Does prozac cause dry mouth: Access to this page has been denied.
Common and Rare Side Effects for Prozac oral
COMMON side effects
If experienced, these tend to have a Severe expression i
Sorry, we have no data available. Please contact your doctor or pharmacist.
If experienced, these tend to have a Less Severe expression i
- problems with ejaculation
- widening of blood vessels
- throat irritation
- inflammation of the tissue lining the sinuses
- dry mouth
- the inability to have an erection
- difficulty sleeping
- flu-like symptoms
- excessive sweating
- muscle tremors
- a skin rash
- decreased appetite
- generalized weakness
- abnormal dreams
- anxious feelings
INFREQUENT side effects
If experienced, these tend to have a Severe expression i
Sorry, we have no data available. Please contact your doctor or pharmacist.
If experienced, these tend to have a Less Severe expression i
- abnormal sexual function
- altered interest in having sexual intercourse
- hyperactive behavior
- a change in vision
- ringing in the ears
- abnormal heart rhythm
- hair loss
- joint pain
- taste impairment
- weight loss
- excessive thirst
- heart throbbing or pounding
- chest pain
- an increased need to urinate often
- stomach cramps
- fast heartbeat
RARE side effects
If experienced, these tend to have a Severe expression i
- low amount of sodium in the blood
- acquired hemolytic anemia, an anemia due to destruction of red cells
- a type of blood disorder with a decrease in all types of blood cells called pancytopenia
- low blood counts due to bone marrow failure
- an increased risk of bleeding
- large purple or brown skin blotches
- decreased blood platelets
- manic behavior
- a form of mania that has a lower severity of symptoms
- suicidal thoughts
- neuroleptic malignant syndrome, a reaction characterized by fever, muscle rigidity and confusion
- serotonin syndrome, a type of disorder with high serotonin levels
- sudden blindness and pain upon moving the eye
- a clot in the lung
- pulmonary hypertension
- torsades de pointes, a type of abnormal heart rhythm
- atrial fibrillation
- prolonged QT interval on EKG
- a stroke
- thrombotic thrombocytopenic purpura, a type of blood disorder
- vocal cord swelling
- a spasm of the larynx
- pneumonia with high amount of eosinophil white blood cells
- stomach or intestinal ulcer
- liver failure
- damage to the liver and inflammation
- a blockage of the bile duct that resulting in high bilirubin levels
- bleeding of the stomach or intestines
- kidney failure
- erythema multiforme, a type of allergic skin reaction
- a skin disorder with blistering and peeling skin called Stevens-Johnson syndrome
- erythema nodosum, a skin condition with red and painful nodules
- skin rash with sloughing
- swollen lymph nodes
- trouble breathing
- abnormal liver function tests
- a significant type of allergic reaction called anaphylaxis
- a type of allergic reaction called angioedema
- a serum sickness reaction
- secondary angle-closure glaucoma, a type of eye disorder
If experienced, these tend to have a Less Severe expression i
- low blood sugar
- a high prolactin level
- mood changes
- depersonalization, a disconnection of one’s own sense of reality or identity
- grinding of the teeth
- dilated pupils
- low blood pressure
- bruising under the skin
- a type of stomach irritation called gastritis
- inflammation of the lining of the stomach and intestines
- enlarged breasts
- breastmilk production not associated with childbirth or nursing
- abnormal bleeding from the uterus
- increased sensitivity of the skin to the sun
- memory loss
- loss of muscle coordination
- a type of abnormal movement disorder called dyskinesia
- small reddish-purplish pin-point sized spots on skin
- difficult or painful urination
- bulging of the eyes
Fluoxetine (Oral Route) Side Effects
Drug information provided by: IBM Micromedex
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Hives, itching, or skin rash
inability to sit still
Chills or fever
joint or muscle pain
cool pale skin
difficulty with concentration
dryness of the mouth
fast or irregular heartbeat
lack of energy
mood or behavior changes
purple or red spots on the skin
shakiness or unsteady walk
shivering or shaking
talking, feeling, and acting with excitement and activity you cannot control
trouble with breathing
unusual or incomplete body or facial movements
unusual tiredness or weakness
Incidence not known
Abdominal or stomach pain
back or leg pains
blistering, peeling, or loosening of the skin
blood in the urine or stools
bloody, black or tarry stools
blue-yellow color blindness
chest pain or discomfort
cough or dry cough
decreased urine output
difficulty with breathing
difficulty with swallowing
dizziness or lightheadedness
fast, pounding, or irregular heartbeat or pulse
general body swelling
hives, itching, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
irregular or slow heart rate
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of appetite
loss of bladder control
no blood pressure or pulse
pain in the ankles or knees
painful, red lumps under the skin, mostly on the legs
pains in the stomach, side, or abdomen, possibly radiating to the back
pinpoint red spots on the skin
rapid weight gain
red or irritated eyes
red skin lesions, often with a purple center
redness, tenderness, itching, burning, or peeling of the skin
severe muscle stiffness
sores, ulcers, or white spots on the lips or in the mouth
stopping of heart
sudden shortness of breath or troubled breathing
sudden weakness in the arms or legs
sudden, severe chest pain
swelling of the face, ankles, or hands
swollen or painful glands
thoughts of killing oneself
tightness in the chest
twitching, twisting, or uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
unpleasant breath odor
unusual bleeding or bruising
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
unusually pale skin
use of extreme physical or emotional force
vomiting of blood
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common or rare
breast enlargement or pain
change in sense of taste
changes in vision
feeling of warmth or heat
flushing or redness of the skin, especially on face and neck
increased sensitivity of the skin to sunlight
stomach cramps, gas, or pain
unusual secretion of milk, in females
Incidence not known
Cracks in the skin
loss of heat from the body
painful or prolonged erections of the penis
swelling of the breasts or breast soreness in both females and males
unusual milk production
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Portions of this document last updated: Aug. 01, 2021
Copyright © 2021 IBM Watson Health. All rights reserved. Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes.
Antidepressants, Anti-anxiety Meds & Your Eyes
Dr. David Evans
Last modified on August 6, 2018
One in five Americans use some type of antidepressant or anti-anxiety medication. These powerful drugs can have numerous side effects, many related to your eyes and vision. I wanted to use this weekly blog update to describe these potential side effects and the implications for your quality of vision and eye health.
How are the Eyes Affected?
One of the most common eye-related side effects of antidepressants and anti-anxiety medications is blurred vision. Selective serotonin reuptake inhibitors (SSRIs) like Zoloft, Prozac, Lexapro, etc. directly affect the pupil and ciliary muscle function of the eye and can make it difficult to focus on near objects. If the patient already has an eye condition such as dry eye or glaucoma, these side effects can worsen the conditions and potentially cause significant vision problems.
And speaking of dry eye, antidepressants can actually cause it. Drugs such as citalopram, fluoxetine, fluvoxamine, alprazolam and sertraline dry-out fluids and mucus membranes in the body, leading to dry eye. They can also cause dry mouth, which has its own consequences for dental health. Strangely enough, one of the consequences of this dry eye is over-stimulation of reflex tear production, resulting in excess tear formation.
Certain mental health medications can also lead to significant changes in coordinated eye movements, creating issues for depth perception. Patients can experience vision changes caused by shifting of the lens, difficulty with accommodation (affecting your ability to focus across varying distances) and other abnormal eye movements. Specifically, lithium (which is often used to treat bipolar disorder) is known to cause eye movement-related side effects, in addition to causing dry eye.
Researchers are now growing more interested in the connection between antidepressant and anti-anxiety medications, and eye disease. A number of studies are now evaluating their impact on the development of glaucoma and cataracts. Unlike the other side effects, (which are well documented) this potential connection is in the investigational stages. Future data could create new questions and concerns for patients regularly taking these medications.
What Should You Do?
The best course of action is to ensure your eye doctor is fully aware of all medications you are taking. Such communication is key because if your doctor doesn’t have this knowledge, it could lead to confusion about managing your vision. For example, if you’ve recently started taking an antidepressant or anti-anxiety medication and are seeking a change to your eyeglasses/contacts prescription, your eye doctor will want to wait before fulfilling this request. Making a change in your prescription may or may not fix the eye problem if it is related to the medication(s).
Your doctor may wait for the symptoms to subside, stabilize or worsen, before prescribing treatment. Monitoring these vision changes over time is often best before making treatment decisions, and waiting could save you time and money. No need to pay for a new prescription, and new glasses or contacts when your vision is not stable due to medications.
In addition to sharing this information with your eye doctor, it’s also important that any vision changes are shared with your prescribing doctor. If the ocular side effects are severe, your prescribing doctor may look to alter the dose, or switch to a different medication.
Patients who follow these basic steps of communication with their doctors are doing their best to protect their eyes without compromising their mental health.
