Over-the-counter fluoxetine analogues and substitutes are cheaper and safer. Choosing fluoxetine analogues depending on the goal Fluoxetine synonyms analogues

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• ATH classification: fluoxetine
• Active ingredients / composition: fluoxetine

Cheap analogues of Fluoxetine

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Popular analogues of Fluoxetine

The list of drug analogues based on the statistics of the most requested drugs

All analogues of Fluoxetine

The above list of analogues of drugs, which indicates substitutes for fluoxetine, is the most suitable, since they have the same composition of active ingredients and match the indications for use

Analogues by indication and method of application

Different composition, may coincide in indication and method of application

To compile a list of cheap analogues of expensive drugs, we use the prices provided 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 options for analogues of the desired medicine, as well as prices and addresses of pharmacies in which it is available.

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fluoxetine price

fluoxetine instruction

INSTRUCTIONS
on the use of funds
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.
The composition of the capsule shell: gelatin - 36.44 mg, titanium dioxide - 1.52 mg, indigo carmine - 40 mcg.

Package
10 pieces. - cellular contour packings (2) - packs of cardboard.

pharmachologic effect
Antidepressant of the group of selective serotonin reuptake inhibitors. It has a thymoanaleptic and stimulating effect.
Selectively blocks the reverse neuronal uptake of serotonin (5HT) in the synapses of neurons of the central nervous system. Inhibition of serotonin reuptake leads to an increase in the concentration of this neurotransmitter in the synaptic cleft, enhances and prolongs its action on postsynaptic receptor sites. By increasing serotonergic transmission, fluoxetine inhibits the metabolism of the neurotransmitter by the mechanism of negative membrane communication. With prolonged use, fluoxetine inhibits the activity of 5-HT1 receptors. Weakly affects the reuptake of norepinephrine and dopamine. It does not have a 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 in endogenous depression and obsessive-compulsive disorders. It has an anorexigenic effect, can cause weight loss. Does not cause orthostatic hypotension, sedation, non-cardiotoxic. A stable 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), the use with food slightly inhibits the absorption of fluoxetine. Cmax in 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 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 an 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 an 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 administration with MAO inhibitors (and within 14 days after their cancellation);
- simultaneous reception of thioridazine (and within 5 weeks after the abolition of fluoxetine), pimozide;
- pregnancy;
- the 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;
- Hypersensitivity to the drug.

Carefully
Suicidal risk: in depression, there is a possibility of suicidal attempts, which may persist until a stable remission occurs. Individual cases of suicidal thoughts and suicidal behavior have been described during therapy or shortly after its completion, similar to the action of other drugs of close pharmacological action (antidepressants). Careful monitoring of patients at risk is necessary. Physicians should encourage patients to promptly report any thoughts or feelings that cause concern.
Seizures: Fluxetine should be used with caution in patients who have experienced epileptic seizures.
Hyponatremia: Cases of hyponatremia have been reported. Basically, 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 in the liver and excreted by the kidneys and through the gastrointestinal tract. In patients with severe hepatic impairment, it is recommended to prescribe lower doses of fluoxetine, or to 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 concentration 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.

Dosage and administration
The drug is taken orally, at any time, regardless of the meal.
depressive state
The initial dose is 20 mg 1 time / day in the morning, regardless of the meal. If necessary, the dose can be increased to 40-60 mg / day, divided into 2-3 doses (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 can 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.
The use of the drug by patients of different ages
There are no data on changes in doses depending on age. Treatment of elderly patients should be started with a dose of 20 mg / day.
Accompanying illnesses
Prescribe fluoxetine to patients with impaired liver or kidney function is recommended with the use of low doses and lengthening the interval between doses.

Use during pregnancy and lactation
Contraindicated in 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 side of the cardiovascular system: often (≥ 1% - ≤10%) - atrial flutter, hot flashes; infrequently (≥ 0.1% - ≤1%) - hypotension; rarely (≤ 0.1%) - vasculitis, vasodilation.
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 side of the central nervous system: very often (≥ 10%) - headache; often (≥ 1% - ≤10%) - impaired attention, dizziness, lethargy, drowsiness (including hyperdrowsiness, sedation), tremor; infrequently (≥ 0.1% - ≤1%) - psychomotor agitation, hyperactivity, ataxia, impaired coordination, bruxism, dyskinesia, myoclonus; rarely (≤ 0.1%) - bucco-glossal syndrome, convulsions, serotonin syndrome.
Mental disorders: very often (≥ 10%) - insomnia (including early morning awakening, initial and secondary insomnia); often (≥ 1% - ≤ 10%) - unusual dreams (including nightmares), nervousness, tension, decreased libido (including lack of libido), euphoria, sleep disturbance; infrequently (≥ 0.1% - ≤1%) - depersonalization, hyperthymia, orgasm disturbance (including anorgasmia), thought disorders; rarely (≤ 0.1%) - manic disorders.
From the side of the skin: often (≥ 1% - ≤10%) - hyperhidrosis, pruritus, polymorphic skin rash, urticaria; infrequently (≥ 0.1% - ≤1%) - ecchymosis, tendency to bruising, alopecia, cold sweat; rarely (≤ 0.1%) - angioedema, photosensitivity reactions.
From the senses: often (≥ 1% - ≤10%) - blurred vision; infrequently (≥ 0.1% - ≤1%) - mydriasis.
From the genitourinary system: often (≥ 1% - ≤10%) - frequent urination (including pollakiuria), ejaculation disorder (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); infrequently (≥ 0.1% - ≤1%) - dysuria; rarely (≤ 0.1%) - sexual dysfunction, priapism.
Post-marketing messages
On the part of the endocrine system, there have been cases of insufficiency of antidiuretic hormone.
These side effects often occur at the beginning of fluoxetine therapy or with an increase in the dose of the drug.

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 a significant improvement in treatment occurs, such patients should be under the supervision of a physician.
In children, adolescents and young people (under 24 years of age) with depression, 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 correlated with the benefits of their use. In short-term studies, the risk of suicide did not increase in people over 24 years of age, and slightly decreased in people over 65 years of age. Any depressive disorder in itself increases the risk of suicide. Therefore, during treatment with antidepressants, all patients should be monitored for early detection of violations or changes in behavior, as well as suicidal tendencies.
Against the background of electroconvulsive therapy, the development of prolonged epileptic seizures is possible.
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 persist for several weeks.
Patients with diabetes may develop hypoglycemia during fluoxetine therapy and hyperglycemia after its withdrawal. 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.

