renal function (creatinine clearance 10 ml/min) requiring hemodialysis.
Directions for use and doses
The drug is taken orally, at any time, regardless of meals.
Depressive state
The initial dose is 20 mg 1 time / day in the first half of the day, regardless of meals. If necessary, the dose can be increased to 40-60 mg/day, divided into 2-3 doses (by 20 mg/day weekly). The maximum daily dose is 80 mg in 2-3 doses.
The clinical effect develops 1-2 weeks after the start of treatment; in some patients it may be achieved later.
Obsessive-compulsive disorders
The recommended dose is 20-60 mg/day.
Bulimic neurosis
The drug is used in a daily dose of 60 mg, divided into 2-3 doses.
Use of the drug in patients of different ages
There are no data on changes in doses depending on age. Treatment of elderly patients should begin with a dose of 20 mg/day.
Accompanying illnesses
It is recommended to prescribe fluoxetine to patients with impaired liver or kidney function using low doses and lengthening the interval between doses.
Use during pregnancy and breastfeeding
Contraindicated during pregnancy and lactation.
Side effects
When using fluoxetine, as in cases of using drugs from the group of selective serotonin reuptake inhibitors, the following adverse events are noted.
From the cardiovascular system: often (≥ 1% - ≤10%) - atrial flutter, hot flashes; uncommon (≥ 0.1% - ≤1%) - hypotension; rarely (≤ 0.1%) - vasculitis, vasolidation.
From the digestive system: very often (≥ 10%) - diarrhea, nausea; often (≥ 1% - ≤10%) - dry mouth, dyspepsia, vomiting; infrequently (≥ 0.1% - ≤1%) - dysphagia, taste perversion; rarely (≤ 0.1%) - pain along the esophagus.
From the hepatobiliary system: rarely (≤ 0.1%) - idiosyncratic hepatitis.
From the immune system: very rarely (≤ 0.1%) - anaphylactic reactions, serum sickness.
Metabolic and nutritional disorders: often (≥ 1% - ≤10%) - anorexia (including weight loss) of the body.
From the musculoskeletal system: infrequently (≥ 0.1% - ≤1%) - muscle twitching.
From the central nervous system: very often (≥ 10%) - headache; often (≥ 1% - ≤10%) - impaired attention, dizziness, lethargy, drowsiness (including hypersomnolence, sedation), tremor; infrequently (≥ 0.1% - ≤1%) - psychomotor agitation, hyperactivity, ataxia, incoordination, bruxism, dyskinesia, myoclonus; rarely (≤ 0.1%) - bucco-glossal syndrome, seizures, serotonin syndrome.
Mental disorders: very often (≥ 10%) - insomnia (including early morning awakening, initial and moderate insomnia); often (≥ 1% - ≤ 10%) - unusual dreams (including nightmares), nervousness, tension, decreased libido (including lack of libido), euphoria, sleep disorder; infrequently (≥ 0.1% - ≤1%) - depersonalization, hyperthymia, impaired orgasm (including anorgasmia), thinking disorders; rarely (≤ 0.1%) - manic disorders.
From the skin: often (≥ 1% - ≤10%) - hyperhidrosis, itching, polymorphic skin rash, urticaria; uncommon (≥ 0.1% - ≤1%) - ecchymosis, tendency to bruise, alopecia, cold sweat; rarely (≤ 0.1%) - angioedema, photosensitivity reactions.
From the senses: often (≥ 1% - ≤10%) - blurred vision; uncommon (≥ 0.1% - ≤1%) - mydriasis.
From the genitourinary system: often (≥ 1% - ≤10%) - frequent urination (including pollakiuria), ejaculation disorders (including lack of ejaculation, dysfunctional ejaculation, early ejaculation, delayed ejaculation, retrograde ejaculation), erectile dysfunction, gynecological bleeding (including bleeding from the cervix, dysfunctional uterine bleeding, bleeding from the genital tract, menometrorrhagia, menorrhagia, metrorrhagia, polymenorrhea, postmenopausal bleeding, uterine bleeding, vaginal bleeding); uncommon (≥ 0.1% - ≤1%) - dysuria; rarely (≤ 0.1%) - sexual dysfunction, priapism.
Post-marketing messages
On the part of the endocrine system, cases of antidiuretic hormone deficiency have been reported.