Sertraline Side Effects: A Complete Guide
Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 7/23/2021
With tens of millions of prescriptions in the United States alone, sertraline is an FDA-approved and widely used SSRI medication on the market.
Safe and effective, sertraline has been used since the 1990s by tens of millions of people every year without major side effects.
Sertraline (often prescribed under the brand name Zoloft) is approved by the Food and Drug Administration for the treatment of many different mental health disorders, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder major depressive disorder (MDD), social anxiety disorder (SAD) or premenstrual dysphoric disorder (PMDD).
However, like all SSRIs, sertraline side effects do exist, and you should be aware of them before you consider treatment.
Most sertraline side effects occur in the first few weeks of treatment and tend to disappear over time. However, some can last for several months or occur at any time while using the medication.
Although rare, it’s possible to experience several more serious side effects if you use sertraline to treat depression, anxiety or any other condition.
Below, we’ve listed the common and uncommon side effects of sertraline. We’ve also linked to relevant studies and other data to provide some more context on how common or uncommon these side effects really are.
Most Common Side Effects of Sertraline
Sertraline belongs to a class of medications known as selective serotonin reuptake inhibitors, or SSRIs.
Like other SSRIs, it can cause a range of mild side effects that typically occur during the first few weeks of treatment.
We’ve listed these common side effects below.
Fatigue and Tiredness
Fatigue and drowsiness are two of the most common side effects of sertraline (Zoloft), as well as several other SSRIs.
If you’re using sertraline to treat depression, fatigue and tiredness from the medication can also be compounded by the effects of depression on your mood.
It’s very common to feel a little low in energy during the first few weeks of taking sertraline, according to the National Alliance on Mental Illness.
Dealing with fatigue and tiredness from sertraline can be a frustrating experience, but it usually passes.
As the medication reaches a steady state in your body, you’ll generally start to notice a less pronounced effect on your energy levels before this side effect fades completely.
If you have persistent fatigue or drowsiness after starting sertraline that doesn’t disappear within one month, it’s best to contact your healthcare provider.
Sexual Side Effects
Sertraline and other SSRIs can cause a variety of sexual side effects, from difficulty achieving orgrasm, to a decreased sex drive and erectile dysfunction.
Sexual side effects are some of the most common side effects of sertraline and other commonly used SSRI medications.
According to a review of certain studies, between 40 percent and 65 percent of people who take SSRIs experience some side effects related to sexual desire and performance.
It’s worth noting the research did find that of the SSRIs, sertraline has one of the lower likelihoods of affecting sexual function.
These side effects can affect both men and women. In men, one of the most common side effects is a higher level of difficulty achieving orgasm and ejaculating.
Some men also experience a lower general level of interest in sex after using SSRIs such as sertraline.
In women, the most common sexual side effect of sertraline and other SSRIs is a lower level of interest in sex.
Like many other sertraline effects, sexual side effects can often fade over time as your body gets used to the medication.
If persistent, sexual side effects can be treated by adjusting your dosage or switching to a different medication.
Insomnia and a general reduction in sleep quality are both common side effects of SSRIs and other antidepressants.
People who use sertraline may find that they now have trouble sleeping, or find themselves waking up frequently throughout the night. Sertraline can also cause you to be more sleepy than usual.
While it doesn’t list the effects of sertraline specifically, a 2017 review of research literature notes that it’s common for antidepressants to affect sleep.
This review found that the prevalence of insomnia attributed to treatment with SSRIs was 17 percent compared to nine percent taking placebo.
Like many other SSRI side effects, the study states that these effects are most common in the short term.
There are several ways to deal with sleep disturbances from sertraline. The first is to wait it out, as this side effect tends to fade away as the medication reaches a steady-state in your body.
It’s also possible to take sertraline in the morning to reduce its concentration by the time you sleep.
Finally, it’s important to avoid caffeine and other stimulants that could prevent you from falling asleep in a normal amount of time.
Try to only consume coffee, caffeinated soda and energy drinks before noon to avoid them affecting you when it’s time to fall asleep.
the best way to try counseling
It’s not uncommon to feel dizzy during the first few weeks of using sertraline. Like other common side effects, this is thought to be a result of your body adjusting to the medication.
Dizziness is a short-term side effect of sertraline that usually doesn’t persist for longer than two to four weeks.
Interestingly, sertraline is linked to lower levels of dizziness in the long term in studies, indicating that it could help you feel less dizzy once the medication stabilizes in your body.
If you notice frequent dizziness or lightheadedness after using sertraline that lasts for more than four weeks, it’s important to contact your healthcare professional to discuss the potential of low blood pressure caused by your sertraline dose.
This side effect, like most, may be managed by using a lower dose of the medication. However, if this side effect doesn’t get better after a few weeks, speak to your healthcare provider.
Weight Gain or Weight Loss
Sertraline and other SSRIs are associated with weight fluctuation, although not all people who take these medications will gain or lose weight.
Most of the weight gain caused by antidepressants is mild, with a 2017 study from Australia by BMJ Open finding that, on average, high-dosage antidepressant users gain 0.28kg (about 0.6lbs) per year.
According to a 2018 BMJ UK study, researchers concluded that antidepressants may contribute to a long-term increased risk of weight gain.
Another study by Nutrients found that antidepressant use is associated with a higher total calorie intake.
However, a known side effect of sertraline (discussed more in-depth below) is, in fact, loss of appetite.
There’s also some research out there to suggest that — at least in the short term — sertraline may actually cause you to lose weight. Especially if you’re diabetic.
In one smaller study from Primary Care Diabetes involving 33 patients with type 2 diabetes, for instance, researchers found at the end of the 12-week observation period a decrease in overall weight, body mass index and waist circumference, overall.
If you’re concerned about weight gain or weight loss from sertraline, it’s best to talk to your healthcare provider.
Most of the time, you can avoid changes in your body mass and composition by monitoring your food intake and maintaining your pre-treatment eating habits while using sertraline.
Loss of Appetite
Sertraline could potentially cause you to have a reduced appetite.
Like other side effects of sertraline, this is usually temporary and should wear off after the first few weeks on the medication.
The key to avoiding weight loss from sertraline is to talk to your healthcare provider and monitor your food intake.
By staying consistent with your eating habits and activity level, it’s easier to maintain your body mass and composition while using sertraline or any other SSRI.
Diarrhea is a common side effect of sertraline. In comparative studies of sertraline and other SSRIs, about 14 percent of people who were prescribed sertraline at a typical dose experienced diarrhea compared to those on other SSRIs.
Like many other Zoloft side effects, diarrhea usually occurs in the first few weeks of treatment.
Most of the time, diarrhea becomes less frequent and disappears completely as your body adjusts to the medication and your dosage of sertraline reaches a steady state.
If you have persistent diarrhea from sertraline, the best approach is to contact your healthcare provider.
This side effect, like others, may often be managed by reducing your dosage of sertraline or switching to a different antidepressant, such as paroxetine or fluoxetine, which are both less likely to cause diarrhea.
It’s possible that you may experience headaches after you start using sertraline, particularly in the first few weeks of treatment.
Like other common side effects, Zoloft headaches usually disappear after two to four weeks of use as the medication stabilizes in your body.
The link between sertraline and headaches is a complicated one.
While headaches have been reported to be a side effect of taking sertraline, according to Journal of the Association of Physicians of India (in a study of 50 people), sertraline has been shown to be effective in treating chronic tension-type headaches.
While some painkillers can interact with sertraline, it’s safe to take Tylenol® if you experience headaches after starting sertraline.
Be aware that Tylenol may reduce the effectiveness of sertraline in your body. It is important to discuss what medications you’re taking with your healthcare provider before you start on sertraline.
If you have persistent or severe headaches from sertraline that don’t improve over time, it’s best to talk to your healthcare provider.
Simple changes to your sertraline usage such as taking your medication at a different time of day or reducing your dosage can help to limit or get rid of headaches.
Finally, dry mouth is a common side effect of sertraline and other antidepressants. While there’s no clear reason for this, researchers believe that the effects of sertraline and other SSRIs on the brain can also affect your gastrointestinal system.
According to the FDA, 14 percent of people prescribed antidepressants experience some level of dry mouth compared to 9% in placebo.
Although SSRIs like sertraline are less likely to cause dry mouth than other antidepressants (in one study published in Oral Diseases: Leading in Oral, Maxillofacial, Head and Neck Medicine, it affected about 14 percent of people), it’s still fairly common.
There are several ways to treat dry mouth from sertraline. Like other side effects, dry mouth is often temporary, meaning it should go away on its own over the course of several weeks as the medication reaches a steady state in your body.
It’s also possible to reduce the severity of dry mouth by avoiding caffeine, alcohol, tobacco, any spicy foods and other substances that can cause dehydration.
