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PHARMACOLOGICAL COMPATIBILITY*

Fluoxetine Metabolization

Fluoxetine is an antidepressant belonging to the family of selective serotonin reuptake inhibitors (SSRIs) with fewer side effects than the classic tricyclic antidepressants. It selectively inhibits the reuptake of serotonin by central nervous system (CNS) neurons.

CONTRAINDICATIONS

Hypersensitivity to fluoxetine.

In combination with MAOI antidepressants, do not start treatment until 5 weeks after stopping treatment with fluoxetine or start with fluoxetine until 2 weeks after stopping treatment with irreversible MAOIs and the day after with reversible MAOIs.

CAUTIONS

Precautions should be taken when prescribing fluoxetine in patients with hepatic insufficiency, history of seizures, unstable seizure disorders/epilepsy, mania/hypomania, bleeding disorders; hepatic dysfunction; patients with congenital long cardiac interval QT syndrome, family history of QT prolongation or other clinical conditions that predispose to arrhythmias (such as hypokalemia and hypomagnesemia, bradycardia, acute myocardial infarction). Precautions should be taken in patients with diabetes; high intraocular pressure or at risk of narrow-angle glaucoma

Extreme cautions when prescribing fluoxetine in concomitance with oral anticoagulants, drugs that affect platelet function or that increase the risk of hemorrhage.

Careful monitoring should be performed in patients with a history of suicidal events and with a significant degree of suicidal ideation before initiating treatment with fluoxetine.

In children and adolescents under 18 years old: if the decision to initiate treatment is adopted, supervise the appearance of symptoms of suicide or mania/hypomania and monitor pubertal growth and development.

It is advisable to gradually reduce the dose for at least 1-2 weeks to avoid withdrawal symptoms. There is a risk of akathisia/psychomotor restlessness and ventricular arrhythmias.

Avoid concomitant administration with tamoxifen.

SIDE EFFECTS

Decreased appetite, insomnia, anxiety, nervousness, restlessness, tension, decreased libido, sleep disorders, abnormal dreams; attention disturbance, dizziness, dysgeusia, lethargy, drowsiness, tremor; blurry vision; palpitations; blush, yawns vomiting, dyspepsia, dry mouth; rash, urticaria, pruritus, hyperhidrosis; arthralgia; urinate frequently; gynecological hemorrhage, erectile dysfunction, ejaculation disorder; feeling of nervousness, chills and weight loss.

PHARMACOLOGIC INTERACTIONS

Fluoxetine is contraindicated in concomitance with MAOI antidepressants.

Fluoxetine potentiates the action of: medicinal products metabolized by CYP2D6 (it is mandatory to adjust the narrow range to the minimum therapeutic range, when concomitancy with flecainide, encainide, carbamazepine, and tricyclic antidepressants).

Fluoxetine can reduce the effect of tamoxifen.

Fluoxetine potentiates the effect of oral anticoagulants.

There is a risk of appearance of serotonin syndrome during treatment with fluoxetine along with: tramadol, triptans, lithium, tryptophan, selegiline.

The adverse effects of fluoxetine are increased with the intake of Hypericum perforatum.

Avoid taking fluoxetine with alcohol.

BRAND NAMES

  • Adofen ®
  • Luramon ®
  • Prozac ®
  • Reneuron ®

GENE OR REGION STUDIED


  • CYP2D6