Influence on the ability to drive vehicles and control mechanisms
Taking fluoxetine can adversely affect the performance of work that requires a high rate of mental and physical reactions.

drug interaction
Fluoxetine and its main metabolite, norfluoxetine, have long half-lives, which must be considered when fluoxetine is combined with other drugs, as well as when it is replaced by another antidepressant.
You can not use the drug simultaneously with MAO inhibitors, incl. antidepressants - MAO inhibitors; furazolidone, procarbazine, selegiline, and also tryptophan (precursor of serotonin), since it is possible to develop a serotonergic syndrome, manifested in confusion, hypomania, psychomotor agitation, convulsions, dysarthria, hypertensive crises, chills, tremor, nausea, vomiting, diarrhea.
After the use of MAO inhibitors, the appointment of fluoxetine is allowed no earlier than 14 days. MAO inhibitors should not be used earlier than 5 weeks after the abolition of fluoxetine.
Simultaneous administration of drugs metabolized with the participation of the CYP2D6 isoenzyme (carbamazepine, diazepam, propafenone) with fluoxetine should be carried out using the minimum therapeutic doses. Fluoxetine blocks the metabolism of tricyclic and tetracyclic anti-depressants trazodone, metoprolol, terfenadine, which leads to an increase in their concentration in the blood serum, enhancing their action and increasing the frequency of complications.
In patients on stable maintenance doses of phenytoin, plasma concentrations of phenytoin 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.
With simultaneous use with drugs with a high degree of protein binding, especially with anticoagulants and digitoxin, it is possible to increase the plasma concentration of free (unbound) drugs and increase the risk of adverse effects.

Overdose
Symptoms: psychomotor agitation, convulsive seizures, drowsiness, cardiac arrhythmias, tachycardia, nausea, vomiting.
Other serious symptoms of fluoxetine overdose (whether fluoxetine taken alone or concomitantly with other drugs) included coma, delirium, QT interval prolongation, and ventricular tachyarrhythmia, including ventricular fibrillation and cardiac arrest, decreased blood pressure, syncope, mania, pyrexia, stupor, and a neuroleptic malignant syndrome-like condition
Treatment: specific antagonists to fluoxetine have not been found. Symptomatic therapy is carried out, gastric lavage with the appointment of activated charcoal, with convulsions - diazepam, maintenance of breathing, cardiac activity, body temperature.

Storage conditions
In a dry, dark place at a temperature not exceeding 25°C. Keep out of the reach of children.

Best before date
3 years.

pharmachologic effect

Antidepressant, a propylamine derivative. The mechanism of action is associated with selective blockade of neuronal reuptake of serotonin in the CNS. Fluoxetine is a weak antagonist of cholino-, adreno- and histamine receptors. Unlike most antidepressants, fluoxetine does not appear to cause a decrease in the functional activity of postsynaptic β-adrenergic receptors. Helps improve mood, reduces feelings of fear and tension, eliminates dysphoria. Does not cause sedation. When taken in average therapeutic doses, it practically does not affect the functions of the cardiovascular and other systems.

Pharmacokinetics

Absorbed from the gastrointestinal tract. Weakly metabolized during the "first pass" through the liver. Eating does not affect the degree of absorption, although it may slow down its rate. C max in plasma is achieved after 6-8 hours. C ss in plasma is achieved only after continuous administration for several weeks. Protein binding 94.5%. Easily penetrates through the BBB. It is metabolized in the liver by demethylation to form the main active metabolite of norfluoxetine.

T 1/2 fluoxetine is 2-3 days, norfluoxetine - 7-9 days. Excreted by the kidneys 80% and through the intestines - about 15%.

Indications

Depression of various origins, obsessive-compulsive disorders, bulimic neurosis.

Dosing regimen

Initial dose - 20 mg 1 time / day in the morning; if necessary, the dose can be increased after 3-4 weeks. The frequency of admission is 2-3 times / day.

Maximum daily dose when taken orally for adults is 80 mg.

Side effect

From the side of the central nervous system: anxiety, tremor, nervousness, drowsiness, headache, sleep disturbances are possible.

From the digestive system: possible diarrhea, nausea.

From the side of metabolism: possible increased sweating, hypoglycemia, hyponatremia (especially in elderly patients and with hypovolemia).

From the reproductive system: decreased libido.

Allergic reactions: possible skin rash, itching.

Others: pain in the joints and muscles, shortness of breath, fever.

Contraindications for use

Glaucoma, atony of the bladder, severe renal dysfunction, benign prostatic hyperplasia, simultaneous administration of MAO inhibitors, convulsive syndrome of various origins, epilepsy, pregnancy, lactation, hypersensitivity to fluoxetine.

Use during pregnancy and lactation

Contraindicated for use during pregnancy and lactation.

Use in children

Overdose

Symptoms: psychomotor agitation, seizures, drowsiness, cardiac arrhythmias, tachycardia, nausea, vomiting.

Other serious symptoms of fluoxetine overdose (whether fluoxetine taken alone or concomitantly with other drugs) included coma, delirium, QT interval prolongation, and ventricular tachyarrhythmia, including ventricular fibrillation and cardiac arrest, decreased blood pressure, syncope, mania, pyrexia, stupor, and a neuroleptic malignant syndrome-like condition

Treatment: specific antagonists to fluoxetine have not been found. Symptomatic therapy is carried out, gastric lavage with the appointment of activated charcoal, with convulsions - diazepam, maintenance of breathing, cardiac activity, body temperature.

drug interaction

With simultaneous use with drugs that have a depressant effect on the central nervous system, with ethanol, a significant increase in the inhibitory effect on the central nervous system is possible, as well as an increase in the likelihood of convulsions.

With simultaneous use with MAO inhibitors, furazolidone, procarbazine, tryptophan, serotonin syndrome may develop (confusion, hypomania, restlessness, agitation, convulsions, dysarthria, hypertensive crisis, chills, tremor, nausea, vomiting, diarrhea).

With simultaneous use, fluoxetine inhibits the metabolism of tricyclic and tetracyclic antidepressants, trazodone, carbamazepine, diazepam, metoprolol, terfenadine, phenytoin, which leads to an increase in their concentration in blood serum, an increase in their therapeutic and side effects.

With simultaneous use, it is possible to inhibit the biotransformation of drugs metabolized with the participation of the CYP2D6 isoenzyme.

With simultaneous use with hypoglycemic agents, their action may be enhanced.

There are reports of an increase in the effects of warfarin when it is used simultaneously with fluoxetine.

With simultaneous use with haloperidol, fluphenazine, maprotiline, metoclopramide, perphenazine, periciazine, pimozide, risperidone, sulpiride, trifluoperazine, cases of extrapyramidal symptoms and dystonia have been described; with dextromethorphan - a case of the development of hallucinations is described; with digoxin - a case of increasing the concentration of digoxin in the blood plasma.

With simultaneous use with lithium salts, an increase or decrease in the concentration of lithium in the blood plasma is possible.

With simultaneous use, it is possible to increase the concentration of imipramine or desipramine in the blood plasma by 2-10 times (may persist for 3 weeks after the abolition of fluoxetine).

With simultaneous use with propofol, a case is described in which spontaneous movements were observed; with phenylpropanolamine - a case is described in which dizziness, weight loss, hyperactivity were observed.

With simultaneous use, it is possible to enhance the effects of flecainide, mexiletine, propafenone, thioridazine, zuclopenthixol.

Terms of dispensing from pharmacies

The drug is dispensed by prescription.

Terms and conditions of storage

In a dry, dark place at a temperature not exceeding 25°C. Keep out of the reach of children. Shelf life - 3 years.

