Fluoxetine


Thông tin thuốc gốc
Chỉ định và Liều dùng
Oral
Depression
Adult: Initially, 20 mg once daily. May gradually increase up to max 80 mg daily in 2 divided doses, if no clinical response after several wk.
Child: ≥8 yr Initially, 10 mg daily, may increase to 20 mg daily after 1-2 wk. Low wt childn: Initially, 10 mg daily, may increase to 20 mg daily after several wk, only if clinical response is insufficient.
Elderly: Max: 60 mg daily.

Oral
Obsessive compulsive disorder
Adult: Initially, 20 mg once daily, increased up to 60 mg daily if no clinical response after several wk. Max: 80 mg daily in 2 divided doses.
Child: ≥7 yr Initially, 10 mg daily, may increase to 20 mg daily after 2 wk; increase further up to 60 mg daily after several wk as necessary. Low-wt childn: Initially, 10 mg daily, may increase to 20-30 mg daily after several wk, if required.
Elderly: Max: 60 mg daily.

Oral
Premenstrual dysphoric disorder
Adult: 20 mg daily continuously. Alternatively, 20 mg daily to be started 14 days before menstruation and continued until 1st day of menses; repeat w/ each cycle.

Oral
Bulimia nervosa
Adult: 60 mg daily as a single or in divided doses.

Oral
Panic disorder
Adult: Initially, 10 mg once daily, increase to 20 mg daily after a wk. May further increase to 60 mg daily, if no clinical response after several wk.
Hepatic Impairment
Reduce dose and/or dosing frequency.
Cách dùng
May be taken with or without food.
Chống chỉ định
Concomitant admin or w/in 2 wk of MAOI withdrawal. Concomitant use w/ pimozide or thioridazine.
Thận trọng
Patient w/ history of mania/hypomania, seizure disorder; DM, raised intraocular pressure or at risk of acute narrow-angle glaucoma. Patient w/ risk factors for QT prolongation. Hepatic and severe renal impairment. Elderly, childn. Pregnancy and lactation.
Phản ứng phụ
Insomnia, nervousness, anxiety, restlessness, tension, sleep disorder, abnormal dreams, headache, attention disturbances, dizziness, lethargy, tremor, somnolence, dysgeusia, blurred vision, palpitations, flushing, yawning, vomiting, dry mouth, dyspepsia, urticaria, rash, pruritus, hyperhidrosis, frequent urination, arthralgia, gynaecological bleeding, erectile dysfunction, ejaculation disorder, fatigue, chills, feeling jittery; decreased appetite, wt and libido.
Potentially Fatal: Suicidal thoughts and behaviour, serotonin syndrome.
Thông tin tư vấn bệnh nhân
May impair ability to drive or operate machinery.
MonitoringParameters
Monitor closely for clinical worsening, suicidal behaviour or thoughts and unusual behavioural changes; signs/symptoms of serotonin syndrome.
Quá liều
Symptoms: Nausea, vomiting, seizure, CV dysfunction ranging from asymptomatic arrhythmias to cardiac arrest (including ventricular arrhythmias and nodal rhythm) or ECG changes indicative of QTc prolongation to cardiac arrest, pulmonary dysfunction, signs of altered CNS status ranging from excitation to coma. Management: Symptomatic and supportive treatment. May admin activated charcoal w/ sorbitol.
Tương tác
May lead to serotonin syndrome w/ serotonergic drugs (e.g. triptans, TCAs, fentanyl, tramadol, lithium, buspirone, tryptophan). May increase risk of bleeding w/ aspirin, NSAIDs, warfarin and other anticoagulants. May increase plasma levels of phenytoin.
Potentially Fatal: May increase risk of serotonin syndrome w/ concomitant admin or w/in 14 days of MAOIs withdrawal. May increase the QTc prolonging effect of pimozide and thioridazine.
Food Interaction
Increased risk of serotonin syndrome w/ St John's wort.
Tác dụng
Description: Fluoxetine selectively inhibits serotonin reuptake at the presynaptic neuronal membrane leading to increased synaptic concentrations of serotonin, resulting in numerous functional changes associated w/ enhanced serotonergic neurotransmission.
Onset: W/in a wk.
Pharmacokinetics:
Absorption: Readily absorbed from the GI tract. Time to peak plasma concentration: Approx 6-8 hr.
Distribution: Widely distributed in the body; enters breast milk. Volume of distribution: 20-40 L/kg. Plasma protein binding: Approx 95%.
Metabolism: Extensively metabolised in the liver via demethylation to its main active metabolite norfluoxetine.
Excretion: Mainly via urine (approx 60%). Elimination half-life: Approx 1-3 days (fluoxetine); approx 4-16 days (norfluoxetine).
Đặc tính

Chemical Structure Image
Fluoxetine

Source: National Center for Biotechnology Information. PubChem Database. Fluoxetine, CID=3386, https://pubchem.ncbi.nlm.nih.gov/compound/Fluoxetine (accessed on Jan. 21, 2020)

Bảo quản
Store between 20-25°C. Protect from light.
Phân loại MIMS
Phân loại ATC
N06AB03 - fluoxetine ; Belongs to the class of selective serotonin reuptake inhibitors. Used in the management of depression.
References
Anon. Fluoxetine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 26/11/2015.

Buckingham R (ed). Fluoxetine Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 26/11/2015.

Fluoxetine Hydrochloride Capsule (Aurobindo Pharma Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 26/11/2015.

Joint Formulary Committee. Fluoxetine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 26/11/2015.

McEvoy GK, Snow EK, Miller J et al (eds). Fluoxetine Hydrochloride. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 26/11/2015.

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