Sugar-free gums can also help to stimulate saliva production and keep your mouth and throat properly hydrated.
It is also recommended that you avoid using mouthwash products that contain alcohol as they can make the problem worse.
Finally, if you have persistent dry mouth from sertraline, you should talk to your healthcare provider.
Just like many other side effects of sertraline, dry mouth can often be avoided by adjusting your dosage or switching to a different SSRI medication.
Serious Side Effects of Sertraline
People who use sertraline may not experience any side effects, or may only experience a few of the mild side effects listed above.
However, it’s also possible for sertraline to cause a variety of potentially serious adverse effects in some users.
Below, we’ve listed some of the serious potential side effects of sertraline. If you experience any of these side effects, you should contact your healthcare provider as soon as possible for medical assistance.
Fainting and Extreme Dizziness
According to the FDA, fainting is not frequently reported, but is still a potential side effect of sertraline.
A small percentage of people who use sertraline may also experience severe dizziness and lightheadedness.
If you feel faint, weak or severely dizzy, or feel differences in your heart rate after taking sertraline, you should seek medical help as soon as possible.
A small number of people who use sertraline have reported severe chest pain after taking the medication.
If you experience severe or unusual chest pain after taking sertraline, you should seek medical help as soon as possible.
It’s important to point out that this side effect is very rare. Overall, sertraline is a safe and effective drug that’s widely used successfully, including by people with certain heart problems that make other SSRIs unsuitable.
Sertraline is one of several SSRIs that may increase the chance of bleeding.
This means that if you injure yourself in a way that results in bleeding while using sertraline, your body might have difficulty forming a normal blood clot.
Clotting issues from sertraline use can potentially occur as a result of taking sertraline together with other medications, such as blood thinners.
If you use other medications that could affect your clotting ability, it’s essential that you inform your healthcare provider before considering sertraline.
According to a study published in Federal Practitioner, Sertraline and other antidepressants have the potential to cause priapism, a condition that can result in a long-lasting, painful erection that is not associated with sexual stimulation.
Priapism can cause the penis to stay erect for hours at a time, resulting in severe discomfort and potentially causing damage to penile tissue.
Priapism is a rare side effect of sertraline and other SSRIs. If you experience a persistent, painful erection after taking sertraline or any other antidepressant, you should seek immediate medical assistance.
Sertraline and several other widely used antidepressants can increase your risk of experiencing suicidal thoughts.
The risk of suicidal thoughts appears to be the highest in young adults under the age of 25 who take antidepressants.
If you experience suicidal thoughts after you start using sertraline, it’s important to seek medical assistance as soon as possible.
Like any other medication, it is important to seek immediate medical advice if you experience an allergic reaction to sertraline.
Warning signs of allergic reaction include hives, swollen face, sore throat, and anaphylaxis.
Learn More About Sertraline
While many of the side effects listed above can look alarming, it’s worth remembering that most people who use sertraline either experience no side effects at all, or light, transient side effects that disappear as they become accustomed to the medication.
You should not take sertraline if you have glaucoma, history of heart problems, or are breastfeeding.
For the vast majority of users, it’s a safe, effective and important medication that provides real benefits.
However, in addition to the side effects listed above, sertraline can potentially have drug interactions with a wide range of other medications and substances, like combining alcohol and sertraline, monoamine oxidase inhibitors (MAOIs), nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or even St. John’s Wort.
Use of sertraline with other SSRIs could lead to an increased risk of a life-threatening condition called serotonin syndrome. Our Sertraline 101 Guide goes into more detail on sertraline interactions.
Be sure to discuss all drugs you are taking, including over-the-counter medicine, with your healthcare professional before taking sertraline.
Do not stop taking sertraline without seeking medical advice.
Abruptly ending sertraline before your next dose could lead to serious withdrawal symptoms, including eye pain, nausea, headaches, irritability, nightmares, or suicidal thoughts.
Read 25 more facts about sertraline here.
it’s never been easier to talk to a psychiatry provider about treatments
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.
Common Prescriptions That Will Ruin Your Teeth
There are as many as 5,847 cosmetic dental offices in the U.S. — and many are taking note of a link between certain commonplace medications and patients’ dental and oral health. In other words, some U.S. men and women may be taking prescription drugs that will result in high cosmetic dentistry costs later in life. What seemingly innocent meds can have permanent and devastating effects on your teeth?
There Are Some Things You Need To Know, If You Are On Antidepressants Or Anti-Anxiety Pills
Some of the most popular antidepressants can also have significant impacts on your dental and oral health, local dentists reveal. Dry mouth, for example, is one of the most common side effects of antidepressants and anti-anxiety pills. While dry mouth may seem like a relatively small issue (drink some water, right?), that’s not necessarily true. In fact, extreme cases of dry mouth — also called xerostomia — can lead to serious dental problems, such as bad breath, periodontal disease, and tooth decay. Some antidepressants may also adversely affect dental implants. In most cases, full dental implants, partial implants, and implant supported dentures have an impressive success rate of 98%. Unfortunately, among patients taking medications to treat depression, that success rate is much lower. What can and should you do about it? Find a good dentist. The best dentists will be able to guide you through dental and oral care and treatments — and offer advice and alternatives for patients taking antidepressants when necessary.
Most Women Take This Every Day…
Fluctuating hormones can cause deteriorating oral health in pregnant women. It can increase the likelihood of mild to severe gum disease and even result in some pretty scary symptoms, like bleeding gums. Hormonal birth control methods work by tricking the body into thinking it is pregnant. What does that mean? If you are taking hormonal birth control pills or using other hormonal contraceptives, you may be at greater risk for inflamed gums, among other things. The best dentists should be professional and respect your privacy — and you should feel comfortable disclosing all medications to them, including the use of hormonal birth control pills.
The best dentists reveal that 3 million Americans have dental implants — and that number is climbing by 500,000 a year. The increased need for dental implants, along with other dental procedures, may be (at least in part) due to a lack of awareness about the medications we take everyday and how they may affect our dental and oral health down the line.
Fluoxetine (Prozac) | NAMI: National Alliance on Mental Illness
- Capsules: 10 mg, 20 mg, 40 mg
- Prozac Weekly®
- Capsules (delayed-release): 90 mg
- Capsules: 10 mg, 20 mg, 40 mg
- Capsules (delayed release): 90 mg
- Liquid: 20 mg/5ml
- Tablets: 10 mg, 20 mg, 60 mg
Generic name: Fluoxetine (floo OKS e teen)
All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.
What Is Fluoxetine And What Does It Treat?
Fluoxetine is an antidepressant medication that works in the brain. It is approved for the treatment of major depressive disorder (MDD), obsessive compulsive disorder (OCD), panic disorder, bulimia nervosa, and premenstrual dysphoric disorder (PMDD).
Symptoms of depression include:
- Depressed mood – feeling sad, empty, or tearful
- Feeling worthless, guilty, hopeless, and helpless
- Loss of interest or pleasure in your usual activities
- Sleep and eat more or less than usual (for most people it is less)
- Low energy, trouble concentrating, or thoughts of death (suicidal thinking)
- Psychomotor agitation (‘nervous energy’)
- Psychomotor retardation (feeling like you are moving and thinking in slow motion)
- Suicidal thoughts or behaviors
Obsessive compulsive disorder (OCD) occurs when a person experiences the following symptoms at the same time:
- Obsessions (unwanted, recurrent, and disturbing thoughts)
- Compulsions (repetitive, ritualized behaviors that the person feels driven to perform in order to lessen the anxiety produced by the obsessions)
Panic disorder occurs when a person experiences unexpected and repeated episodes of intense fear. These episodes have physical symptoms including chest pain, shortness of breath, heart palpitations, sweating, dizziness, and nausea. Fear of future episodes is also part of panic disorder.
Bulimia is a condition where a person binges on food, then uses various methods to purge (e.g., use of laxatives, vomiting) in order to prevent weight gain.
Premenstrual dysphoric disorder (PMDD) is a condition where a woman experiences depression, tension, and irritability for a few days prior to menstruation that end when menstruation begins. These symptoms are more severe than those of premenstrual syndrome (PMS).
Fluoxetine may also be helpful when prescribed “off-label” for body dysmorphic disorder, binge eating disorder, generalized anxiety disorder (GAD), social phobia (also known as social anxiety disorder), dysthymia, or posttraumatic stress disorder (PTSD). “Off-label” means that it hasn’t been approved by the Food and Drug Administration for this condition. Your mental health provider should justify his or her thinking in recommending an “off-label” treatment. They should be clear about the limits of the research around that medication and if there are any other options.
What Is The Most Important Information I Should Know About Fluoxetine?
Do not stop taking fluoxetine, even when you feel better. With input from you, your health care provider will assess how long you will need to take the medicine.