Application for violations of liver function

Use with extreme caution in patients with impaired liver function.

Application for violations of kidney function

Contraindicated in severe renal impairment. Use with extreme caution in patients with moderate and mild renal impairment.

Use in elderly patients

special instructions

Use with extreme caution in patients with impaired liver and kidney function, with a history of epileptic seizures, cardiovascular diseases.

In patients with diabetes mellitus, a change in blood glucose levels is possible, which requires correction of the dosing regimen of hypoglycemic drugs. When used in debilitated patients while taking fluoxetine, the likelihood of developing epileptic seizures increases.

With the simultaneous use of fluoxetine and electroconvulsive therapy, prolonged epileptic seizures may develop.

Fluoxetine can be used no earlier than 14 days after the abolition of MAO inhibitors. The period after the abolition of fluoxetine before the start of therapy with MAO inhibitors should be at least 5 weeks.

Elderly patients require correction of the dosing regimen.

The safety of fluoxetine in children has not been established.

Avoid drinking alcohol during treatment.

Influence on the ability to drive vehicles and control mechanisms

During the period of treatment, one should refrain from potentially hazardous activities that require increased attention and rapid psychomotor reactions.

International name

Group affiliation

Dosage form

pharmachologic effect

Antidepressant, selective serotonin reuptake inhibitor.

Improves mood, reduces tension, anxiety and fear, eliminates dysphoria. Does not cause orthostatic hypotension, sedation, non-cardiotoxic.

A stable clinical effect occurs after 1-2 weeks of treatment.

Indications

Contraindications

Side effects

From the nervous system: dizziness, headache, drowsiness or insomnia, lethargy, fatigue, asthenia, tremor, agitation, anxiety, suicidal tendencies (common in patients with depressive disorders), mania or hypomania.

From the digestive system: loss of appetite, dry mouth or hypersalivation, nausea, diarrhea.

Allergic reactions: skin rash, urticaria.

Other: increased sweating, weight loss, decreased libido, systemic disorders of the lungs, kidneys or liver, vasculitis.

Application and dosage

Inside, with depression, the initial dose is 20 mg / day 1 time, in the morning; if necessary, the dose is increased weekly by 20 mg / day. The maximum daily dose is 80 mg in 2-3 doses.

With bulimia and for elderly patients - 60 mg in 3 divided doses, with obsessive-compulsive disorders - 20-60 mg / day. Maintenance therapy - 20 mg / day. The course of treatment is 3-4 weeks.

special instructions

When treating patients with underweight, anorexigenic effects should be taken into account (progressive weight loss is possible).

In diabetic patients, the appointment of fluoxetine increases the risk of developing hypoglycemia and hyperglycemia - when it is canceled. In this regard, the dose of insulin and / or any other hypoglycemic drugs used orally should be adjusted. Until a significant improvement in treatment occurs, patients should be under the supervision of a physician.

During treatment, one should refrain from taking ethanol and engaging in potentially hazardous activities that require increased attention and speed of mental and motor reactions.

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.

In liver diseases and in the elderly, treatment should begin with 1/2 dose.

Interaction

Enhances the effects of alprazolam, diazepam, ethanol and hypoglycemic drugs.

It increases the plasma concentration of phenytoin, tricyclic antidepressants, maprotiline, trazodone by 2 times (it is necessary to reduce the dose of tricyclic antidepressants by 50% while using it).

Against the background of electroconvulsive therapy, the development of prolonged epileptic seizures is possible.

Tryptophan enhances the serotonergic properties of fluoxetine (increased agitation, motor restlessness, gastrointestinal disturbances).

MAO inhibitors increase the risk of developing serotonin syndrome (hyperthermia, chills, increased sweating, myoclonus, hyperreflexia, tremor, diarrhea, impaired coordination of movements, autonomic lability, agitation, delirium and coma).

Drugs that have a depressing effect on the central nervous system increase the risk of developing side effects and increasing the inhibitory effect on the central nervous system.

With simultaneous use with drugs with a high degree of protein binding, especially with anticoagulants and digitoxin, it is possible to increase the plasma concentration of free (unbound) drugs and increase the risk of adverse effects.

Fluoxetine reviews: 7

I have been taking this drug for over a month now and it seems to help with my depression. But I would not advise anyone who has signs of depression to take it. In general, writing reviews about any medication is not entirely correct and possibly dangerous. After all, the body of each individual, and this means that the selection of the drug should also be individual. Reviews are relevant about ordinary products, but not about pills, this is already too much.

I’ve been drinking flu for 2 months .... I began to sleep soundly ... I don’t know if it’s good or bad, but I sleep pregnant day and night ... but I sleep well .... but otherwise everything is fine ... I lost weight from 57 up to 49 in a month ... by the evening, cheerfulness is still rushing)) and in the morning it’s better not to wake up, it’s useless ...

I read about the side effects and it's scary to drink. 1 capsule in the morning to sleep better became like I feel calmer. my head is a little dull, as if I'm slowing down. I drink along with carbamazepine as prescribed by a doctor. Diagnosis of VVD

Who has depression against the background of a lot of weight, then generally cool !! We kill two rabbits.

Everything would be fine, but I just don’t want sex on it ((

They prescribed 10 mg 1 / day (I have problems with muscle regulation: they either relaxed or contracted, and violations occurred after taking 1 tablet of a muscle relaxant and a tablet of AD-Velafax). We waited for almost a year that it would pass, but ... Took 4 days b / s day, because. I have a weight of 44 kg and intolerance to all neurological "frills". Scheme 1 dose of 2, 5 mg - squeezed the larynx, a so-called "lump in the throat" appeared, then the limbs relaxed so much that there was a feeling that the arms were amputated to the shoulder area and , most importantly, tightness, burning and press in the head. The 2nd dose went better. In the 3rd dose I decided to increase it to 5mg - just awful: again a sharp relaxation of the muscles of the body, limbs, and my head was squeezed so that I suffered from terrible pain for 2 days, and even my face tightened (pressure in the zygomatic region, pressure on the nose , eyes) and the jaws began to contract spontaneously. 3 reception 2, 5mg is almost the same, but there was a sleep disturbance and the jaw squeezes like with bruxism. Those. I got worse. I’ll try to drink it for 2 weeks (according to the number of doses) with seduxen, but if seduxen doesn’t remove the side effects for me in the form of clenched jaws and spasms of my healthy internal organs, it’s become fried from the smell, then I’m afraid I’ll have to change it. It’s a shame, because they picked me Blood pressure according to the Fol method, because I realized that my tolerance was not good.

Anastasia, 01/26/2017, age: 16

I drank fluoxetine for about 2 months, pursued the goal of losing weight. So I lost 10 kg. The volumes dropped very quickly. I am very glad, but these 2 months were very difficult, because I slept all day, it was impossible to wake me up.

Write your review

The pharmacological property of Fluoxetine is based on its ability to inhibit the reuptake of serotonin, the main neurotransmitter called the hormone of pleasure (or happiness), into the central nervous system.

