Fluoxetine similar drugs without prescriptions. Over-the-counter fluoxetine analogues and substitutes are cheaper and safer. Use in the elderly

Fluoxetine, also known under the trade name Prozac, is one of the most popular antidepressants and belongs to the group of selective serotonin reuptake inhibitors.

It was created in 1974 and, after passing all the necessary security checks, entered the retail market in 1987. Over the years on the market, it has confirmed its high efficiency and has not lost its relevance to this day. There are hundreds of millions of prescriptions for fluoxetine-containing antidepressants worldwide.

A detailed academic article on this drug can be found on Wikipedia.

The principle of action of fluoxetine can be in a highly simplified form, "on the fingers", can be represented as follows.

Our body has a neurotransmitter called serotonin. It affects many internal processes, including digestion and vascular tone, but primarily on our mental well-being - self-confidence, calmness, the ability to enjoy life. If for some reason the level of serotonin is insufficient, a person may begin to experience depression, blues, complex for far-fetched reasons and always doubt himself.

Why the body may be deficient in serotonin is a complex and multifaceted question. We are more interested in what can be done to bring his balance back to normal. And there are two ways to bring the balance back to normal - increase the incoming flow or reduce the outgoing one.

The incoming flow can be increased in a variety of ways - for example, by systematic sports or oriental health practices, meditation. The problem is that often a serotonin-deficient person does not have the strength to force himself to do this, and then also to wait for the results.

Another way to increase the incoming flow is by drinking alcoholic beverages. Once in the body, alcohol causes a sharp release of serotonin, which improves mood, inner stiffness disappears and life begins to seem more pleasant and colorful for a while. And then the intoxication passes, the level of serotonin falls back, there comes a need for repetition. The negative impact of alcohol on the ability to think and its general destructive effect on the body is obvious to everyone, but, unfortunately, for many people, alcohol libations are the only known and proven effective way to somehow maintain their psycho-emotional state.

But after all, serotonin in one quantity or another is produced by any organism! This means that it is not necessary to interfere in the processes of its production - you can try to somehow slow down its removal and come to a normalization of the balance on this side. It is on this principle that the effect of fluoxetine is based - it initiates the reuptake of serotonin, preventing it from being excreted as quickly as before. Together with the fact that in some volumes serotonin is produced one way or another in the body, this eventually leads to an increase in its amount.

This path is much more gentle, since we do not bring anything to the body beyond what was already in it, and is much better controlled by the intensity of the impact - unlike the same alcohol, which provokes an excessively large one-time release of serotonin, or playing sports , the one-time effect of which is insufficient, and the cumulative effect is excessively extended in time.

In a more scientific language, the principle of action of fluoxetine and other drugs of the SSRI group is described in the instructions for them, and is more clearly shown in the video below.

Medicines with fluoxetine

Many fluoxetine-based antidepressants are currently available on the market under various trade names.

• Prozac
• Prodep
• Profluzak
• Fluval
• fluoxetine
• Fluoxetine-Acri
• Fluoxetine-Canon
• Fluoxetine Hexal
• Flunisan
• fluoxetine hydrochloride
• Fluoxetine Lannacher
• Apo-Fluoxetine
• Fluxen

The best fluoxetine-containing drug

What is the best drug available on the market? In fact, this is a difficult question, because all of them are based on the same active substance - fluoxetine, and it is not clear how, apart from the trade name, one drug differs from another. Therefore, it is recommended to start with one of the two most common brands in Russia - Fluoxetine-Canon or Fluoxetine Lannacher. Both drugs have many positive reviews. In rare cases, it may turn out that the purchased drug is subjectively “not yours” - this is completely normal, and in such a situation it is worth trying to simply change fluoxetine from one brand to another.

And in order not to experience the pangs of choice, you can immediately give preference to Prozac, the oldest drug based on fluoxetine, which was brought to the market by Eli Lilly, which originally discovered and registered the substance fluoxetine in 1974. The only disadvantage of Prozac is the higher cost compared to analogues.

Fluoxetine analogs

Fluoxetine analogues include other andidepressants from the SSRI group.

• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Citalopram
• Escitalopram (Cipralex)
• Alaproclat
• Fluvoxamine (Fevarin)
• etoperidon
• Zimelidine
• Dapoxetine
• Indalpin
• Vilazodon
• Venlafaxine
• Desvenlafaxine
• Duloxetine
• Milnacipra
• Levomilnacipran
• Atomoxetine
• Bupropion

The basis of their action is the same principle, but different active substances. In case of individual intolerance to fluoxetine or insufficiency of exposure, it is necessary to try other drugs.

In no case should you start taking a new SSRI drug less than 2 weeks after stopping the previous SSRI drug or antidepressants of the MAO inhibitor group. Ignoring this prescription will lead to the fact that the interactions of several different active substances of the SSRI group will overlap each other, which can provoke serotonin syndrome - a very unpleasant and potentially deadly phenomenon.

useful links

• Recommendations for choosing an SSRI drug for depressive disorder

Prescription for fluoxetine

Fluoxetine is dispensed from pharmacies by prescription, since the decision to prescribe antidepressants and other psychoactive drugs can only be made by a qualified specialist after personal consultation with the patient.

Can you buy fluoxetine without a prescription?

However, it is quite possible to buy fluoxetine even without a prescription. Since this drug does not give the effect of euphoria and is not suitable for recreational use, and is also not a precursor for the manufacture of drug-containing drugs, it is not included in the list of drugs for medical use subject to subject-quantitative accounting.

How to buy fluoxetine without a prescription

To purchase fluoxetine without a prescription, you need to give the impression of an adult sane person who controls himself and understands what he is doing.

It should be understood that the decision to sell this or that drug without a prescription is primarily a matter of morality. Therefore, it is likely that a pharmacy pharmacist will want to refuse to sell to a person who outwardly can be mistaken for a teenage boy, or a young girl - because it is no secret to anyone that girls tend to not be fully aware of the consequences of such behavior, which can lead to negative results.

A well-groomed appearance, age over 25, a calm voice and a lack of nervousness in behavior with a probability of 80% will ensure the purchase of any prescription drug, even in the absence of a paper prescription on hand.

Fluoxetine in popular culture

• The 2001 film Prozac Nation features a young journalist who takes Prozac (the brand name for Eli Lilly's antidepressant drug fluoxetine) to cope with depression.
• Tony Soprano, one of the protagonists of the crime series The Sopranos, takes Prozac
• In 2010, the film "Love and other drugs" was released, the main character of which works as a medical representative and actively participates in the competition between Prozac (fluoxetine) and Zoloft (sertraline), belonging to the same group of antidepressants.

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

pharmachologic effect

The drug has an anorexigenic effect, eliminates depression and relieves the feeling of depression.

Pharmacodynamics and pharmacokinetics

Fluoxetine - what is it?

The active substance of the drug fluoxetine hydrochloride is a white (or almost white) crystalline powder, sparingly soluble in water.

What is fluoxetine?

Fluoxetine is a selectively inhibitory neuronal reuptake of serotonin (ONZR) agent. The drug belongs to the pharmacotherapeutic group “Antidepressants”.

Pharmacodynamics

The medicine is intended for oral administration. The mechanism of its action is associated with the ability to selectively (selectively) and reversibly inhibit ONZS.

The antidepressant fluoxetine has little effect on the uptake of dopamine and norepinephrine and has little effect on acetylcholine receptors and H1-type histamine receptors.

Along with antidepressant, it also has a stimulating effect. After taking the tablets / capsules, the patient's feeling of fear, anxiety and mental tension decreases, mood improves, symptoms of dysphoria are eliminated.

Wikipedia notes that the drug does not cause orthostatic hypotension, does not have a sedative effect, and is not cardiotoxic.

It takes 3 to 4 weeks to achieve a stable clinical effect with regular use of the drug.

Pharmacokinetic parameters:

• absorption in the alimentary canal is good;
• bioavailability - 60% (when taken orally);
• TSmax - from 6 to 8 hours;
• binding to plasma proteins (including alpha (α)-1-glycoprotein and albumin) - 94.5%;
• T½ hour.

The liver is involved in the metabolism of the substance. As a result of its biotransformation, a number of unidentified metabolites are formed, as well as norfluoxetine, the selectivity and activity of which are equivalent to those of fluoxetine.

