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Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius;
Morocco; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal;
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Coast; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Mali; Mauritania;
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Prozac 20 (Korea; Malaysia; Mexico; Philippines; Taiwan; Thailand)
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Флуоксетин / Fluoxetine (Russia)
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Generic Name: fluoxetine hydrochloride Other Forms: Prozac Weekly, Sarafem (for PMDD), oral solution (It's minty fresh! Really, it tastes like mint-flavored mouthwash.) What is Prozac: Prozac is an
antidepressant, specifically Prozac is an SSRI. What are Prozac's FDA Approved Uses: Prozac is approved for:
Off-Label Uses: Fibromyalgia
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Pros: Prozac's long half-life makes the issue of med compliance a little less of a big deal, hence the approval for depressed teenagers. It also has studies backing it up for PMDD, by Lilly and independent researchers, including the Amen clinic, where I'm treated. You can see at the Amen Clinic's case studies in practice the more common form of PMDD that responds to SSRIs will respond to whichever SSRI you get along with the best. Prozac Weekly does have an advantage for certain forms of PMDD.
Cons: That really long half-life means it takes forever to wean yourself off of Prozac (fluoxetine hydrochloride) to avoid SSRI discontinuation syndrome. But only if the discontinuation syndrome hits you hard, which is fairly uncommon with Prozac (fluoxetine hydrochloride). In fact some more enlightened doctors will prescribe the liquid form to help wean patients off of other SSRIs and Effexor (venlafaxine). The sexual side effects, though, are pretty bad. For being the weakest of the SSRIs the side effects are pretty gnarly.
Prozac's side effects:
Typical Side Effects: The usual for SSRIs - headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation, weight gain, loss of libido. Most everything but the weight gain and loss of libido usually goes away within a couple of weeks. With Prozac (fluoxetine hydrochloride) it's a coin toss as to losing or gaining weight. Sometimes it will just kill your appetite.
For tips on how to cope with these side effects, please see our
side effects page.
Not So Common Side Effects: Rash, 'flu-like symptoms, anger/rage.
Freaky Rare Side Effects: Bleeding gums, amnesia, anti-social reaction (oh, come on, like we're not anti-social already), herpes (again, blaming the med for an STD), excessive hair growth, engorged breasts (a.k.a. porno boobs), involuntary tongue protrusion (according to the PI sheet / PDR one 77-year-old woman stopped sticking her tongue out at everyone after they stopped giving her Prozac (fluoxetine hydrochloride)).
Interesting Stuff Your Doctor Probably Won't Tell You: Prozac (fluoxetine hydrochloride) has been found to make a lot of other drugs work better. Great, huh? Not always, as with some meds it can be to the point of overdose. But it was that effect that lead to the breakthrough of the antipsychotic & antidepressant cocktail to treat bipolar depression. Anyway, Tegretol (carbamazepine) could suddenly get toxic on you and Xanax (alprazolam) could knock you out if you add Prozac (fluoxetine hydrochloride) to them, or add them to Prozac (fluoxetine hydrochloride), so be careful and always check your drug-drug interactions! A big part of this is the usual pharmacokinetic stuff of liver enzymes being able to deal with only so much, and Prozac (fluoxetine hydrochloride) gives your liver a bit of a workout. But that doesn't explain the entire effect of all of the drug-drug interactions. There's some pharmacodynamic (how meds work in your brain) stuff going on as well.
Prozac (fluoxetine hydrochloride) isn't such a hot idea for anyone with diabetes, and not because of potential weight gain, rather it messes with your glycemic control.
Prozac's Dosage and How to Take Prozac: I'm just going to cover the dosages for adults. Even though Prozac (fluoxetine hydrochloride) is the only modern antidepressant approved for kids, with kids it's still a lot trickier.
Depression - 20mg in the morning, increasing by 20mg a day after at least a week, taken either in the morning or at noon until a maximum of 80mg a day is reached.
OCD & Bulima - 20mg in the morning, increasing by 20mg a day after at least a week, taken either in the morning or at noon until a maximum of 60mg a day is reached.
Panic - 10mg in the morning. Increase to 20mg, either all in the morning or split into morning and noon. Hold there for awhile before increasing. Although you can go up to 60mg a day, few people responded to anything above 20mg a day.
Like any SSRI I recommend starting out with half the recommended dosage (except for Panic, that's as low as you can get) and then increasing to 20mg after a week. If you don't feel anything go up to 30mg, but stay there until you've given it a try for a month, otherwise it'll just be a pain in the ass to stop it. Even at 30mg you'll know after a month if it's going to do something for you.