It is he who is responsible for a good mood, the absence of tearfulness, pickiness, boredom. The therapeutic effect of the drug improves the patient's psycho-emotional activity and does not affect blood pressure, the functional activity of the heart, does not cause drowsiness and lethargy.

The drug is prescribed for:

• obsessive-compulsive syndrome of obsessive states;
• various depressions;
• sleep disorders;
• bulimia nervosa;
• anorexia;
• premenstrual dysphoria;
• alcoholism.

Pros and cons of the drug

The main advantages of the drug are:

• lack of hypnotic effect and cardiotoxic action;
• availability in the pharmacy network;
• democratic value.

The disadvantages of the drug include the presence of the following side effects:

• an allergic reaction to the main component of the drug;
• pregnancy;
• breastfeeding a baby;
• pathological processes in the liver and kidneys;
• diabetes mellitus;
• epileptic states.

Such a predominance of "minuses" over "pluses" is a consequence of the fact that this drug is already outdated. To date, the pharmacological industry provides patients with modern analogues of Fluoxsetin, which have the ability to selectively affect the human body.

Clinical picture of overdose

Symptoms develop rapidly. Signs for the initial stage are as follows:

• severe nausea and vomiting;
• excitement, which is replaced by drowsiness;
• mydriasis;
• increase in heart rate to 100 per minute or more;
• minor muscle twitches;
• increased reflexes;
• convulsive seizures.

In severe cases, rigidity develops. Deterioration in overdose is accompanied by:

• rise in temperature;
• oppression of consciousness;
• difficulty breathing.

Death occurs from respiratory and heart failure.

Two cases of death have been described with the use of fluoxetine.

Lethal dose

The minimum amount is 500 mg. Severe overdose occurs with an increase in the permissible concentration by 5 times.

Dosage and administration

Inside, at any time, regardless of the meal.

Depressive state. The initial dose is 20 mg / day in the morning, regardless of the meal. If necessary, the dose can be increased to 40-60 mg / day, divided into 2-3 doses (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 can be achieved later.

Bulimic neurosis. The drug is used in a daily dose of 60 mg in 2-3 doses.

The use of the drug by patients of different ages. There are no data on changes in doses depending on age. Treatment of elderly patients should be started with a dose of 20 mg / day.

Accompanying illnesses. Prescribe fluoxetine to patients with impaired liver or kidney function is recommended with the use of low doses and lengthening the interval between doses.

Expiry date of fluoxetine

Do not use after the expiry date stated on the packaging.

Storage conditions for Fluoxetine

In a dry, dark place, at a temperature not exceeding 25 °C.

Keep out of the reach of children.

Possible analogues (substitutes)

Fluoxetine (from 28.00 rubles), Apo-Fluoxetine (from 66.70 rubles), Fluoxetine Lannacher (from 112.00 rubles), Prozac (from 430.43 rubles), Bioxetine ... doctor.

Why is the drug dangerous?

Side effects are observed if a person abuses the medicine and takes it without consulting a doctor. In this case, damage to almost all systems and organs in the human body should be expected. The abuse of pills has had a particular resonance in Canada and America.

Mode of application

Initial dose - 20 mg 1 time / day in the morning; if necessary, the dose can be increased after 3-4 weeks. The frequency of admission is 2-3 times / day.

The maximum daily oral dose for adults is 80 mg.

How to apply: dosage and course of treatment

Fluoxetine is taken by mouth.

With depression, obsessive-compulsive disorders, the initial dose is 20 mg of fluoxetine per day (in the morning), regardless of food intake. If necessary, the dose can be increased to 40 - 60 mg / day, divided into 2-3 doses. The maximum daily dose is 80 mg.

The clinical effect develops 1-4 weeks after the start of treatment, in some patients later.

In bulimia nervosa, the drug is used in a daily dose of 60 mg, divided into 2-3 doses.

Patients with renal and hepatic insufficiency, as well as those with low body weight, are recommended to use lower doses - 10 mg of fluoxetine per day and lengthen the interval between doses.

The duration of admission is determined by the attending physician and can be carried out for several years.

What does the official manufacturer's summary say?

In the cells of the brain, the very “happiness hormone” - serotonin - is actively synthesized. At the same time, the central nervous system is not inhibited, but on the contrary, it is stimulated by excipients.

The centers of hunger, localized in the brain, are effectively blocked, as a result of which there is a feeling of satiety and uncontrolled appetite is suppressed.

As a result of complex biochemical processes launched by the agent in the body, the following changes occur:

• The feeling of hunger and the desire to "seize" stress with various delicacies are eliminated;
• Portions of food for full saturation are halved;
• Rapid weight loss occurs
• Together with this, physical activity increases, self-confidence arises, a feeling of readiness to “turn mountains”;
• Irritability and apathy against the background of hunger no longer bother a woman;
• Night sleep becomes calm and strong.

It would seem that fluoxetine is an ideal tool for weight loss. And it is not for nothing that their appearance on the pharmaceutical market has been transformed into a real fashionable canon. You eat little, you can follow any strict diet, while your mood remains upbeat, and physical activity and energy grow exponentially ...

If everything were so perfect, drug manufacturers would have made a billion-dollar fortune, and not lawsuits in their favor.

CAS code

ATX

N06AB03 Fluoxetine

Therapeutic effects, pharmacokinetics

Fluoxetine is a selective inhibitor of the reuptake of the neurotransmitter serotonin in the synapses of the structures of the central nervous system. This leads to the accumulation of serotonin in the synapses, the improvement of the conduction of a nerve impulse and the development of a therapeutic effect in the form of an improvement in a person's mood (an antidepressant effect). The main active ingredient of the drug has practically no effect on the reuptake of other neurotransmitters (adrenaline, dopamine). It also does not directly affect the various receptors in the synapses of the brain. Unlike other antidepressants, it does not reduce the activity of postsynaptic beta-adrenergic receptors. The drug does not affect appetite, can lead to a decrease in the patient's body weight, does not cause the development of orthostatic hypotension (a pronounced decrease in blood pressure when the position of the human body changes from horizontal to vertical) and does not have a toxic effect on the heart. A stable therapeutic effect is usually achieved 1-2 weeks after the start of the drug.

After taking the Fluoxetine capsule orally, the active ingredient is well absorbed into the blood (bioavailability reaches 95%). It is evenly distributed in tissues and penetrates through the blood-brain barrier into the structures of the central nervous system, where it has a therapeutic effect. Metabolized in the liver with the formation of decay products due to the methylation reaction, they are excreted from the body mainly in the urine (85%) and less in the feces (15%).

Contraindications to the use of fluoxetine

Antidepressant overdose occurs when using fluoxetine on the advice of a friend, colleague, or neighbor. If the drug helped one person, then in another it will provoke serious complications, even cause death. The fact is that after a short course of therapy, fluoxetine is addictive. The dosage recommended by the doctor does not cause euphoria and the person begins to take more pills.

Attempts to cancel the drug, as a rule, are unsuccessful - a withdrawal syndrome develops. It is characterized by the following features:

• visual disturbances;
• nausea, vomiting;
• dizziness;
• trembling of hands and head;
• irritability, anxiety.