Pharmacologically inactive metabolic products are eliminated by the kidneys.

Due to the fact that the substance is excreted from the body rather slowly, the plasma concentration necessary to maintain the therapeutic effect is maintained for several weeks.

Indications for use: why are tablets and Fluoxetine prescribed?

Indications for the use of Fluoxetine:

• depression (especially accompanied by fears), including with the ineffectiveness of other antidepressants;
• obsessive-compulsive disorder (OCD);
• kinorexia (to reduce uncontrolled food cravings, the drug is used as part of complex psychotherapy).

Contraindications

The drug is not prescribed for:

* After the use of MAO inhibitors, Fluoxetine can be used no earlier than 14 days later; MAO inhibitors after the end of the course of treatment with Fluoxetine are prescribed no earlier than after 5 weeks.

side effects of fluoxetine

General disorders that occur during the use of the drug can manifest themselves in the form of hyperhidrosis, chills, heat or a feeling of cold, photosensitivity, neuroleptic syndrome, alopecia, lymphadenopathy, anorexia, erythema multiforme, which can progress to malignant exudative or develop into Lyell's syndrome.

Some patients experience symptoms of serotonin toxicity, including:

On the part of the digestive system, the following are possible: diarrhea, nausea, loss of appetite, vomiting, dysphagia, dyspepsia, change in taste, pain in the esophagus, dry mouth, dyskinesia, liver dysfunction. In isolated cases, idiosyncratic hepatitis may develop.

CNS reactions to taking pills are manifested in the form of: bruxism, headache, weakness, sleep disturbances (night delirium, pathological dreams, insomnia), dizziness, fatigue (hypersomnia, drowsiness); disturbances of attention, processes and concentration of thinking, memory; anxiety and associated psycho-vegetative syndrome, dysphemia, panic attacks, suicidal thoughts and / or attempts to take one's own life.

The possibility of developing is not excluded:

Discontinuation of treatment with the drug can provoke a withdrawal syndrome, the main signs of which are: sensitivity disorders, dizziness, sleep disorders, asthenia, nausea and / or vomiting, agitation, headache, tremor.

Reviews of side effects indicate that the drug is addictive when taken uncontrolled. In some cases, the addiction is so strong that a person needs the help of a specialist to treat it.

Other adverse reactions that patients mention in the reviews are severe drowsiness, tremors, convulsions, decreased appetite, and nausea. However, there are people who, during the treatment, did not have any undesirable effects at all.

Instructions for use Fluoxetine

Tablets are taken orally. Eating does not affect the absorption of the drug.

To relieve depressive symptoms, the drug should be taken once a day, in the morning, at a dose of 20 mg. If clinically necessary, 3-4 weeks after the start of therapy, the frequency of doses is increased to 2 r. / day. (tablets are taken in the morning and in the evening).

Patients with an insufficient response to treatment at a dosage of 20 mg / day, in some cases, the daily dose is gradually increased by domg. In this case, you need to divide it into 3-4 doses. The highest dose for elderly and senile people is 60 mg / day.

Dosage for bulimic neurosis - 60 mg / day. (tablets are taken 3 rubles / day, one at a time), with OCD - depending on the severity of clinical symptoms - from 20 to 60 mg / day.

It should be borne in mind that increasing the dose may increase the severity of side effects.

Maintenance dose - 20 mg / day.

When does the drug start to work?

A significant improvement in the condition is usually noted after about 2 weeks of systematic medication.

How long should I take fluoxetine?

It takes six months to eliminate depressive symptoms.

With obsessive manic disorders (HMP), the drug is given to the patient for 10 weeks. Further recommendations depend on the results of treatment. If there is no clinical effect, the treatment regimen with Fluoxetine is reviewed.

In the presence of positive dynamics, therapy is continued with the use of an individually selected minimum maintenance dose. The patient's need for further treatment should be reassessed periodically.

Long-term - more than 24 weeks in patients with NMR and more than 3 months in patients with bulimia nervosa - has not been studied.

After completion of treatment with Fluoxetine, the active substance circulates in the body for another 2 weeks, which should be taken into account when stopping treatment or prescribing other drugs.