These side effects more often occur at the beginning of fluoxetine therapy or when the dose of the drug is increased.
special instructions
Careful monitoring of patients with suicidal tendencies is required, especially at the beginning of treatment. The risk of suicide is highest in patients who have previously taken other antidepressants and in patients who experience excessive fatigue, hypersomnia, or restlessness during treatment with fluoxetine. Until significant improvement in treatment occurs, such patients should be under medical supervision.
In children, adolescents and young adults (under 24 years of age) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and suicidal behavior. Therefore, when prescribing fluoxetine or any other antidepressants in children, adolescents and young adults (under 24 years of age), the risk of suicide should be weighed against the benefits of their use. In short-term studies, the risk of suicide did not increase in people over 24 years of age, but it decreased slightly in people over 65 years of age. Any depressive disorder itself increases the risk of suicide. Therefore, during treatment with antidepressants, all patients should be monitored for early detection of disturbances or changes in behavior, as well as suicidality.
During electroconvulsive therapy, prolonged epileptic seizures may develop.
The interval between the end of therapy with MAO inhibitors and the start of treatment with fluoxetine should be at least 14 days; between the end of treatment with fluoxetine and the start of therapy with MAO inhibitors - at least 5 weeks.
After discontinuation of the drug, its therapeutic concentration in the blood serum may remain for several weeks.
In patients with diabetes mellitus, hypoglycemia may develop during fluoxetine therapy and hyperglycemia after its discontinuation. Doses of insulin and/or oral hypoglycemic agents may need to be adjusted at the start or after treatment with fluoxetine.
When treating patients with underweight, anorexigenic effects should be taken into account (progressive weight loss is possible).
While taking fluoxetine, you should refrain from drinking alcohol, because. the drug enhances the effect of alcohol.
Impact on the ability to drive vehicles and operate machinery
Taking fluoxetine may negatively affect the performance of work that requires a high speed of mental and physical reactions.
Drug interactions
Fluoxetine and its main metabolite, norfluoxetine, have long half-lives, which must be taken into account when combining fluoxetine with other drugs, as well as when replacing it with another antidepressant.
The drug should not be used simultaneously with MAO inhibitors, incl. antidepressants - MAO inhibitors; furazolidone, procarbazine, selegiline, as well as tryptophan (a precursor of serotonin), since the development of serotonergic syndrome is possible, manifested in confusion, hypomanic state, psychomotor agitation, convulsions, dysarthria, hypertensive crises, chills, tremor, nausea, vomiting, diarrhea.
After using MAO inhibitors, fluoxetine should be prescribed no earlier than 14 days. MAO inhibitors should not be used earlier than 5 weeks after stopping fluoxetine.
Concomitant use of drugs metabolized by the CYP2D6 isoenzyme (carbamazepine, diazepam, propafenone) with fluoxetine should be carried out using minimal therapeutic doses. Fluoxetine blocks the metabolism of the tricyclic and tetracyclic anti-depressive drugs trazodone, metoprolol, terfenadine, which leads to an increase in their concentration in the blood serum, enhancing their effect and increasing the frequency of complications.
In patients stable on maintenance doses of phenytoin, plasma phenytoin concentrations increased significantly and symptoms of phenytoin toxicity (nystagmus, diplopia, ataxia, and CNS depression) appeared after initiation of concomitant treatment with fluoxetine.
The combined use of fluoxetine and lithium salts requires careful monitoring of the concentration of lithium in the blood, because it is possible to increase it.
Fluoxetine enhances the effect of hypoglycemic drugs.
When used simultaneously with drugs that are highly protein bound, especially with anticoagulants and digitoxin, plasma concentrations of free (unbound) drugs may increase and the risk of adverse effects may increase.
Overdose
Symptoms: psychomotor agitation, seizures, drowsiness, heart rhythm disturbances, tachycardia, nausea, vomiting.
Other serious symptoms of fluoxetine overdose (both when fluoxetine was taken alone and when taken concomitantly with other drugs) included coma, delirium, QT prolongation and ventricular tachyarrhythmia, including atrial fibrillation and cardiac arrest, decreased blood pressure, syncope, mania, pyrexia, stupor and neuroleptic malignant syndrome-like state
Treatment: specific antagonists to fluoxetine have not been found. Symptomatic therapy is carried out, gastric lavage with the administration of activated charcoal, for convulsions - diazepam, maintenance of breathing, cardiac activity, body temperature.
Storage conditions
In a dry place, protected from light, at a temperature not exceeding 25°C. Keep out of the reach of children.