Fluoxetine should not be taken by young people under 18 years of age: many of them have a hormonal background that is not yet stable. In the United States, ten years ago, a young man staged the execution of classmates in his school. After examination, it was determined that he was under the influence of Prozac at the time of the shooting.

Acute and chronic renal failure are contraindications to taking the drug. Do not use fluoxetine in the presence of the following pathologies:

1. Increased individual sensitivity to the ingredients.
2. Hepatic pathologies.
3. Pregnancy and lactation period.
4. Diseases of the endocrine system.
5. Epilepsy.

Taking an antidepressant in such cases will cause overdose symptoms. With these diseases, there is a violation of blood filtration from toxic compounds, there are problems with their removal from the body. Taking just one tablet of fluoxetine would be a lethal dose for humans.

World experience

In the 1980s, a study was conducted that showed that fluoxetine was not suitable for treating depression. Moreover, the drug can cause the development of psychosis, mental disorders and other side effects. There are also unofficial statistics that prove that the drug has a negative effect on the body, pushing for suicide more than other antidepressants.

Despite the danger, the drug continues to be prescribed for the treatment of severe forms of depression, justified by the fact that it helps. Scientists from the University of Hull are convinced that the drug acts solely as a placebo and has no therapeutic effect.

The opinion remains that pills cannot be treated on their own. The dosage must be calculated and prescribed by a doctor, otherwise addiction and side effects may occur.

Medicinal properties

This antidepressant drug promotes selective inhibition of the reuptake of a substance such as serotonin, which subsequently causes an increase in its level directly in the synaptic cleft, there is an increase and prolongation of the effect on the postsynaptic receptors themselves. Due to the increase in serotonergic transmission by the type of negative feedback, fluoxetine contributes to the inhibition of neurotransmitter metabolism. With prolonged use of drugs, inhibition of the activity of specific 5-HT1 receptors is recorded. The drug has a mild effect on the reuptake of substances such as dopamine and norepinephrine. At the same time, there is no direct effect on H1-histamine, serotonin, α-adrenergic receptors, as well as m-cholinergic receptors. Compared with other drugs that have an antidepressant effect, it does not provoke a decrease in the activity of the postsynaptic β-adrenergic receptors themselves.

The drug exhibits a therapeutic effect in endogenous depressive states, as well as obsessive-compulsive disorders. With regular use, dysphoria is eliminated, mood improves, excessive nervous tension, severe anxiety, and a sense of fear are stopped. In addition, an anorexigenic effect is manifested, weight may decrease during treatment. The drug is non-cardiotoxic, does not provoke the development of orthostatic hypotension, when taking capsules there is no strong sedative effect. Persistent therapeutic effect is recorded after 1-2 weeks. from the start of admission.

The contents of the capsules are rapidly absorbed by the mucous membranes of the gastrointestinal tract, the highest plasma concentrations are observed after 6-8 hours. The bioavailability index does not exceed 60%. It should be noted that food intake does not affect bioavailability.

Communication with plasma proteins is recorded at the level of 94.5%. The drug component is evenly distributed in organs and tissues. Steady-state plasma concentration is reached within a few weeks.

As a result of metabolic transformations, the formation of an active metabolite, which is norfluoxetine, is observed, and several unidentified metabolites are also formed.

Approximately 80% of metabolic products are excreted by the renal system, 15% - by the intestines. The duration of the half-life is 4-6 days. In persons suffering from cirrhosis of the liver, the excretion of the drug is extended by about 3-4 p.

"Backward Effect"

Fluoxetine is a powerful drug that has a powerful effect on the functioning of the brain and nervous system. It does not have fat-burning, and even stimulating effects. Moreover, it will not "kill" your exorbitant appetite if you just like to have a snack or a big meal.

It can weaken the craving for food only if it is due to a deficiency of the "hormone of joy", i.e. has a nervous connotation. Competent physicians do not allow their patient to take the drug if they are not 100% sure of the nature and genesis of his disorder.

Fluoxetine is officially indicated to be taken in such conditions:

• Chronic depression (do not confuse with blues);
• insomnia;
• CNS disorders;
• Schizophrenia;
• migraine conditions;
• neuroses;
• Obsessive states (in particular, fear);
• Bulimia.

If the medicine is taken by an absolutely healthy person without permission, this provokes an excess of serotonin, the consequences of which can become even more deplorable than with its deficiency.

Who needs to take the drug?

A well-known antidepressant is prescribed for various mental disorders. Often this list includes:

• various kinds of depression;
• CNS disorders;
• bulimia.

And also the drug is prescribed to patients with alcoholism, social phobia, neuropathy through diabetes, panic attacks, autism and other mental disorders.

Analogues of the drug Fluoxetine

According to the structure, analogues are determined:

1. Fluval.
2. Fluoxetine hydrochloride.
3. Fluxonil.
4. Phloxet.
5. Prozac.
6. Profluzak.
7. Portal.
8. Deprenon.
9. Prodep.
10. Framex.
11. Flunisan.
12. Fluoxetine GEXAL (Lannacher; Nycomed; OBL; Canon).
13. Deprex.
14. Apo Fluoxetine.

special instructions

Before prescribing Fluoxetine capsules, the doctor must carefully read the instructions and pay attention to several features of the correct use of the drug, which include:

The active component of the drug can reduce the functional activity of the nervous system, therefore, the performance of work that requires sufficient concentration of attention and speed of psychomotor reactions is excluded.

With the simultaneous use of drugs that are actively metabolized in the liver, it may be necessary to reduce the average therapeutic dosage of capsules. Suicidal tendencies may appear in children, adolescents and young people while taking Fluoxetine capsules, which requires careful monitoring.

It is not recommended to drink alcohol during the course of drug therapy. Fluoxetine and its breakdown products are excreted from the body over a long period of time. This is important to consider when prescribing drugs of other pharmacological groups.

Patients with concomitant diabetes may have a marked decrease in blood sugar (hypoglycemia) after starting this drug. Against the background of electroconvulsive therapy (ECT), seizures of striated skeletal muscle spasms may develop.

In patients with suicidal tendencies against the background of the use of the drug, careful monitoring is required. In patients with low body weight, it may be further reduced while taking the drug, as it can reduce appetite.

In the pharmacy network, Fluoxetine capsules are dispensed by prescription. To prevent complications and negative health effects, it is not recommended to take them on their own without an appropriate medical prescription.

Children, during pregnancy and lactation

Contraindicated in pregnancy and lactation.

Use in children

In children and adolescents with depression, other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and suicidal behavior. Therefore, the appointment of the drug in childhood refers to contraindications for admission.

Active ingredient, group

Fluoxetine (Fluoxetine), Antidepressant

chemical name

(±)-N-Methyl-gamma-benzenepropanamine (and as hydrochloride); racemic (50/50) mixture of R- and S-enantiomers

fluoxetine for weight loss

Fluoxetine is often prescribed for bulimic syndrome - a mental syndrome, which is accompanied by a lack of satiety and uncontrolled overeating.