Patients with insufficiency of liver / kidney function, elderly people with concomitant diseases, as well as patients taking other drugs, are prescribed a half dose of the drug. In some cases, it is advisable to transfer the patient to an intermittent reception.

If, after a dose reduction / withdrawal of the drug, the patient's condition worsens, it is necessary to return to treatment with the previous effective therapeutic dose. Gradual dose reduction is resumed after the appearance of positive dynamics.

If we compare Fluoxetine and Fluoxetine Lannacher or Fluoxetine and Fluoxetine OZONE, we can conclude that the instructions for use of Fluoxetine Lannacher and Fluoxetine OZONE provide recommendations similar to those listed above.

Overdose

An overdose of fluoxetine is accompanied by: nausea / vomiting, convulsions, hypomania, anxiety, agitation, grand mal seizures.

The victim of an overdose should wash the stomach, give sorbitol, enterosorbent and - with convulsions - diazepam. It is also important to monitor respiratory activity and parameters characterizing the functional state of the heart. In the future, symptomatic and supportive therapy is carried out.

Interaction

Doubles the plasma concentration of tricyclic antidepressants, phenytoin, trazodone, maprotiline. When prescribing fluoxetine in combination with tricyclic antidepressants, the dose of the latter should be reduced by 50%.

May provoke an increase in the plasma concentration of Li +, which in turn increases the likelihood of developing its toxic effects. In the case of simultaneous use, it is recommended to control the concentration of Li + in the blood.

The use as an adjunct to electroconvulsive therapy can cause the development of prolonged epileptic seizures.

The serotonergic effects of the drug are enhanced in combination with tryptophan. The likelihood of developing serotonin intoxication increases in the case of simultaneous administration with agents that suppress the MAO enzyme.

The likelihood of adverse reactions and increased inhibitory effect on the central nervous system increases in combination with drugs that depress the central nervous system.

Reception with drugs that are characterized by a high degree of protein binding can provoke an increase in the plasma concentration of unbound (free) agents, as well as an increase in the likelihood of developing undesirable effects.

Terms of sale: how is fluoxetine dispensed - by prescription or not?

You cannot buy fluoxetine without a prescription.

Storage conditions

Tablets should be stored below 25°C.

Best before date

special instructions

In the treatment of patients with low body weight, when prescribing the drug, anorexigenic effects should be taken into account.

Diabetics may develop hypoglycemia during treatment with fluoxetine, and after discontinuation of the drug, hyperglycemia. With this in mind, it is recommended to make changes in the dosing regimen of insulin and / or oral hypoglycemic agents. Until the clinical picture improves, patients with diabetes should be under constant medical supervision.

During the period of treatment, it is necessary to refrain from engaging in activities that require a high speed of psychomotor reactions and increased attention.

The tablets contain lactose, so they should not be taken with galactosemia, lactase deficiency, glucose / galactose malabsorption syndrome.

Like other antidepressants, fluoxetine can cause affective disorders (mania or hypomania).

The central organ of drug metabolism is the liver, the kidneys are responsible for the excretion of metabolites. Patients with liver pathologies should be given low or alternative daily doses.

In renal failure (with Clcr less than 10 ml / min.) After 2 months of treatment with a dose of 20 mg / day. plasma concentration of fluoxetine/norfluoxetine is the same as in patients with healthy kidneys.

Depression is associated with an increased risk of suicidal thoughts and suicide attempts. The risk persists until complete remission. Clinical experience with the drug shows that the risk of suicide increases, usually in the early stages of recovery.

Patients with mental illness and depressive syndrome should be under constant supervision. In placebo-controlled studies in a group of patients treated with antidepressants, it was found that the risk of suicidal behavior is highest in people younger than 25 years of age.

Patients who have been switched to a lower/higher dose also require special monitoring.

The use of fluoxetine is associated with the development of akathisia, the subjective signs of which are the constant need to be in motion, as well as the inability to sit or stand. These phenomena are especially pronounced in the first weeks of treatment. For patients who develop similar symptoms, the drug is prescribed in the minimum effective dose.

With abrupt discontinuation, approximately 60% of patients develop withdrawal symptoms. The likelihood of their occurrence depends on the dose used, the duration of the course, as well as the level of dose reduction. The dose is recommended to be reduced by titration within 7-14 days.