Best before date
3 years.
In this article you can read the instructions for use of the drug Fluoxetine. Reviews of site visitors - consumers of this medicine, as well as the opinions of specialist doctors on the use of Fluoxetine in their practice are presented. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Fluoxetine analogues in the presence of existing structural analogues. Use for the treatment of bulimia and weight loss in adults, children, as well as during pregnancy and breastfeeding. Interaction of the drug with alcohol.
Fluoxetine- an antidepressant from the group of selective serotonin reuptake inhibitors. It has a thymoanaleptic and stimulating effect.
Selectively blocks the reverse neuronal uptake of serotonin (5HT) at the synapses of neurons in the central nervous system. Inhibition of serotonin reuptake leads to an increase in the concentration of this neurotransmitter in the synaptic cleft, enhancing and prolonging its effect on postsynaptic receptor sites. By increasing serotonergic transmission, fluoxetine inhibits neurotransmitter metabolism through the negative membrane binding mechanism. With long-term use, fluoxetine inhibits the activity of 5-HT1 receptors. 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. It has an anorexigenic effect and can cause weight loss. Does not cause orthostatic hypotension, sedation, and is noncardiotoxic. A lasting clinical effect occurs after 1-2 weeks of treatment.
Compound
Fluoxetine hydrochloride + excipients.
Pharmacokinetics
When taken orally, the drug is well absorbed from the gastrointestinal tract (up to 95% of the dose taken); administration with food slightly inhibits the absorption of fluoxetine. The drug accumulates well in tissues, easily penetrates the blood-brain barrier, binding to blood plasma proteins is more than 90%. Metabolized in the liver by demethylation to the active metabolite norfluoxetine and a number of unidentified metabolites. It is excreted by the kidneys in the form of metabolites (80%) and the intestines (15%), mainly in the form of glucuronides.
Indications
- depression of various origins;
- obsessive-compulsive disorders;
- premenstrual dysphoria;
- bulimic neurosis.
Release forms
Capsules 10 mg and 20 mg (trademarks Lannacher, Canon and others, sometimes mistakenly called tablets).
Instructions for use and dosage regimen
The drug is taken orally, at any time, regardless of meals.
Depressive state
The initial dose is 20 mg 1 time per day in the morning, regardless of meals. If necessary, the dose can be increased to 40-60 mg per day, divided into 2-3 doses (by 20 mg per day weekly). The maximum daily dose is 80 mg in 2-3 doses.
The clinical effect develops 1-2 weeks after the start of treatment; in some patients it may be achieved later.
Obsessive-compulsive disorders
Bulimic neurosis
The drug is used in a daily dose of 60 mg, divided into 2-3 doses.
For premenstrual dysphoric disorders, the recommended dose is 20 mg per day.
Use of the drug in patients of different ages
There are no data on changes in doses depending on age. Treatment of elderly patients should begin with a dose of 20 mg per day.
Side effect
- atrial flutter;
- hot flashes;
- hypotension;
- vasculitis;
- diarrhea;
- nausea, vomiting;
- dry mouth;
- dyspepsia;
- dysphagia;
- perversion of taste;
- pain along the esophagus;
- anaphylactic reactions;
- serum sickness;
- anorexia (including weight loss) of the body;
- muscle twitching;
- headache;
- attention disorder;
- dizziness;
- lethargy;
- drowsiness (including hypersomnolence, sedation);
- tremor;
- psychomotor agitation;
- hyperactivity;
- ataxia;
- lack of coordination;
- convulsions;
- insomnia (including early morning awakening, initial and moderate insomnia);
- unusual dreams (including nightmares);
- nervousness;
- tension;
- decreased libido (including lack of libido);
- euphoria;
- orgasmic dysfunction (including anorgasmia);
- thinking disorders;
- manic disorders;
- skin itching;
- polymorphic skin rash;
- hives;
- cold sweat;
- blurred vision;
- frequent urination (including pollakiuria);
- ejaculation disorders (including absence of ejaculation, dysfunctional ejaculation, early ejaculation, delayed ejaculation, retrograde ejaculation);
- erectile disfunction;
- gynecological bleeding (including bleeding from the cervix, dysfunctional uterine bleeding, bleeding from the genital tract, menometrorrhagia, menorrhagia, metrorrhagia, polymenorrhea, postmenopausal bleeding, uterine bleeding, vaginal bleeding);
- sexual dysfunction;
- priapism.