The use of the drug can reduce appetite and relieve the constant feeling of hunger.

Thus, we can conclude that fluoxetine can only get rid of excess weight if the cause of its gain is appetite.

However, the drug is not intended for weight loss, its main purpose is the treatment of depression. Decreased appetite and weight loss are side effects.

The drug is quite powerful, and the body often reacts to its intake 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 the minimum dosage - one once a day. With good tolerance, you can switch to taking two tablets - one is drunk in the morning, the second in the evening.

The maximum allowable 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 the forums confirm the effectiveness of the remedy - in 1-3 months people easily got rid of 5-13 kg. At the same time, all patients who took Fluoxetine note that drinking it only for the sake of losing weight, like Phenibut or Phenotropil, in the absence of indications, is still not worth it.

Why people are looking for fluoxetine analogues

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, Framex and Flunat can be distinguished - these are more affordable medicines that cost from 100 to 150 rubles, and their low price is due to a less eminent name.

Side effect

Fluoxetine is a high-quality and proven drug, but it has certain disadvantages, or rather a number of side effects:

• violation of the chair;
• infrequent headaches that appear an hour after ingestion;
• increased heart rate, which can lead to tachycardia;
• overdrying of the mucous membrane;
• blurred vision;
• increase in sweat secretions;
• general malaise;
• in women, when taking the drug, pain in the mammary glands and menstrual irregularities (up to several weeks) were found;
• nausea and vomiting;
• noise in ears;
• constant feeling of fatigue;
• sleep disorders;
• depressive state;
• acne and allergic irritations;
• broken bones;
• sexual apathy (loss of interest in sex).

The list of contraindications is rather big and that is why most people are looking for more harmless analogues. For example, it can be Flunat or Deprex. The preparations are distinguished by their natural composition and less aggressive effect on the patient's body.

Lack of 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 drug.

If this medicine is not in the pharmacy, then you should pay attention to Profluzak and Fluval, which are identical in their action and composition.

Recipe

Rp.: Caps. Fluoxetini 0.02 № 20

D.S. 20 mg 1 time / day.

Cross-drug interactions

The drug enhances the therapeutic effect of hypoglycemic drugs, diazepam, and alprazolam.

Fluoxetine is able to increase the plasma level of maprotiline, a number of tricyclic antidepressants, phenytoin by about 2 r.

During electroconvulsive treatment, epileptic seizures may occur.

Tryptophan is able to increase the serotonergic properties of this drug.

MAO inhibitors significantly increase the likelihood of the so-called serotonin syndrome.

Drugs that inhibit the work of the central nervous system, increase the likelihood of developing side symptoms, and also increase the inhibitory effect on the nervous system.

When taking drugs that are characterized by a high degree of binding to plasma proteins, including anticoagulants and digitoxin, an increase in the level of unbound drugs may be observed, while the likelihood of developing adverse symptoms increases.

Antidepressants do not solve the problem (suicide statistics after Prozac, worldwide Prozac ban)

The statistics of the disease are relentless and show that in the world about forty million people suffer from Prozac addiction, while the mortality and suicide rates are higher than other drugs. There was a particularly large wave of indignation in Europe, America and Canada, where the drug was withdrawn from free access, it can only be obtained by prescription, and some countries even banned its use.

In Russia, the situation with Prozac is deplorable. Despite many deaths and an understandable suicidal tendency, the pills have been approved for free access and can be bought at any pharmacy without a doctor's prescription. This has provoked an increase in the number of people addicted to antidepressants and puts their lives at risk.

Probability of toxemia

The main danger is that the substance can accumulate in the body, which leads to serious damage to the central nervous system. Probably the appearance of nightmares, suicidal tendencies.

Dosage

When deciding to treat with fluoxetine, you need to know how much to take the medication. The initial therapeutic dose is 20 mg per day. It is divided into two doses, and the first dose is taken in the first half of the day.

If necessary, the norm is allowed to be increased to 80 mg. In this case, the increase should be done gradually, at 20 mg / day.

The maximum therapeutic effect, when the drug begins to fully act, is achieved after 10-14 days of systematic use. Therefore, many, without waiting for this, increase the dose, which can provoke fluoxetine poisoning.

The lethal dose for an adult healthy person is from 10 to 20 grams. The toxic content in the bloodstream is 40 mg/l, and the death-causing content corresponds to 50 mg/l.

Signs of toxemia

If you do not follow the rules while taking fluoxetine, an overdose will manifest itself with the following symptoms:

As the substance is absorbed by the cells, the victim shows additional signs:

• convulsions;
• difficulty breathing;
• arterial hypotension;
• blanching of the skin;
• thready pulse;
• dizziness;
• fainting state.

The first symptoms and signs of an overdose

An overdose is characterized by the following symptoms:

• nausea, vomiting,
• frequent heart rate
• fever,
• constant desire to sleep
• lethargy,
• loss of consciousness,
• dizziness,
• pressure drop,
• coma.

In case of severe drug poisoning, cardiac arrest is possible, which can cause death.

However, it is impossible to say exactly what the lethal dose of this drug is, so suicidal people rarely choose it to settle accounts with life. Only two cases are known where an overdose caused death. However, in those cases, the dead also took codeine, temazipam.

Signs of intoxication in a person can be individually or all at once, much depends on the body. But in any case, you need to provide the victim with the necessary assistance.

Terms of dispensing from pharmacies

On prescription.

Side effects of fluoxetine

No poison (drug) can be used without consequences. Fluoxetine is dangerous and leads to negative changes:

Paranoia;

convulsions;

Muscle atrophy and anorexia;

Increased salivation;

Urinary and fecal incontinence;

Violations of sexual functions;

• Blood clots, arrhythmia and the risk of heart attacks.

Recovering from Prozac Addiction

Methods of narcology in the fight against fluoxetine will only help to solve physical problems and will not help to cope with a negative emotional (mental) state. The Narconon rehabilitation program will help you get rid of psychological addiction.

It takes into account all aspects of addiction, from the causes of use to the consequences (mental degradation of a person, depression, negative thoughts).

The Narconon program also gives a person the knowledge to deal with problems and difficulties. A person feels better, he has more self-confidence, he can live a full life. And 75% of those who completed the program no longer abuse either drugs, including fluoxetine, or alcohol.

Use in the elderly

There are no special instructions for dosing Fluoxetine-Canon for elderly patients.

Consequences of fluoxetine - existing risks of taking

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

• manic pursuit
• suicidal tendencies
• Dizziness
• Shiver
• convulsions
• poor appetite
• Diarrhea
• Increased salivation
• Heart rhythm disorder
• Urinary retention or incontinence
• sexual dysfunction
• Allergic rashes.

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

Allergic rashes are a common side effect of fluoxetine.

Nosological classification (ICD-10)

Contraindications and precautions

Price: from 86 to 219 rubles.

The drug is contraindicated in the following cases:

• Signs of atony of the bladder
• Pregnancy and lactation
• epileptic seizures
• Diagnosis of glaucoma
• BPH
• Pathologies of the renal system
• The development of a convulsive syndrome
• The presence of excessive susceptibility to the components.