Prozac Weekly - You just take the one capsule a week for everything. That's it.
Days to Reach a Steady State: Four to five weeks.
When you're fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you'll have fewer valleys after this point. In theory anyway.
How Long Prozac Takes to Work: Like all SSRIs anywhere from a couple days to over a month. If you don't feel any positive benefit after six weeks, then you should talk to your doctor about either another SSRI or trying a med that hits another neurotransmitter. Because of the long time it takes to reach a steady state, you might want to give Prozac (fluoxetine hydrochloride) a full two months. Just don't keep upping the dosage every week until then, otherwise it will be much harder and take much longer to stop taking Prozac.
Prozac's Half-Life & Average Time to Clear Out of Your System: Prozac (fluoxetine hydrochloride) has the longest half-life of any med I've written up, 9.3 days. That's why there's such an animal as Prozac Weekly. Thus it takes 45 days to clear out of your system.
How to Stop Taking Prozac: Your doctor should be recommending that you reduce your dosage by 10-20mg a day every 3-4 four days, if not more slowly than that. For more information, please see the page on how to safely stop taking these crazy meds. Unlike other medications, the time to step down from Prozac isn't based on half-life, it's based on anecdotal evidence. In other words, people's experiences. Now, if you start to experience SSRI discontinuation syndrome once you're down around 30-40mg a day, then you will have to look at reducing your dosage by 10mg a day every week to every month. But only if you're prone to the worst effects of discontinuation syndrome. Which is unusual with Prozac (fluoxetine hydrochloride). Here's where you really have to balance the suckiness of what you're dealing with in the way of side effects or whatever vs. SSRI discontinuation syndrome. And if you're taking Prozac Weekly you'll have to switch to the regular flavor to step down, as weekly is one size fits all. However, that extra-long half-life tends to make discontinuation less harsh, so you'll probably be able to to get off of Prozac (fluoxetine hydrochloride) a lot sooner. In fact switching to Prozac (fluoxetine hydrochloride) from another SSRI or Effexor (venlafaxine) is a good way of dealing with the discontinuation syndrome of the meds with the shorter half-lives. As Prozac comes in a liquid form, you can always switch to that to wean yourself off the last bit really slowly, ml by ml.
If you've worked your way up to a particular dosage, it's usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.
How Prozac Works In Your Brain: Like all SSRIs Prozac (fluoxetine hydrochloride) doesn't make you produce more serotonin, rather it makes your neurons soak for a longer period of time in the serotonin you already produce. Serotonin is one of the big three neurotransmitters responsible for depression, along with norepinephrine and dopamine. My wild-ass guess / rule of thumb is that imbalances of one or more of the three are responsible for 80% of the depression issues. It's all just a matter of figuring out exactly the extent of the tweaking and what neurotransmitters you exactly need to tweak. Prozac (fluoxetine hydrochloride) is the weakest of the SSRIs, and has the longest half-life, a combination that makes it the best SSRI to start with and the only one approved for use with kids.
Chances Prozac Will Work and How Prozac Compares to Other Meds: If you read the PI sheet you'll just see that for Major Depressive Disorder Prozac (fluoxetine hydrochloride) produced a significantly higher rate of response and remission. But no hard numbers are given. Why? Because "significant" means somewhere in the neighborhood of 20%. That doesn't look to good. So you have about a 1 in 5 chance of it, or any SSRI, doing its job. Part of the problem is that serotonin isn't always the issue with someone's depression. I'll be covering how to figure out which chemicals and/or voltage channels you need to be tweaking in your brain in a future article to try to avoid the med-go-round. Another part of the low response rate is that sometimes these are the wrong meds entirely. SSRIs are for serious depression. Milder depression may require a milder medication, such as trazodone, or no medication at all.
For OCD there are some hard numbers:
| TABLE 1 Outcome Classification (%) on CGI Improvement Scale for Completers in Pool of Two OCD Studies | ||||
| Prozac | ||||
|---|---|---|---|---|
| Outcome Classification | Placebo | 20 mg | 40 mg | 60 mg |
| Worse | 8% | 0% | 0% | 0% |
| No change | 64% | 41% | 33% | 29% |
| Minimally improved | 17% | 23% | 28% | 24% |
| Much improved | 8% | 28% | 27% | 28% |
| Very much improved | 3% | 8% | 12% | 19% |
You can see for yourself what 40mg a day of Prozac (fluoxetine hydrochloride) will do.