There are reports of the appearance of subcutaneous hemorrhages, such as purpura or ecchymosis, during the period of treatment with the drug. Therefore, in patients taking oral anticoagulants that affect platelet function and increase the likelihood of bleeding agents, as well as in patients with a history of bleeding, fluoxetine is prescribed taking into account possible risks.

Fluoxetine's analogs

Which is better: Prozac or Fluoxetine?

The active ingredient in Prozac is fluoxetine. Therefore, when choosing in favor of one or another means, the decisive factors are the price and subjective feelings. The cost of Fluoxetine is significantly lower than the cost of its counterpart.

For kids

Not for use in patients under 18 years of age.

A nineteen-week clinical study showed that in children suffering from depression 8-18 years of age, the use of fluoxetine causes a decrease in height and body weight. The effect of the drug on the achievement of normal growth in adulthood has not been studied.

At the same time, the possibility of growth retardation in puberty cannot be ruled out.

fluoxetine and alcohol

Drinking alcohol during treatment with Fluoxetine is contraindicated.

fluoxetine for weight loss

Fluoxetine is often prescribed for bulimic syndrome - a mental syndrome, 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.

During pregnancy

The safety of the drug in pregnant women has been little studied, the results of some published epidemiological studies are contradictory. Some randomized and cohort studies have not found an increase in the likelihood of congenital anomalies.

A prospective study conducted by ENTIS suggests an increased likelihood of developing congenital anomalies in the structure of large vessels or the heart in children whose mothers took fluoxetine in the 1st trimester of pregnancy, compared with children whose mothers did not receive this drug.

A reliable relationship between taking the drug in early pregnancy and the formation of malformations in the fetus could not be established. A specific group of CCC anomalies has also not been identified.

The use of SSRIs in the last weeks of pregnancy contributes to the development of complications in newborns, in particular, an increase in the duration of mechanical ventilation and tube feeding and the duration of hospitalization.

There are references to the development of apnea, respiratory distress syndrome, seizures, hypoglycemia, lability of body temperature and blood pressure, tremor, hyperreflexia, vomiting, cyanosis, difficulty with adequate nutrition, constant crying, excitability, nervous irritability.

The listed pathological conditions may be a consequence of the withdrawal syndrome of SSRIs or a manifestation of their toxic effects.

Fluoxetine Reviews

Reviews of patients taking Fluoxetine (APO, Lannacher, Canon) leave the impression of the effectiveness of this drug in depression, bulimic neurosis and OCD.

The forums also often discuss the possibility of using the drug for appetite control and weight correction.

The doctors' comments about Fluoxetine for weight loss are unambiguous: you can use the medicine to fight extra pounds only if the cause of weight gain is a mental disorder.

When excess weight is the result of overeating caused by depression or stress, the drug allows you to completely get rid of binge eating attacks in 2-3 weeks and remove up to 5 kg in the first month.

Reviews of those losing weight about Fluoxetine (Lannacher, OZONE, etc.) allow us to conclude that not everyone succeeds in losing weight on this drug: someone’s appetite disappears completely (up to disgust in food), someone remains former.

However, in most cases, the drug has quite serious side effects: many people who took it noted a decrease in sexual desire and a deterioration in sexual life, a feeling of lethargy, severe pain, drowsiness, increased aggression, and the appearance of suicidal thoughts.

In addition, for many losing weight, the disadvantages of the drug were the need to give up driving a car and drinking alcohol, as well as the fact that Fluoxetine is highly addictive.

Summarizing the reviews, we can draw the following conclusions: Fluoxetine is primarily a cure for depression and it can be taken only if indicated and only under the supervision of a doctor.

How much does fluoxetine cost?

The price in Ukraine for Fluoxetine tablets is from 11 UAH per pack No. 10. The price of Fluoxetine in package No. 20 is from 18 UAH.

The price of Fluoxetine in Russian pharmacies depends on which company produced the drug, and varies from 27 to 255 rubles. So, for example, the price of Fluoxetine Lannacher in St. Petersburg is from 112 to 145 rubles per package No. 20, and the price of the drug produced by OZON LLC is roubles.