During the treatment of underweight individuals, it is also necessary to take into account possible anorexigenic effects.

When taking capsules in the case of diabetes, the likelihood of hypo- or hyperglycemia after drug withdrawal increases. With this in mind, the dosage of hypoglycemic and insulin-containing drugs must be adjusted. You will need to stay under the supervision of a doctor until the manifestation of positive dynamics in medical therapy.

Alcohol intake during treatment is not desirable. It is necessary to be especially careful, alcohol enhances the inhibitory effect of the drug on the central nervous system. During the entire period of taking drugs, it is worth refusing to perform potentially dangerous work and drive a car.

The time interval between the end of the use of agents based on MAO inhibitors and the start of taking fluoxetine should be at least 2 weeks; between the completion of fluoxetine therapy and treatment with drugs, including MAO inhibitors - at least 5 weeks.

In the case of liver pathologies, elderly people will be prescribed ½ of the standard dose.

Pharmacology

Pharmacological action - antidepressant, anorexigenic.

It selectively inhibits the reuptake of serotonin, which leads to an increase in its concentration in the synaptic cleft, an increase and prolongation of its action on postsynaptic receptors. By increasing serotonergic transmission, it inhibits the metabolism of a neurotransmitter by a negative feedback mechanism. With prolonged use, it lowers the activity of 5-HT1 receptors. It also blocks the reuptake of serotonin in platelets. Weakly affects the reuptake of norepinephrine and dopamine. It does not have a 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 in endogenous depression and obsessive-compulsive disorders. Improves mood, reduces tension, anxiety and fear, eliminates dysphoria. It has an anorexigenic effect, can cause weight loss. In patients with diabetes mellitus, it can cause hypoglycemia, with the abolition of fluoxetine - hyperglycemia. A pronounced clinical effect in depression occurs after 1-4 weeks of treatment, in obsessive-compulsive disorders - after 5 weeks or more.

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

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

Instructions for use of capsules

The highest daily dosage is 80 mg, taken twice or thrice a day.

In the case of bulimia and when prescribing medication for elderly patients, it is recommended to drink 1 pill three times a day; When prescribing maintenance therapy, patients should take 20 mg of drugs per day. The duration of therapeutic therapy is 3-4 weeks.

Release form

Yellow film-coated tablets in blisters of 10 pcs, 1 or 2 blisters per pack.

Diagnostics

In establishing the cause of an overdose, a specific clinical picture and anamnesis help. Characteristic signs:

• severe vomiting;
• pupil dilation;
• growing convulsions;
• hyperreflexia.

• the presence of depression;
• taking fluoxetine for therapy;
• alcohol abuse.

In blood tests, neutrophils with toxic granularity may be present. There is an increased amount of protein in the urine.

Interaction with other drugs:

Fluoxetine and its main metabolite, norfluoxetine, have long half-lives, which must be considered when fluoxetine is combined with other drugs, as well as when it is replaced by another antidepressant.
Phenytoin. Changes in the concentration of phenytoin in the blood were revealed when combined with fluoxetine. In some cases, manifestations of intoxication were noted. Increasing the dose of phenytoin or fluoxetine with their simultaneous appointment should be carried out with caution and under the control of the clinical dynamics of the condition.
Serotonergic drugs. Simultaneous use of serotonergic drugs (for example, tramadol and triptans) increases the likelihood of developing serotonin syndrome. Simultaneous administration of triptans also increases the likelihood of developing coronary vasoconstriction and arterial hypertension.
Benzodiazepines. With the simultaneous use of fluoxetine and benzodiazepines, an increase in the half-life of the latter is possible. When taking alprazolam and fluoxetine together, an increase in the concentration of alprazolam in the blood and an increase in its sedative effect were observed.
Lithium and tryptophan. There are known cases of the development of serotonin syndrome while taking selective serotonin reuptake inhibitors (SSRIs) and lithium or tryptophan, and therefore the simultaneous administration of fluoxetine with these drugs should be carried out with caution. With the simultaneous administration of fluoxetine and lithium, more frequent and careful monitoring of the clinical condition is necessary.
Drugs metabolized with the participation of the CYP2D6 isoenzyme (propafenone, carbamazepine, tricyclic antidepressants). It should be borne in mind that the metabolism of fluoxetine (as well as tricyclic antidepressants, as well as selective serotonergic antidepressants) is carried out with the participation of the CYP2D6 isoenzyme of the liver cytochrome system. Simultaneous administration of drugs, the main route of biotransformation of which is metabolism with the participation of the CYP2D6 isoenzyme, and having a small interval of therapeutic doses (such as propafenone, carbamazepine, tricyclic antidepressants), should be carried out using the minimum therapeutic doses. The above also applies if less than 5 weeks have passed since fluoxetine was discontinued.
Indirect anticoagulants and other drugs that affect the blood coagulation system (Non-steroidal anti-inflammatory drugs, acetylsalicylic acid). It is known about the change in anticoagulant action (by laboratory parameters and / or clinical manifestations) without any general characteristic trend, but with the likelihood of increased bleeding while taking fluoxetine and oral anticoagulants. The functional state of the blood coagulation system in patients receiving warfarin should be carefully monitored when prescribing and canceling fluoxetine.
Electroconvulsive therapy (ECT). There are rare reports of an increase in the duration of seizures in patients taking fluoxetine and receiving ECT, and therefore caution is advised.
Alcohol. In experimental studies, fluoxetine did not increase the concentration of alcohol in the blood, as well as enhance the effects of alcohol. However, concomitant use of SSRIs and alcohol is not recommended.
Products based on the plant Hypericum perforatum. As with other SSRIs, a pharmacodynamic interaction between fluoxetine and agents based on the plant Hypericum perforatum may develop, which may lead to increased undesirable effects.

Content

According to the pharmacological classification, Fluoxetine (Fluoxetine) refers to antidepressant drugs. Its active substance fluoxetine acts on most receptors in the brain. The tool is produced by Ukrainian and Russian pharmaceutical companies.

Composition of Fluoxetine

Pharmacological properties

The composition of the antidepressant includes a propylamine derivative, the action of which is associated with a selective blockade of the reverse neuronal uptake of serotonin in the central nervous system. The active component weakly antagonizes cholinergic, histamine and adrenoreceptors, does not reduce the functional activity of postsynaptic beta-adrenergic receptors. By taking the capsules, the mood improves, the feeling of fear and tension decreases, and dysphoria is eliminated. The drug does not cause a sedative effect, does not affect the function of the heart and blood vessels.

Once inside, the active ingredient is absorbed in the stomach, poorly metabolized during the first passage through the liver. In the presence of food in the stomach, the rate of absorption slows down. Fluoxetine reaches a maximum in blood plasma after 7 hours, binds to albumin by 94.5%, and penetrates into the meninges. Metabolism occurs by demethylation, the inactive metabolite norfluoxetine is formed. The half-life of the drug is 2-3 days, metabolites - 7-9 days. Excretion is carried out by the kidneys and intestines.