Missing doses of fluoxetine may increase your risk for relapse in your symptoms.
Stopping fluoxetine abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, dizziness, vomiting, nightmares, headache, and/or paresthesias (prickling, tingling sensation on the skin).
Depression is also a part of bipolar illness. People with bipolar disorder who take antidepressants may be at risk for “switching” from depression into mania. Symptoms of mania include “high” or irritable mood, very high self-esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).
Medical attention should be sought if serotonin syndrome is suspected. Please refer to serious side effects for signs/symptoms.
Are There Specific Concerns About Fluoxetine And Pregnancy?
If you are planning on becoming pregnant, notify your health care provider to best manage your medications. People living with MDD who wish to become pregnant face important decisions. Untreated MDD has risks to the fetus, as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers. For women who take antidepressant medications during weeks 13 through the end of their pregnancy (second and third trimesters), there is a risk that the baby can be born before it is fully developed (before 37 weeks).
For mothers who have taken SSRIs during their pregnancy, there appears to be less than a 1% chance of infants developing persistent pulmonary hypertension. This is a potentially fatal condition that is associated with use of the antidepressant in the second half of pregnancy. However, women who discontinued antidepressant therapy were five times more likely to have a depression relapse than those who continued their antidepressant. If you are pregnant, please discuss the risks and benefits of antidepressant use with your health care provider.
Caution is advised with breastfeeding since fluoxetine does pass into breast milk.
What Should I Discuss With My Health Care Provider Before Taking Fluoxetine?
- Symptoms of your condition that bother you the most
- If you have thoughts of suicide or harming yourself
- Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
- If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
- Any other psychiatric or medical problems you have, including a history of bipolar disorder
- All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
- Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
- If you are pregnant, plan to become pregnant, or are breastfeeding
- If you drink alcohol or use drugs
How Should I Take Fluoxetine?
Fluoxetine is usually taken one time per day with or without food.
Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.
The dose usually ranges from 20 mg to 80 mg when taken once daily or 90 mg taken once weekly. Only your health care provider can determine the correct dose for you.
If you are taking fluoxetine for PMDD, it can be taken once daily (everyday) or intermittently (usually starting 14 days prior to menstruation through the first full day of menses of each cycle). Discuss this with your prescriber.
The liquid should be measured with a dosing spoon or oral syringe which you can get from your pharmacy.
The delayed release form should be swallowed whole. It should not be chewed, crushed, or broken.
Consider using a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member or friend to remind you or check in with you to be sure you are taking your medication.
What Happens If I Miss A Dose Of Fluoxetine?
If you miss a dose of fluoxetine that you take daily, take it as soon as you remember, unless it is closer to the time of your next dose. If you take fluoxetine once weekly, take it as soon as possible, then go back to your regular schedule the next week. Discuss this with your health care provider. Do not double your next dose or take more than what is prescribed.
What Should I Avoid While Taking Fluoxetine?
Avoid drinking alcohol or using illegal drugs while you are taking antidepressant medications. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication.
What Happens If I Overdose With Fluoxetine?
If an overdose occurs, call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.
A specific treatment to reverse the effects of fluoxetine does not exist.
What Are The Possible Side Effects Of Fluoxetine?
Common side effects
Headache, nausea, diarrhea, dry mouth, increased sweating, feeling nervous, restless, fatigue, or having trouble sleeping (insomnia). These will often improve over the first week or two as you continue to take the medication.
Sexual side effects, such as problems with orgasm or ejaculatory delay often do not diminish over time.
Rare/serious side effects
Low sodium blood levels (symptoms of low sodium levels may include headache, weakness, difficulty concentrating and remembering), teeth grinding, angle closure glaucoma (symptoms of angle closure glaucoma may include eye pain, changes in vision, swelling or redness in or around eye), serotonin syndrome (symptoms may include shivering, diarrhea, confusion, severe muscle tightness, fever, seizures, and death), seizure, QT prolongation and ventricular arrhythmia including Torsades de Pointes (changes in the electrical activity of your heart; symptoms may include fast, slow or irregular heartbeat, shortness of breath, and dizziness or fainting)
SSRI antidepressants including fluoxetine may increase the risk of bleeding events. Combined use of aspirin, nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen), warfarin, and other anti-coagulants may increase this risk. This may include symptoms such as gums that bleed more easily, nose bleed, or gastrointestinal bleeding. Some cases have been life threatening.
Are There Any Risks For Taking Fluoxetine For Long Periods Of Time?
To date, there are no known problems associated with long term use of fluoxetine. It is a safe and effective medication when used as directed.
What Other Medications May Interact With Fluoxetine?
Fluoxetine should not be taken with or within 6 weeks of taking monoamine oxidase inhibitors (MAOIs). These include phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), rasagiline (Azilect®), and selegiline (Emsam®).
Although rare, there is an increased risk of serotonin syndrome when fluoxetine is used with other medications that increase serotonin, such as other antidepressants, migraine medications called “triptans” (e. g., Imitrex®), some pain medications (e.g., tramadol (Ultram®), amphetamines, and the antibiotic linezolid (Zyvox®).
Fluoxetine may increase the levels and effects of:
- Certain anticonvulsants, such as phenytoin (Dilantin®), carbamazepine (Tegretol®, Equetro®)
- Certain antipsychotics, such as haloperidol (Haldol®), aripiprazole (Abilify®)
- Benzodiazepines, such as alprazolam (Xanax®), diazepam (Valium®)
- Atomoxetine (Straterra®)
- Warfarin (Coumadin®)
- Metoclopramide (Reglan®)
- Tricyclic antidepressants, such as imipramine (Tofranil®), desipramine (Norpramin®)
- Beta blockers, such as metoprolol (Toprol XL®, Lopressor®) and propranolol (Inderal®)
Fluoxetine may decrease the effects of tamoxifen (Nolvadex®) and codeine.
Fluoxetine may increase the effects of other medications that can cause bleeding (e. g., ibuprofen (Advil®, Motrin®), warfarin (Coumadin®), and aspirin).
How Long Does It Take For Fluoxetine To Work?
Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.
Summary Of FDA Black Box Warnings
Suicidal thoughts or actions in children and adults
Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications. This risk may persist until significant remission occurs.
In short-term studies, antidepressants increased the risk of suicidality in children, adolescents, and young adults when compared to placebo. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24. Adults age 65 and older taking antidepressants have a decreased risk of suicidality. Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or health care professional. All patients being treated with antidepressants for any indication should watch for and notify their health care provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.
©2020 The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). CPNP and NAMI make this document available under the Creative Commons Attribution-No Derivatives 4. 0 International License. Last Updated: January 2016.
This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein.
8 Tips to Relieve Your Dry Mouth – Cleveland Clinic
Dry mouth can be incredibly uncomfortable, even if you’ve only experienced it for a short while.
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A number of things can cause this problem, but certain medications, infections, dehydration, as well as cancer treatments are the most common causes, according to family medicine physician Neha Vyas, MD.
Some medications, radiation and chemotherapy can actually damage the salivary glands, leaving you to deal with the result: dry mouth.
Untreated dry mouth can damage oral health
Left untreated, dry mouth, which doctors call xerostomia, can lead to various problems, including:
- Halitosis (bad breath).
- Yeast infections.
- Gingivitis (gum disease).
- Improper denture fit.
Over time, you may experience changes in taste, difficulty swallowing, and in some cases, speech changes. You may also notice cracks and cuts on your lips at the corners of your mouth, or you could experience a burning sensation on your tongue.
“Dry mouth usually resolves on its own one to two months after completing chemotherapy, but it can last six months to a year after radiation to the head and neck,” says Dr. Vyas.
Tips for relieving dry mouth
Regardless of the cause of your dry mouth, it’s important to do something about it. Dr. Vyas suggests the following:
- Stay hydrated. Drink sips of water throughout the day. Ensure you stay hydrated by drinking at least eight to 12 glasses of water daily, unless your doctor advises against it for some reason. Keep a water bottle handy next to you at all times so you can quickly take a sip (or a few!)
- Chew gum or suck on hard candy. Chewing sugarless gum or sucking on sugar-free hard candy helps some people. Make sure it’s sugar-free, though, to avoid calorie and carb overload.
- Avoid alcohol, caffeine and acidic juices. This means you should stay away from that daily coffee or latte and juices made from citrus fruits as well as that glass of wine in the evening. Watch out for hidden alcohol, too, since they hide in things like mouthwashes.
- Moisten your food. Moisten all dry foods with broth, sauces, milk or melted butter. Since your salivary glands aren’t producing enough saliva, this will make it easier to chew and swallow.
- Don’t smoke or use chewing tobacco. In addition to the negative impacts these have on your general health, smoking and chewing tobacco can worsen dry mouth. Quitting smoking is one of the most important things you can do to not only help your dry mouth, but your overall health.