For Panic/Anxiety two studies in the PI sheet with patients taking 20-60mg a day had 42% and 62% of the people taking Prozac (fluoxetine hydrochloride) being free from panic attacks at the end of 12 weeks.
For PMDD, more hard numbers:
Finally for Bulima we get the same weasel wording as with Major Depressive Disorder, "significant improvement."
I'll be back with some comparisons to other meds.
| Comments:
First approved by the FDA to treat depression in December of 1987. You know what can really suck? When you've got someone who is all bipolar and hypersexual in a relationship with someone who has Major Depressive Disorder and takes Prozac (fluoxetine hydrochloride) for it, only to have her libido and all sexual response completely eliminated. Can you spell "issues"? I knew you could. And in other Prozac (fluoxetine hydrochloride) experiences, Mouse was in the Clinical Trials for Prozac (fluoxetine hydrochloride), way back when it was the first SSRI in the US (Luvox (fluvoxamine maleate) predates it in Europe). If and when she feels up to it, and her memory is together enough, she can report her side effects that give you the odds as to what your side effects will be. I'll bet folding money that hers was the anti-social reaction reported above. They probably couldn't believe that someone was that anti-social and it had to be the drug that caused it. Prozac (fluoxetine hydrochloride) is the only SSRI and modern antidepressant above for use for anyone under 18, and for good reason. Its long half-life makes compliance less of an issue. If your kid happens to miss a day's dose now and then, it's not that big a deal. Whereas with Paxil (paroxetine hydrochloride) and Effexor (venlafaxine) missing doses for even one day can start the hell that is SSRI discontinuation syndrome, and they have the worst instances of it. The syndrome is bad enough for adults, but would be beyond a nightmare for kids. See the SSRI page for more details on the vicious cycle kids can get into and how Prozac (fluoxetine hydrochloride) avoids it with its long half-life. Also by being the weakest of the SSRIs Prozac (fluoxetine hydrochloride) keeps kids from getting too much serotonin, which is also a huge problem. Serotonin syndrome is potentially fatal, and while giving kids a med like Paxil (paroxetine hydrochloride) is unlikely to be fatal in of itself, it will be suck-ass enough to cause the kids either start or ramp-up self-injurious or suicidal behavior because they are now feeling a hell of a lot worse from the meds they're taking that everyone tells them are supposed to be making them feel better. Hell, even with adults Prozac (fluoxetine hydrochloride) is the best med to start with if serotonin is the prime suspect in the chemical imbalance for the very same reasons. While its side effects may suck more than the other SSRIs, even for being the weakest SSRI on the market, if you're doing the med-go-round method of figuring out which way to fix your brain (and that's still pretty much the standard way of doing it, unfortunately), trying Prozac (fluoxetine hydrochloride) first is the safest way to go. The discontinuation syndrome sucks so much less with Prozac (fluoxetine hydrochloride). The risk of making things much worse is far lower with Prozac (fluoxetine hydrochloride). You have two ways to go when choosing your first SSRI: Fewer side effects and faster effect - then you want Lexapro (escitalopram oxalate). Less chance of just plain messing you up - you want Prozac (fluoxetine hydrochloride).
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Have questions about Prozac? Want to read about experiences other people have had with Prozac? Check out our Prozac Board.
Manufacturer: Eli Lilly
Sample US Cost:
$107 for 30 20mg capsules of brand-name Prozac or $42 for 30 20mg capsules of generic fluoxetine.As of 11/04/2003. Full retail for the uninsured. Go ahead and gloat, citizens of civilized countries and all of you with full medical coverage.
Sample Canadian Cost: $179 for 100 20mg capsules of brand-name Prozac, $109 for 100 20mg capsules of generic fluoxetine.
As of 11/04/2003. In US dollars, for re-importation to the US. Does not include shipping charges or currency conversion charges you might incur on your credit card. Currency fluctuations will alter the price on a daily basis.
Remedy Find Rating for Depression
Remedy Find Rating for Bipolar
Check for Drug-Drug Interactions
Full Patient/Prescribing/Physician Information Sheet
Canadian Monograph from Internet Mental Health
New Zealand Prozac-20 PI Sheet
UK Oxactin Specification of Product Characteristics Like a US PI sheet - what doctors get
UK Oxactin Patient Information Leaflet
UK Prozac Specification of Product Characteristics Like a US PI sheet - what doctors get
UK Prozac Patient Information Leaflet
Taiwanese U-Zet Patient Information Leaflet in traditional Chinese characters. The Taiwanese PI sheets are the worst on the planet for the dearth of information they provide.