Indications for the use of fluoxetine

Instructions for use highlights the following indications for the use of the drug:

• depression of various origins, accompanied by phobias;
• bulimic neurosis;
• obsessive-compulsive disorders.

How to take fluoxetine

Fluoxetine is for adults only. It is taken in the initial daily dose of 20 mg in the morning, if necessary, it is increased after 3-4 weeks to 60-80 mg. Capsules are used 2-3 times a day. The maximum daily adult dose is 80 mg, in the elderly - 60 mg. With bulimic neurosis, 1 tablet is indicated three times a day, with obsessive-compulsive disorder - 20-60 mg per day. The maintenance daily dose is 20 mg.

How long does it take for the drug to work

After 2 weeks of constant medication, there is a significant improvement in the patient's condition. In case of failure of the liver, kidneys, in old age or when taking other drugs, the dose is halved. Sometimes patients are transferred to an intermittent appointment. Abrupt withdrawal of treatment is not recommended, the dose is reduced gradually over 1-2 weeks to avoid withdrawal syndrome. If after stopping therapy or reducing the dosage, the patient's condition worsens, return to the previous dose. After the appearance of positive dynamics, you can try to reduce the dose.

The duration of the course of treatment

To eliminate depressive symptoms, it is necessary to take pills for six months. With obsessive manic disorders, the patient is treated for 10 weeks, then continued if necessary. If there is no effect, the therapy regimen is changed. With positive dynamics, treatment continues with a minimum maintenance dose. Periodically, the doctor changes the dosage based on the patient's condition.

For bulimia nervosa and obsessive manic disorders, treatment can last up to 12–24 weeks. After completion of treatment, the active ingredient is in the blood for another 2 weeks, which is important to consider when prescribing other drugs.

fluoxetine for weight loss

Fluoxetine tablets are often used to treat bulimic syndrome - a mental disorder in which there is no feeling of fullness, uncontrolled overeating is manifested. Taking the drug reduces appetite, relieves the constant feeling of hunger, helps to lose weight if the cause of weight gain is bulimia. Decreased appetite and weight loss are side effects, but the medication is not intended to shed extra pounds.

If you take the drug uncontrollably, anaphylactic reactions, damage to the lungs, kidneys, skin, and liver may develop. To get rid of bulimia and weight loss, pills are taken 1 pc. per day, with good tolerance - 2 pcs. (morning and evening), but not more than 4 pcs. per day. The drug acts after 4-8 hours, completely excreted from the body in a week. For 1-3 months of admission, you can lose weight by 5-13 kg.

special instructions

Instructions for the use of Fluoxetine suggests considering the point of special instructions:

1. The drug is taken with caution in violation of the function of the kidneys, liver, epileptic seizures in history, diseases of the heart and blood vessels.
2. In diabetes mellitus, taking pills can change the level of glucose in the blood, which leads to the need to adjust the dosage of hypoglycemic drugs.
3. With weakness in patients, the likelihood of developing epileptic seizures increases. Their duration increases with simultaneous electroconvulsive therapy.
4. In old age, the dose is reduced. The medicine is not used in children, in combination with alcohol.
5. While taking the capsules, you must refrain from driving a car, operating mechanisms.

During pregnancy

The tool is prohibited for use during pregnancy and lactation. According to studies, if women in the first trimester of bearing a child were treated with the drug, the children developed congenital anomalies in the structure of the vessels or the heart. Reception of fluoxetine in the last trimester may lead to an increase in the duration of artificial ventilation in newborns, tube feeding, hospitalization.

Infants develop convulsions, constant crying, hypoglycemia, nervous irritability, excitability, distress syndrome, lability of body temperature and pressure, tremor, cyanosis, vomiting, hyperreflexia, and feeding difficulties. During feeding, taking capsules is also prohibited.

drug interaction

The antidepressant fluoxetine can be taken 2 weeks after discontinuation of monoamine oxidase inhibitors. If the transition to these drugs is carried out after treatment with the drug, then 5 weeks should pass. Other drug interactions:

1. The combination of a drug with drugs that depress the brain, enhances the effect of the latter, leads to the development of seizures.
2. The combination of the drug with furazolidone, tryptophan, procarbazine leads to the development of serotonin syndrome.
3. Fluoxetine inhibits the metabolism of trazodone, tricyclic, tetracyclic antidepressants, diazepam, metoprolol, phenytoin, terfenadine, enhances the effect of hypoglycemic agents, warfarin.
4. The combination of the drug with fluphenazine, haloperidol, maprotiline, perphenazine, metoclopramide, periciazine, risperidone, pimozide, trifluoperazine, sulpiride can lead to dystonia, with dextromethorphan - to hallucinations, with propofol - to spontaneous movements, with phenylpropanolamine - to dizziness, hyperactivity, weight loss body.
5. The drug increases the concentration of lithium in plasma while taking metal salts, the level of imipramine, desipramine, digoxin.
6. The agent enhances the effects of thioridazine, flecainide, zuclopenthixol, mexiletine, propafenone.

side effects of fluoxetine

During treatment with the drug, side effects may develop:

• sleep disturbance, anxiety, headache, tremor, drowsiness, nervousness;
• diarrhea, nausea;
• increased sweating (hyperhidrosis);
• hypoglycemia, hyponatremia;
• decrease in libido;
• suicidal thoughts, anxiety;
• arterial hypotension;
• metabolic acidosis, hepatitis, bruxism;
• allergies, itching, skin rash, alopecia, dermatitis, psoriasis, erythema;
• hyperuricemia;
• hypercholesterolemia, hypokalemia, hypocalcemia, hypothyroidism;
• lymphadenopathy;
• joint, muscle pain, arthralgia, arthritis;
• difficulty breathing, fever (hyperthermia), anorexia, chills.

Overdose

Symptoms of fluoxetine overdose are manifested by vomiting, epilepsy, nausea, convulsions, agitation, anxiety, hypomania. According to doctors, high doses of the drug in combination with temazepam, codeine, maprotiline can result in death from renal failure. The victim is washed with a stomach, given enterosorbents, diazepam, norepinephrine. Blood transfusion, peritoneal dialysis, hemodialysis, and forced diuresis are not effective in case of intoxication.

Contraindications

Instructions for use indicates contraindications for taking capsules:

• hypersensitivity to the components of the drug;
• pregnancy, lactation;
• glaucoma;
• epilepsy;
• atony of the bladder;
• convulsions;
• violation of the kidneys;
• hyperplasia or adenoma of the prostate.

Terms of sale and storage

The product belongs to prescription, is stored away from children at temperatures up to 25 degrees for no longer than five years.

Analogues

You can replace the drug with antidepressants, which include the same or a different active ingredient. Fluoxetine analogs:

• Adepress, Reksetin - tablets based on paroxetine;
• Asentra, Serlift - tablets containing sertraline;
• Paroxetine - tablets with the same active ingredient;
• Elycea, Lenuksin - tablets based on escitalopram.

Fluoxetine price

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