- Use a humidifier. Use a humidifier at night, especially in winter, to help moisten the ambient air while you sleep.
- Brush your teeth after each meal. Soften your toothbrush in a cup of warm water so it’s gentler on your gums. Make sure to brush after each meal and at bedtime. Use a fluoride rinse to prevent tooth decay if you are undergoing radiation treatments.
- Talk to your doctor. Your doctor can tell you about products specifically designed to treat dry mouth. Many of these are available over the counter, such as Biotene® products and Oralbalance® moisturizing gel. There are also prescription medications that act as a saliva substitute and others that stimulate the salivary glands to produce more saliva.
Visit your doctor if these treatments do not relieve your discomfort or if you suspect you may have an infection in the mouth.
Memorial Sloan Kettering Cancer Center
This document, provided by Lexicomp ® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.
Trade names: USA
PROzac; Sarafem [DSC]
Trade names: Canada
ACCEL-FLUoxetine [DSC]; ACH-FLUoxetine; ACT FLUoxetine; AG-Fluoxetine; APO-FLUoxetine; Auro-FLUoxetine; BCI FLUoxetine [DSC]; BIO-FLUoxetine; DOM-FLUoxetine; JAMP-FLUoxetine; Mar-FLUoxetine [DSC]; MINT-FLUoxetine; MYLAN-FLUoxetine [DSC]; NRA-Fluoxetine; Odan-FLUoxetine; PMS-FLUoxetine; PRIVA-FLUoxetine; PRO-FLUoxetine; PROzac; RAN-FLUoxetine; RIVA-FLUoxetine; SANDOZ FLUoxetine [DSC]; TEVA-FLUoxetine; VAN-FLUoxetine [DSC]
- Drugs like this have increased the likelihood of suicidal thoughts or actions in children and young people.This risk may be higher in people who have attempted suicide or have had suicidal thoughts in the past. All people taking this drug must be closely monitored. Call your doctor right away if you have signs such as depressed mood (depression), nervousness, anxiety, grumpiness, or anxiety attacks, or if other mood or behavior changes occur or worsen. Call your doctor immediately if you have suicidal thoughts or attempted suicides.
- This drug is not approved for use in children of all ages. Check with your doctor to make sure this drug is right for your child.
What is this drug used for?
- The drug is used to treat depression.
- It is used to treat obsessive-compulsive disorder.
- It is used to treat emotional lability in women in the premenstrual period.
- Used to treat eating disorders.
- Used to treat panic attacks.
- This medicinal product can be used for other indications. Consult your doctor.
What should I tell my doctor BEFORE taking this drug?
- If you are allergic to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergy and how it manifested itself.
- If you are taking any of the following drugs: Linezolid, methylene blue, pimozide, or thioridazine.
- If you have taken a drug for depression or Parkinson’s disease in the past 14 days. These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur.
- If you are taking any medications that can cause certain types of heart rhythm disturbances (prolonged QT interval). There are many medications that can cause these problems.If you are unsure, check with your doctor or pharmacist.
- If you are breastfeeding. Do not breast-feed while taking this drug.
This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.
Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems.You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s approval.
What do I need to know or do while taking this drug?
- Tell all healthcare providers that you are taking this drug.These are doctors, nurses, pharmacists and dentists.
- Avoid driving or other activities that require increased attention until you see how this drug affects you.
- Do not stop taking this drug abruptly without talking to your doctor. This can increase the risk of side effects. If necessary, this drug should be stopped gradually as directed by your doctor.
- Avoid drinking alcohol while taking this drug.
- Consult your doctor before using marijuana, other forms of cannabis, prescription or over-the-counter drugs that may slow you down.
- If you have high blood sugar (diabetes), your blood sugar should be checked regularly.
- It may take several weeks to achieve full effect.
- This drug may increase the risk of bleeding. Sometimes bleeding can be life-threatening.Consult your doctor.
- Very bad and sometimes deadly reactions have happened with a rash in rare cases. There were also disorders of the lungs, kidneys and liver. Call your doctor right away if you have signs such as a change in the amount of urine excreted, dark urine, lack of appetite, nausea or abdominal pain, light colored stools, vomiting or yellowness of the skin or eyes, or shortness of breath.
- The risk of eye problems may be increased in some patients with this drug.Your doctor may order you to see an ophthalmologist to see if you are at increased risk of developing these eye problems. Call your doctor right away if you have eye pain, change in vision, swelling, or redness around the eye.
- This drug may lower sodium levels. Very low sodium levels can be life-threatening, leading to seizures, fainting, difficulty breathing, or death.
- In some cases, the drug may affect the growth rate in children and adolescents.They may need to check their growth rate regularly. Consult your doctor.
- If you are 65 years of age or older, use this drug with caution. You may have more side effects.
- Tell your doctor if you are pregnant or planning to become pregnant. The benefits and risks of taking this drug during pregnancy will need to be discussed.
- Taking this drug during the third trimester of pregnancy may cause some health problems in the newborn.Consult your doctor.
What side effects should I report to my doctor immediately?
WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects. Call your doctor or get medical help right away if you have any of the following signs or symptoms, which may be associated with serious side effects:
- Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
- Signs of low sodium levels such as headache, trouble concentrating, memory impairment, confused thinking, weakness, seizures, and balance problems.
- Significant weight gain or loss.
- Sexual problems such as decreased sex drive or ejaculation problems.
- Penile erection that lasts more than 4 hours.
- Any unexplained bruising or bleeding.
- Increased thirst.
- Menstrual irregularities.
- Frequent urination.
- For problems with body movement control.
- A serious and sometimes fatal complication called serotonin syndrome can occur. This risk may increase with the concomitant use of certain other drugs. Call your doctor right away if you develop agitation, imbalance, confusion, hallucinations, fever, tachycardia or irregular heartbeat, flushing, muscle twitching or stiffness, seizures, tremors or tremors, excessive sweating, severe diarrhea, nausea or vomiting , very severe headache.
- Some type of heart rhythm disorder (long QT interval) has happened with this drug. Sometimes it caused another type of heart rhythm disturbance (polymorphic ventricular tachycardia of the “pirouette” type). See your doctor right away if you have tachycardia, irregular heartbeats, or fainting.
What are some other side effects of this drug?
Any medicine can have side effects.However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:
- Nausea or vomiting.
- Lack of hunger.
- Diarrhea or constipation.
- Dry mouth.
- Strange or unusual dreams.
- Sleep disorders.
- Feeling tired or weak.
- Flu-like symptoms.
- Nervous tension and agitation.
- Excessive sweating.
- Nose or throat irritation.
This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.
You can report side effects to the National Health Office.
You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.
What is the best way to take this drug?
Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.
All forms of issue:
- Take this medication with or without food.
- Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.
- Swallow whole. Do not chew, break, or crush.
- Measure liquid doses with care.Use the dispenser that comes with the medicine. If a dispenser is not included in the package, ask your pharmacist for a dosing product for this drug.
What should I do if a dose of a drug is missed?
- Take the missed dose as soon as you can.
- If it is time for your next dose, do not take the missed dose and then return to your normal dose.
- Do not take 2 doses at the same time or an additional dose.
How do I store and / or discard this drug?
- Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
- The lid must be tightly closed.
- Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
- Dispose of unused or expired drugs.Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.
General information on medicinal products
- If your health does not improve or even worsens, see your doctor.
- You should not give your medicine to anyone and take other people’s medicines.
- Some medicines may have different patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
- A separate patient instruction sheet is attached to the product. Please read this information carefully. Reread it every time you replenish your supply. If you have questions about this drug, talk with your doctor, pharmacist, or other healthcare professional.
- If you think there has been an overdose of a drug, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.
Use of information by the consumer and limitation of liability
This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are appropriate for a particular patient.This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a guide to treatment and does not replace the information provided to you by your healthcare professional.Check with your doctor for complete information on the possible risks and benefits of taking this drug. Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.
© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.
90,000 Antidepressants for inflammatory bowel diseases
What is inflammatory bowel disease?
Inflammatory bowel disease (IBD) is a chronic inflammatory disease that affects the gastrointestinal tract (colon or small intestine, or both).IBD predominantly includes Crohn’s disease and ulcerative colitis. Symptoms of IBD include diarrhea, urgency to bowel movements (including fecal incontinence), abdominal pain, rectal bleeding, fatigue, and weight loss. When people experience symptoms of IBD, they are considered to have an active illness. When IBD symptoms stop, the disease is in remission. IBD is associated with a psychosocial burden, with depression in people with IBD twice as high as in the general population. Anxiety and depression that accompany IBD may be associated with poor quality of life, worsening IBD activity, higher hospital admissions, and decreased adherence to treatment.Up to 30% of people living with IBD take antidepressants, which are prescribed for mental health problems or bowel symptoms, or both.