Russian PI Sheet for Флуоксетин / Fluoexetine from Recipe.ru in Cyrillic, so I don't know who the target audience is.
Please see the section on
how to read these sheets. Don't freak out about every potential side effect. Look at the odds of something having happened during the clinical trials.
Crazy Meds Home Crazy Meds Talk About Antidepressants About SSRIs About Anticonvulsants / Mood Stabilizers About Atypical Antipsychotics About Benzodiazepines About Stimulants Finding a Doctor Sites with More Information Support Group Sites About Crazy Meds Crazy Meds: The Blog
Take care, and keep taking your crazy meds!
Jerod
If you still have unanswered questions about this or other medications,
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Meds Talk. Better yet, if you want to let the world know how they
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If you want to discuss your issues, I suggest checking out one of
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Otherwise, if you're letting me know about how much you like or hate the site,
or need to let me know about medication effects in private, then just drop
a note to jerod23 at gmail dot com Honestly, I usually don't have a
lot of time to answer e-mail these days. The snide autoresponse
message that may or may not hit your mailbox is going to tell you the same
thing.
Another problem is that you may not get a response even if I wanted to send you
one. You see, so many dickweeds with malicious intents and too much time
on their hands have appropriated the crazymeds.org domain name to use for their
spam, viruses and the like. Subsequently some lazy-ass e-mail protection
software authors just go by the domain name, and not the IP address. So
I've been blacklisted because of the actions of others. Or the software
just doesn't like the domain name because of the "crazy" and/or "meds." Or
your question about a particular medication will set off spam flags. So
the e-mail just wouldn't go through regardless. Sorry.
Hey, did you find this page all by itself through Google or some other search engine? Great! But to really appreciate the entire site, you need to start here.
Dead tree references:
Healing Anxiety & Depression
Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam's Sons. Mouse and I are both patients at one of Dr. Amen's clinics.
Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton
Essential Psychopharmacology Stephen M. Stahl, M.D., Ph. D. © 2000. Published by Cambridge University Press
A Primer of Drug Action Robert M. Julien, M.D., Ph. D. © 2001. We use the Ninth Edition. Sometimes that comes up on an Amazon search, usually it doesn't. Published by Worth Publishers
Physicians' Desk Reference Editions 53 & 56 Maria Deutsch & Anu Gupta, Drug Information Specialists, et al. © 1999, 2002. Published by Medical Economics Company.
The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc.
Handbook of Affective Disorders edited by Eugene S. Paykel, M.D. FRCPsych © 1992. Published by The Guilford Press.
Mosby's 2004 Drug Guide David Nissen PharmD, Editor.© 2004. An imprint of Elsevier. The edition we're using isn't listed on Amazon.
End of books used for this article.
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Created Friday, November 07,2003
Last updated Saturday, May 15, 2010
Copyright © 2003 - 2010 Jerod Poore. All rights reserved.
Almost all of the material on this site is copyright © 2002, 2003, 2004, 2005, 2006, 2007 and 2008 Jerod Poore. Except, of course, the PI sheets, those are the property of the drug companies who developed the drugs the sheets are about. And any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That's usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that's OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I'm cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won't necessarily happen to you. Nobody on this site is a doctor, therapist, or a pharmacist. We don't portray them either here or on TV. Only doctors can diagnose and treat an illness. Some doctors tend to get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don't be a cyberchondriac, thinking you have every disease you see a website about, or that you'll get every side effect from every medication. Self-prescribing is just as dangerous. All information on this site has been obtained through personal experience, the experiences of my friends, the experiences of people reported on online support groups, and from sources that are referenced throughout the site. Know your sources! As such the information presented here is not a substitute for real medical advice from your real doctor, just a compliment to it. No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. All brand names of the drugs listed in this site are the trademarks of the companies listed after them in the pages about the drugs, even though those companies may or may not have been acquired by other companies who may or may not be listed in this site by the time you read this. Always read the PI sheet that comes with your medications and never ever throw them away. If you didn't get a PI sheet, demand one. Loudly. Crazy Meds is not responsible for the content of sites we provide links to. We like them, or they're paid advertisements, or they're something you should read to make an informed decision about a particular med. Sometimes they're more than one of those things. But what's on those sites is their business, not ours. Very little information about visitors to this site is collected or saved. And from time to time I do look at search terms used to find it in an effort to make the information I present more relevant. Use only as directed. Void where prohibited.
"Everything is true, nothing is permitted." - Jerod Poore