You can buy Apo-Fluoxetine in Moscow or St. Petersburg for a dime.

The cost of the drug in Belarus is about 120 thousand rubles.

Do I need a prescription for the drug? Undoubtedly needed. After all, Fluoxetine is far from harmless pills. Side effects with uncontrolled use of the drug can be quite serious.

Due to the fact that the drug is not available without a prescription, many are interested in the question of how to buy Fluoxetine online. The attitude to prescription drugs in online pharmacies is no less strict than in conventional ones.

In most cases, when receiving the pills, it is enough to show the doctor's prescription to the courier, but some pharmacies do not deliver prescription drugs, so you need to personally drive up to pick up the medicine.

• Internet pharmacies in Russia Russia
• Internet pharmacies of Ukraine Ukraine
• Internet pharmacies of Kazakhstan Kazakhstan

WER.RU

ZdravZone

Pharmacy IFK

Pharmacy24

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BIOSPHERE

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Dana: The drug is good, you need to take it for a long time, but due to this you are cured as it should and.

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All materials presented on the site are for reference and informational purposes only and cannot be considered a method of treatment prescribed by a doctor or sufficient advice.

We choose analogues of Fluoxetine depending on the goal

Fluoxetine is a strong antidepressant intended for drug therapy in obsessive and depressive states, which are accompanied by the presence of anxiety and fears.

The systematic use of this drug helps patients overcome apathy, improve mood, normalize appetite and sleep, reduce feelings of fear and tension.

First encounter with medicine

The active ingredient of the drug is fluoxetine hydrochloride.

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:

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:

• dizziness and headache;
• asthenia;
• increased sweating;
• decrease in libido;
• the appearance of pain in the bones, mammary glands;
• noise in ears;
• chair instability;
• rashes on the skin;
• dry mouth;
• violations of taste and olfactory sensations;
• decreased vision.

• 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.

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.

Analogues for the active substance, composition, action

According to the active substance fluoxetine hydrochloride, there are the following analogues:

Similar medicines in composition and effects on the body:

• Portal, composition: fluoxetine and vitamin supplements;
• Prodep, composition: fluoxetine and calcium;
• Prozac, composition: fluoxetine and sedatives.

Unlike Fluoxetine, almost all similar drugs contain fewer impurities, which means they are more harmless.

TOP - 15 best analogues

• Apo-Fluoxetine - an antidepressant that has a calming effect and improves mood;
• Bioxetine is a fairly effective selective inhibitor, it is often prescribed for neuroses, since it has practically no side effects;
• Deprex is a remedy that contains the active substance fluoxetine, which has a sedative and invigorating effect in case of neuralgia;
• Deprenon - a potent depressant (it is prescribed for serious mental disorders);
• Portal is an antidepressant in the form of capsules, which, thanks to its natural composition, has proven itself well as a medicine in the fight against bulimia nervosa;
• Prodep is an antidepressant, a selective serotonin reuptake inhibitor that improves mood, reduces tension, anxiety and fear;
• Prozac is a natural medicine used for depression (regardless of the degree of depressive disorder - mild, moderate, severe), bulimia, anorexia, alcoholism, obsessive-compulsive disorders;
• Profluzak is a strong antidepressant used in the fight against psychological, nervous conditions;
• Flunat is an auxiliary drug based on fluoxetine, which enhances the effects of Alprazolam, Diazepam and ethanol;
• Fluval is not the most popular, but nevertheless a worthy analogue of Fluoxetine, which is used in conjunction with electroconvulsive therapy;
• Framex is an antidepressant that should be taken only under the supervision of a doctor, since when used together with other drugs, it can increase blood concentration, which can lead to adverse consequences;
• Fluoxetine-Kanon - a potent sedative used for violent nervous disorders;
• Floxet is a complete analogue of Fluoxetine, which is used for depression and other disorders;
• Fluoxetine-Lannacher is a selective inhibitor that is used for bulimia nervosa and anorexia;
• Fluoxetine - Nycomed - a sedative based on the parent drug.

The question of price and free access

Cheap analogues of the antidepressant Fluoxetine:

Over-the-counter fluoxetine analogues:

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

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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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.

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.