What are antidepressants?
Antidepressants are medicines used to treat depression and other mental disorders such as anxiety. Antidepressants are not currently approved by regulatory agencies for the specific treatment of anxiety and depression as part of the management of physical symptoms or for reducing bowel inflammation in people with IBD.However, some antidepressants have indications for treating pain in chronic conditions and are commonly used to treat functional bowel symptoms in conditions such as irritable bowel syndrome.
What did the researchers learn?
Previous studies of antidepressant therapy for IBD were reviewed. Data from some of these studies have been pooled using a technique called meta-analysis. In the analysis, people on antidepressants were compared to those on antidepressants in terms of levels of anxiety and depression, as well as other metrics such as quality of life, side effects, and IBD activity.
What did the researchers find?
Researchers searched the medical literature up to 23 August 2018. Four published studies involving 188 people examined antidepressant therapy in people with IBD. The age of the participants ranged from 27 to 37.8 years. In three studies, participants had IBD in remission, and in one, participants had either active IBD or IBD in remission. Participants in one study had comorbid anxiety or depression.One study used duloxetine (60 mg per day), one used fluoxetine (20 mg per day), one used tianeptine (36 mg per day), and one used various antidepressants. Three studies had a placebo control group (such as sugar pills), and one study did not receive a control group.
Analysis showed that symptoms of anxiety and depression improved in those taking antidepressants compared with placebo. Participants who received antidepressants experienced more side effects than those who received a placebo.Side effects reported by those taking antidepressants included: nausea, headache, dizziness, sleepiness, sexual problems, insomnia, fatigue, low mood / anxiety, dry mouth, poor sleep, restless legs, and hot flashes. Several aspects of quality of life were improved, as well as the activity of IBD in the antidepressant group. The overall quality of the studies included in this review was low because the studies were small in number and included individuals with IBD who differed in key characteristics.In addition, different types of antidepressants have been evaluated, so the evidence for any one antidepressant was uncertain. Therefore, further research is needed to confirm these observations.
Results for the outcomes assessed in this review are uncertain, and no clear conclusions can be drawn about the benefits and harms of antidepressants for IBD. More research is needed to make clear conclusions about the benefits and harms of antidepressant use in people with IBD.
FGBNU NTSPZ. ‹– Depression in General Medicine: A Guide for Physicians ››
One of the main arguments in favor of the use of first-line antidepressants in the treatment of affective disorders in general medical practice is the minimal (in comparison with second-line drugs) severity of side effects.
Differences in the complications of thymoanaleptic therapy clearly stand out when comparing the main manifestations of the undesirable action of representatives of first-line antidepressants (SSRIs, SSOZS) and TCAs, which is clearly demonstrated by the data given in Table.fourteen.
Nevertheless, it is impossible to completely exclude complications even with the use of psychotropic agents of sparing action. The greatest likelihood of developing side effects of psychopharmacotherapy occurs in patients with somatic diseases, as well as in elderly people who exhibit an increased sensitivity to psychotropic drugs; in these contingents, even with careful titration of doses, in addition to the main thymoanaleptic effect, side effects may also appear.
The main side effects of antidepressants include anti-cholinergic disorders of the central and autonomic nervous system, cardiovascular system, complications from the hematopoietic organs, metabolic endocrine disorders (changes in body weight, dysfunction of the genital area, allergic reactions).
Side effects often appear at the initial stages of treatment (in the first 2 weeks) and sometimes persist for 3-4 weeks of therapy, and then undergo a reverse development.With more persistent and at the same time pronounced violations, a decrease in doses is indicated, and, if necessary, a cessation of therapy.
Treatment with tianeptine (CCOZS) is accompanied by a minimum of undesirable effects. Side effects of the drug are most often limited to complaints of dry mouth, nausea, drowsiness during the day. Only in some cases there are also phenomena of transient orthostatic hypotension, dizziness, headaches, allergic skin reactions. The most common side effects of SSRIs are:
– decreased appetite,
Along with this, undesirable phenomena from the autonomic and central nervous system are possible:
– headaches (citalopram),
– strengthening (or appearance) of anxiety,
– a feeling of inner tension.
The latter appear in the first weeks of treatment or with increasing doses.
There are transient extrapyramidal disorders in the form of tremors.As for other disorders (parkinsonism, akathisia, dyskinesia), then, judging by the data of a number of publications, they are recorded only in isolated cases. The use of fluoxetine and paroxetine may be accompanied by increased bleeding and even bleeding.
With SSRI therapy, neurotoxic reactions (serotonin syndrome) are possible, affecting the gastrointestinal tract and the nervous system (colic in abdomen, flatulence, loose stools, nausea, vomiting; tremor, dysarthria, muscle hypertonia, hyperreflexia, myoclonic twitching, ataxia).In more severe cases, hyperthermia, confusion, symptoms of disorientation join [Malin DI, 2000].
Severe complications often occur during drug interactions with combined use:
– SSRIs and MAOIs,
– SSRIs and OIMAO-A (moclobemide),
– TCA (anafranil) and OIMAO-A.
Along with the side effects of great importance (especially in a general medical network), the effects of antidepressants associated with overdose are of great importance.The risk of deliberately taking large amounts of drugs for suicidal purposes creates safety benefits for first-line antidepressants. This is evidenced by comparative data on the safety of some first and second line antidepressants, presented in table. 15.
The safety of first-line drugs is indicated by the data of S. Las-mier et al. (1991) for tianeptine. Reception of large doses of this drug (from 12 to 60 tablets) (summarized 12 cases of the use of tianeptine for suicidal purposes) does not lead to death and is not accompanied by significant (compared with the norm) deviations of clinical and electrocardiological parameters of the cardiovascular system.
Table 15. Safety of antidepressants [based on R. Priest, D. Baldwin, 1994]
Measure of danger (number of deaths in case of overdose per 1 million prescriptions)
The degree of danger
First line antidepressants
Fluoxetine (Prozac) Fluvoxamine (Fevarin) Mianserin (Lerivon)
Less than 10
Clomipramine (Anafranil) Maprotiline (Ludiomil) Trazadone (Tritgiko)
More than 10
Imipramine (Melipramine) Fenelzine (Nardil)
More than 20
Amitriptyline Trianylcypramine (Transamin)
In case of an overdose of milnacipran (ixel), vomiting, hyperventilation, tachycardia are observed.However, even taking excessively high daily amounts of the drug (1900-2800 mg) does not lead to severe complications and ends with a complete recovery [Montgomery S. A. et at, 1996].
Reception of mirtazapine (Remeron) in excessive doses (up to 315 mg – 4 observations) is accompanied only by transient somnolence without impairment of the functions of the respiratory and cardiovascular systems [Montgomery SA, 1995].
90,000 Depression: Taste of Life or Compression of Feelings?
- Katerina Arkharova
- BBC Russian Service, London
Photo author, PA
Depression often remains unrecognized
25 years ago in the West for the first time on sale antidepressant Prozac or, as it is also called, “the pill of happiness”, prescribed to improve mood and treat depression.
The drug was originally developed to lower blood pressure, but the trials revealed another beneficial property: a small group of volunteers with mild depression noticeably improved their mood.
The advertised new medicine suddenly seemed like a magic pill, capable of relieving therapists who are besieged by dull hypochondriacs suffering from “everything and nothing”, and where the pill is, there is the disease for which it was required.
Five years after the emergence of Prozac in the West, Elizabeth Wurzel’s novel The Nation of Prozac was released (and a film soon followed), in which the American journalist describes her depression in detail.
The trend, as always, was laid by stars and other celebrities who began to dazzle the audience first with the details of their psychotherapy sessions, then with a long list of medications taken to help overcome the next “life crisis”.
Just as a century before that girls were supposed to faint, and ardent youths suffer from consumption, so it became almost fashionable to admit depression, especially among the “creative” brethren.
Runny nose in war?
Where was the depression hiding before that and why did we practically hear nothing about it in the Soviet Union? Or was the depression class alien to the Soviet people, or the effect of a “runny nose in the war” was triggered: when a family of five lives in the same room, they have to stand in hourly queues for food, and go to the toilet with yesterday’s newspaper, then somehow there is no time for depression?
Doctor of Medical Sciences, Professor Boris Polozhiy from the Serbsky Institute dispelled my doubts on this score, saying that depression was also diagnosed in the USSR, although, in comparison with Western countries, according to the statistics of depressive disorders, less was recorded, which is partly due to the tradition of domestic psychiatry, which did not distinguish depression in the framework of some other mental disorder.
However, since the end of the twentieth century, there has been a worldwide tendency towards an increase in the number of patients with depressive disorders of various nature – and Russia is no exception, the doctor says.