Contraindications
- simultaneous use with MAO inhibitors (and within 14 days after their discontinuation);
- simultaneous use of thioridazine (and for 5 weeks after discontinuation of fluoxetine), pimozide;
- pregnancy;
- breastfeeding period;
- severe renal impairment (creatinine clearance less than 10 ml/min);
- liver failure;
- lactase deficiency, lactose intolerance, glucose-galactose malabsorption;
- age under 18 years;
- hypersensitivity to the drug.
Use during pregnancy and breastfeeding
Contraindicated during pregnancy and lactation.
Use in children
In children and adolescents with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and suicidal behavior. Therefore, the use of the drug in childhood is contraindicated.
special instructions
Careful monitoring of patients with suicidal tendencies is required, especially at the beginning of treatment. The risk of suicide is highest in patients who have previously taken other antidepressants and in patients who experience excessive fatigue, hypersomnia, or restlessness during treatment with fluoxetine. Until significant improvement in treatment occurs, such patients should be under medical supervision.
In children, adolescents and young adults (under 24 years of age) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and suicidal behavior. Therefore, when prescribing fluoxetine or any other antidepressants in children, adolescents and young adults (under 24 years of age), the risk of suicide should be weighed against the benefits of their use. In short-term studies, the risk of suicide did not increase in people over 24 years of age, but it decreased slightly in people over 65 years of age. Any depressive disorder itself increases the risk of suicide. Therefore, during treatment with antidepressants, all patients should be monitored for early detection of disturbances or changes in behavior, as well as suicidality.
During electroconvulsive therapy, prolonged epileptic seizures may develop.
The interval between the end of therapy with MAO inhibitors and the start of treatment with fluoxetine should be at least 14 days; between the end of treatment with fluoxetine and the start of therapy with MAO inhibitors - at least 5 weeks.
After discontinuation of the drug, its therapeutic concentration in the blood serum may remain for several weeks.
In patients with diabetes mellitus, hypoglycemia may develop during fluoxetine therapy and hyperglycemia after its discontinuation. Doses of insulin and/or oral hypoglycemic agents may need to be adjusted at the start or after treatment with fluoxetine.
When treating patients with underweight, anorexigenic effects should be taken into account (progressive weight loss is possible).
While taking fluoxetine, you should refrain from drinking alcohol, because. the drug enhances the effect of alcohol.
Impact on the ability to drive vehicles and operate machinery
Taking fluoxetine may negatively affect the performance of work that requires a high speed of mental and physical reactions.
Drug interactions
Fluoxetine and its main metabolite, norfluoxetine, have long half-lives, which must be taken into account when combining fluoxetine with other drugs, as well as when replacing it with another antidepressant.
The drug should not be used simultaneously with MAO inhibitors, incl. antidepressants - MAO inhibitors; furazolidone, procarbazine, selegiline, as well as tryptophan (a precursor of serotonin), since the development of serotonergic syndrome is possible, manifested in confusion, hypomanic state, psychomotor agitation, convulsions, dysarthria, hypertensive crises, chills, tremor, nausea, vomiting, diarrhea.
After using MAO inhibitors, fluoxetine should be prescribed no earlier than 14 days. MAO inhibitors should not be used earlier than 5 weeks after stopping fluoxetine.
In patients stable on maintenance doses of phenytoin, plasma phenytoin concentrations increased significantly and symptoms of phenytoin toxicity (nystagmus, diplopia, ataxia, and CNS depression) appeared after initiation of concomitant treatment with fluoxetine.
The combined use of fluoxetine and lithium salts requires careful monitoring of the concentration of lithium in the blood, because it is possible to increase it.
Fluoxetine enhances the effect of hypoglycemic drugs.
When used simultaneously with drugs that are highly protein bound, especially with anticoagulants and digitoxin, plasma concentrations of free (unbound) drugs may increase and the risk of adverse effects may increase.
Analogues of the drug Fluoxetine
Structural analogues of the active substance:
- Apo Fluoxetine;
- Deprex;
- Deprenon;
- Portal;
- Prodep;
- Prozac;
- Profluzak;
- Phloxet;
- Fluval;
- Fluxonil;
- Flunisan;
- Fluoxetine HEXAL;
- Fluoxetine Lannacher;
- Fluoxetine Nycomed;
- Fluoxetine OBL;
- Fluoxetine Canon;
- Fluoxetine hydrochloride;
- Framex.
If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.
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