Author of the photo, SPL
Prozac was also called “pills of happiness”
“The attitude to this is quite serious, including the drug treatment of depression,” explains Professor Polozhiy. Unlike, say, the United States, we do not recommend general practitioners to deal with depression, because after all, prescribing antidepressants and treating depression is a task that requires a certain specialization. “
However, as the psychiatrist says, now in Russia they are advocating that the local doctor could at least recognize depression and refer the patient to a specialist.
“And the fact that depressions remain unrecognized, undetected is a problem, because, alas, often the outcome of severe, untreated depression is suicide, and in this regard, our country is not yet in the most prosperous place in the world,” says the psychiatrist …
Compression of feelings
In Britain, indeed, not only the diagnosis of depression, but also its treatment (not in particularly severe cases) is the prerogative of a family doctor, not a psychiatrist.And if a few decades ago it was considered a sign of “weakness of character” to go to a doctor complaining of despondency, but now it is very easy to get an antidepressant, as N. living in London and wishing to remain incognito says.
N., left after a divorce with a small child in her arms in tight financial circumstances, felt that she needed some help, and her family doctor immediately prescribed her the antidepressant citalopram. However, she was surprised that this drug is prescribed for any condition – depression, anxiety syndrome, and anxiety attacks, without choosing a medicine for a specific person.
“These drugs are designed to equalize your condition; you stop feeling anxiety, pain, depression, but at the same time they even out your positive feelings – there are no bright emotions in one direction or the other; they do not cure,” he admits N.
Are antidepressants capable of “curing” depression or any other psychological condition at all?
“Most of the people I see here with depression, it is provoked by social situations, the fact that the person has lost his job, that the person does not have a good home, or the husband is an alcoholic – that is, situations that the pill will never cure,” explains the British family doctor Marina Diel.“Therefore, here the pill is like a stick to those who are lame, so that you can overcome some at least little things, gives you a little more energy to cope and look at things differently.”
Prozac and similar antidepressants are to selective serotonin reuptake inhibitors (SSRIs) and act as follows: they slow down the excretion from the brain of the so-called “neurotransmitters” (chemicals that help transmit impulses between nerve fibers), in particular, serotonin, the so-called “hormone of joy”.
It is believed that a lack of it is sometimes caused by depression, but experiments have shown that a decrease in serotonin levels does not always lead a person to depression, so how much serotonin a person needs to be happy and whether it is in it, scientists do not know, so it is not surprising that many people have a bias against taking these drugs.
According to the Mental Health Foundation, in Britain one in four Britons in any given year can be diagnosed with a mental disorder, and according to the US National Institute of Mental Health (National Institute of Mental Health), 10% suffer from depression in one form or another.
Is it easy to diagnose? Rather no than yes, Marina Diel believes, since this is a rather subjective assessment, both on the part of the doctor and the patient.
To be honest: nowadays we are often diagnosed not by a doctor at all, but by the Internet. On netdoctor.co.uk, I found the Golberg test and, after answering the questions, found that I had a “mild form of depression.” However, another test – on depressedtest.com, where the questionnaire is larger – did not confirm the diagnosis. Can you trust this diagnostic method?
Of course not, says Moscow psychologist Natalya Yaroshuk.: “The only big plus of this is that for a person who doubts something, this will be another reason to go somewhere.”
At the same time, as Natalya Yaroshuk says, a competent psychiatrist, psychotherapist and even a psychologist of a depressed patient calculates immediately by their appearance, since the disease “flows” outward both in posture and facial expression, and sometimes even in clothes …
“One of the manifestations of a depressive state is a weakening of muscle tone, a weakening of energy,” she says.
How can one fail to recall the opposite “diagnosis” of Doctor Chekhov, given to them, according to Bunin, decadents: “What decadents they are!” Lena’s Story
Living in a small English town, Lena came to her family doctor wearing a combat outfit and put in front of him a sheet of A4 paper with the symptoms listed on it – it was difficult for her to speak out loud about her condition.The doctor sent her home, advising her to run for an hour every day, which, oddly enough, is one of the ways to overcome depression, known since the days of Horace, since physical exertion produces endorphins (“hormones of joy”).
Lena did not have any momentary reasons for falling into depression – on the surface, everything was not so bad, but she internally experienced emigration to England, accompanied not only by a deterioration in the social status of the whole family, but also by financial hardships, and was unhappy with the new work, where the situation was not the most welcoming.
From the third visit Lena managed to prescribe an antidepressant, which from the very first half dose caused her to have a panic attack.
“I went to work and suddenly felt that something was happening to me: I was shaking, an attack began, and I was working with people and I had to run away to the staff room,” says Lena.
Lena was allowed to breathe in a bag – this method of relieving a seizure, probably seen by many mainly in American movies, is based on the fact that a person breathes carbon dioxide exhaled by him and thus reduces the flow of oxygen (which increases stress and tension during hyperventilation) to the brain …
“At the institute [in the Soviet Union] I had four years of medicine and we were given a diploma of” civil defense nurse “, but I didn’t know what to do in such cases,” my interlocutor is surprised.
Both doctors and patients emphasize that antidepressants are not aspirin, they do not begin to act immediately, and their effect is not the same on different people, therefore both the drug and the dose must be selected individually.
“Antidepressants at the very beginning can have a very strong side effect, so you need to be very careful with them,” Lena warns.“Therefore, suicides, and seizures, and various unpleasant things occur, because doctors prescribe how they prescribe to everyone, but all people have different organisms and different reactions to medications.”
N., who took an antidepressant for a short time, admits that for people like her – people who like to keep everything under control, to be “in themselves” – it is very difficult to take pills, on which your emotional state and self-control depend.
“You feel that you are giving control to the pill, and this is your nature is even more annoying, “says N.
Photo author, AP
Jogging can be useful in fighting depression dosages were recommended) during periods of deterioration, such as in winter, when there is little sunlight and it is difficult to force yourself to get out of bed and go to work.
Antidepressants are not believed to be chemically addictive, unlike tranquilizers.But maybe we can talk about psychological dependence?
“Most likely yes, although not one hundred percent,” replies Professor Polozhiy, “because sometimes diseases also adapt to drugs, then you have to change drugs, apply some other methods.”
Patients with a severe recurrent course of the disease are forced to constantly use a small dose of antidepressants as a prophylactic agent, although the pros and cons of this approach, according to the psychiatrist, are still actively discussed.
“It is impossible to exclude a psychological background: a person is simply afraid of this condition and prefers to take medications,” says the psychiatrist.
On the other hand, a 2008 experiment at the Department of Psychology at the University of Hull, England, showed that depressed patients responded just as well to the placebo pill as those who took antidepressants.
As a result of these studies, scientists led by Professor Irwin Kirsch concluded that Prozac and other similar antidepressants are needed only for patients with severe clinical depression.
Where to get strength?
How can you help yourself? Lena, over the years of struggle with depression, which, according to her, is caused not only by socio-psychological, but also genetic, and even seasonal factors (this is called seasonal affective disorder – SAD) has developed her own recipes. “Even if you don’t want to move at all, at least do finger exercises in the morning, massage your head, arms, legs and neck,” she says. , the eyes are half-closed, that is, the expression is very unpleasant … “
Many people who are not by hearsay familiar with the depressive state testify that they overcame themselves through force, each in their own way: physical exercises, walks, fasting (under the supervision of a specialist), reading only humorous literature or watching exclusively comedies.
One woman confessed that during especially difficult periods she was greatly helped by walking near the school next to her house: the sonorous voices of children running out for recess, their unreasonable laughter charged her with at least a little bit of joy in life.
The fact that depression is now more common is hardly surprising. As doctors-specialists point out, against the background of the loss for many of the meaning and values of life, depression cannot but arise, and this happens not only in the post-Soviet space, where a huge country collapsed overnight, but all over the world.
Globalization, migration, emigration; when former doctors of science become fitters and polishers, when those who remain in their own country turn into downtrodden marginalized people, when adolescence lasts until botox old age, and life still does not start – all this does not contribute to mental health.
Another question, is it necessary to rush to the first-aid kit at every turn of fate or its absence? As the ancient Romans said, what does not kill us makes us stronger.
Active substance FLUOXETINUM | Compendium
MeSH, RTECS, USPDDN: benzenpropamine, N -methyl- γ – (4- (trifluoromethyl) phenoxy) -, (+ -) -.
M m = 309.33 Yes. log P (octanol-water) = 4.05. Solubility in water at 25 ° C = 60.3 mg / l. White or off-white crystalline powder.
Release form: capsules, p / o tablets.
Medicinal preparations containing the active substance FLUOXETIN
fluoxetine is an oral antidepressant that selectively and reversibly inhibits neuronal serotonin reuptake.Slightly affects the seizure of norepinephrine and dopamine. Weakly acts on cholinergic and H 1 -receptors. Promotes mood improvement, eliminates fear and tension, dysphoria. Does not have a sedative effect. Has no cardiotoxic effect. A persistent clinical effect develops after 3-4 weeks of constant admission.
Well absorbed in the digestive tract. Oral bioavailability is more than 60%. C max fluoxetine in blood plasma is observed 6-8 hours after administration.About 94.5% of fluoxetine binds to serum plasma proteins, including albumin and α 1 -glycoprotein. It undergoes biotransformation in the liver with the formation of norfluoxetine and a number of unidentified metabolites. In terms of activity and selectivity of action, norfluoxetine is equivalent to fluoxetine. Inactive metabolites formed in the liver are excreted by the kidneys. The relatively slow excretion of fluoxetine (T ½ – from 2 to 3 days) ensures the maintenance of the therapeutic concentration in the blood plasma for several weeks, therefore, the cessation of therapy does not cause the development of a withdrawal syndrome.
various types of depression (especially depression accompanied by fear), including those resistant to treatment with other antidepressants, obsessive-phobic disorders, bulimic neurosis (to reduce appetite and reduce body weight).
is prescribed only for adults. The usual dose for depression is 20 mg once a day. If necessary, after 3-4 weeks the dose is increased by 20 mg / day. The maximum daily dose is 80 mg.
Elderly and senile persons are prescribed in a dose not exceeding 60 mg / day.
With a single dose (20 mg), the drug is taken in the morning, with a double dose – in the morning and evening.
In case of bulimic neurosis, a daily dose of 60 mg is prescribed in 3 divided doses; with obsessive-phobic disorders – 20-60 mg / day, depending on the severity of the disease.
The course of treatment should be long enough (2-3 months).
hypersensitivity to fluoxetine, simultaneous treatment with MAO inhibitors, pregnancy and lactation, childhood, decompensated epilepsy, severe renal dysfunction (glomerular filtration rate less than 10 ml / min).
asthenia, increased sweating, nausea, diarrhea, anorexia, dyspepsia, vomiting, dry mouth, headache, dizziness, irritability, insomnia, tremor, increased fatigue, convulsions, mania and hypomania, pharyngitis, dysphonia, bronchitis, ichitis immunopathological reactions (pruritus, rash, vasculitis, serum sickness, thrombocytopenia, thrombocytopenic purpura, rarely anaphylactic shock), sexual dysfunctions (increased libido, weakening of orgasm or anorgasmia), rarely hyponatremia, especially when combined therapy with diuretics.
, care must be taken when prescribing to patients with cardiovascular diseases and persons performing potentially hazardous work (driving vehicles, mechanisms). In diabetic patients, fluoxetine can alter blood glucose levels, which requires a dose adjustment of antidiabetic drugs.
Alcohol should not be consumed during treatment with fluoxetine.
is contraindicated for simultaneous use with MAO inhibitors.After the end of taking MAO inhibitors, the use of fluoxetine is possible no earlier than 14 days later. Before starting the use of MAO inhibitors, at least 5 weeks should pass after taking fluoxetine. It is recommended to be careful when using fluoxetine and other psychotropic drugs: lithium preparations (both increase and decrease in the concentration of the latter in the blood plasma are possible), tricyclic antidepressants, tryptophan drugs.
nausea, vomiting, agitation, hypomania, convulsions are possible.Treatment: gastric lavage, the use of activated charcoal with sorbitol, for convulsions, diazepam is administered.
Venlafaxine (Velafax, Velaxin, Newvelong, Venlaxor) – Empathy
Appointed by a psychiatrist for major depressive disorder, social anxiety disorder, and generalized anxiety disorder. It can also be used for attention deficit disorder, post-traumatic stress disorder, obsessive-compulsive disorder. In some cases, it is used by doctors of other specialties (neurologists, therapists) for the treatment of chronic pain syndrome, with diabetic neuropathy, fibromyalgia.It can be used in combination with other drugs. Like all antidepressants, it is sold in the pharmacy strictly by prescription.
Already in the first weeks, venlafaxine exhibits therapeutic effects : improving mood, increasing concentration, reducing anxiety and obsessions.
Recommended doses : 75 mg to 375 mg. The therapeutic dosage of 150 mg per day is reached gradually over 7-10 days.This time is necessary to assess the tolerance of the drug and the selection of an effective dose. If there is no effect within two weeks, the dosage can be gradually increased. At a high daily dosage, venlafaxine has an activating effect and can be effective in melancholy, apathy, asthenic depression. Even if the condition improves, in order to prevent recurrence of depression, venlafaxine is taken for at least six months.
Venlafaxine belongs to the serotonin and norepinephrine reuptake inhibitors (SNRI).There are not very many drugs in this group, and venlafaxine is the most commonly used among them. It increases the concentration of serotonin, norepinephrine and dopamine at the synapses . By blocking the reuptake of the neurotransmitter, it leads to a longer time of stimulation of postsynaptic receptors. At a dose of 75 mg / day, it affects the metabolism of serotonin, at a dose of 225 mg / day, it begins to affect norepinephrine metabolism. The effect of venlafaxine on the dopamine metabolism system is less pronounced.
Venlafaxine has side effects similar to other antidepressants , and many body systems are affected with varying likelihood. In the first weeks of admission, nausea, sweating, dizziness, dry mouth, unusual dreams, tremors, decreased appetite, sleep disturbances in the form of insomnia or drowsiness may be disturbing. Some patients complain of yawning. Decreased libido, erectile dysfunction and ejaculation in men, anorgasmia in women can persist for the entire period of treatment.In predisposed patients, it can cause seizures and increased intraocular pressure. In addition, at a dosage of 225 mg per day, venlafaxine can increase mean arterial pressure, so patients with hypertension often require an increase in the dosage of antihypertensive drugs.
Venlafaxine, like most psychotropic drugs, is not recommended to be combined with alcohol, since it is possible to increase the effect of alcohol, increase its toxicity, and also worsen the mental state.
In no case should you stop taking venlafaxine on your own, you should consult a psychiatrist about any disturbing side effects.
Venlafaxine is available as immediate release tablets and extended release capsules. The difference in price is significant, however, according to studies, which are confirmed by clinical practice, the effect of their intake is not the same, despite the fact that the active ingredient is the same.
Taking the extended-release capsules is usually more convenient for the patient. This form has the advantages of gradually releasing the active substance, which reduces the risk of side effects and achieves a constant concentration throughout the day. The capsules are taken once a day. You cannot open and divide them.
When using immediate-release tablets, the concentration of the drug in the blood rises rapidly, which leads to more frequent side effects.The drug is quickly excreted, so immediate-release tablets must be taken 3 times a day. The tablets can be split or crumbled.
Venlafaxine is not prescribed for children and adolescents under 18 years of age, pregnant and lactating women, with angle-closure glaucoma and while taking MAO inhibitors. It is necessary to inform the doctor about the presence of seizures in the past, a tendency to arrhythmias, increased intraocular pressure, blood pressure, and the use of any medications.
It should be noted that, in the case of an abrupt discontinuation of , patients complain of worsening of their condition more often than with SSRIs. Symptoms of depression can begin to bother with renewed vigor, and in addition, dizziness, drowsiness, muscle tremors, a feeling of numbness and impaired sensitivity in the fingers often occur.
To to avoid withdrawal syndrome , venlafaxine should be withdrawn gradually under the supervision of a psychiatrist.In normal cases, the daily dose is gradually reduced over two weeks, but with higher doses, this period can be extended.
Venlafaxine is one of the most important antidepressant drugs in the practice of a psychiatrist. It is used both in hospital and outpatient treatment. The prolonged form reduces the frequency of side effects and is preferred for use. It should be taken only under the supervision of a psychiatrist, reporting any side effects and in no case should you stop taking it yourself.
Prozac instructions for use: indications, contraindications, side effects – description Prozac Capsules (694)
When used simultaneously with drugs that have a depressing 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 development convulsions.
With simultaneous use with MAO inhibitors, furazolidone, procarbazine, tryptophan, the development of serotonin syndrome is possible (confusion, hypomania, motor restlessness, agitation, convulsions, dysarthria, hypertensive crisis, chills, tremor, nausea, vomiting), vomiting,
With the simultaneous use of fluoxetine inhibits the metabolism of tricyclic and tetracyclic antidepressants, trazodone, carbamazepine, diazepam, metoprolol, terfenadine, phenytoin, which leads to an increase in their concentration in the 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 isoenzyme CYP2D6.
With simultaneous use with hypoglycemic agents, their effect may be enhanced.
There are reports of increased effects of warfarin when 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 hallucinations has been described; with digoxin – a case of an increase in the concentration of digoxin in the blood plasma.