All you need to know about Prozac

If one is taking a short-acting SSRI medication and was told to discontinue it or decrease dosage, but he\she would like to avoid or to minimize the effects of medication withdrawal.

At first, that person should ask his\her physician if a special dose produced by some pharmaceutical companies and offered them as in the form of sample to doctors exists for the specific goal of discontinue.

If such a dose is not available, the main idea is that patient should try to decrease dosage gradually, in a smooth flowing manner. It is usually recommended to use half of the increments that health care provider would normally suggest for the process of discontinue in most people.

Pills

Patient should always carefully read leaflet of his\her drug to make sure that pills can be splitted. He\she can halve pills with help of pill splitter (it can be purchased for some dollars at the nearest pharmacy). This makes very easy to get half-arrow dosage of the original titration recommendation and take each step down for a week.

Capsules

Patient obviously can’t open them and take the contents raw…but dosage can still tapered off. Some empty gel caps should be purchased (just a couple bucks for a hundred). He\she should take a single daily dosage, open capsules and redistribute the medication into the empty gel caps to spread the total daily dosage into smaller increments. Each capsule should be rubbed before storage with a dry cloth to get any of the medication off of the outside of the capsule. A daily dosage amount should be gradually reduced, using each amount for a week.

That method showed a right spirit when discontinuing Paxil, one of the most notorious drugs for causing SSRI Discontinuation Syndrome. Doctor may acknowledge patient with the discontinuation problem and to give him\her helpful suggestions for reducing the discomfort. So, and the side effects were much more tolerable due to abovementioned method.

The main condition of minimizing of withdrawal symptoms is that the brain’s production of acetylcholine is not interrupted. Using food supplements containing choline, lecithin, and B complex is the easiest way to do it. Prerequisite levels of the neurotransmitter acetylcholine in the brain can be maintained with the B vitamins. Shortage of that neurotransmitter induces abstinence symptoms. Choline supplements or lecithin supplements (which are 13 percent choline) are also recommended because they are able to amplify the level of choline used by brain to produce acetylcholine during decreasing of dosage or discontinuing of antidepressant therapy.

Physician can suggest making dietary changes until the drug is not fully discontinued. A wide variety of foods contains lecithin and choline, but many of them are high also in cholesterol and fats. One of the best dietary sources of lecithin and choline is egg yolks. Beef steak, liver, organ meat, spinach, soybeans, cauliflower, wheat germ, peanuts, and brewer’s yeast also contain significant amount of dietary choline.

A lot of medicines (monoamine oxidase inhibitors, tricyclic antidepressants, antiparkinsonian agents, traditional antipsychotics, and clozapine.) acting on the central nervous system can lead to appearance of withdrawal syndrome symptoms. Condition known as rebound (an agitated state of emotion that occurs at the end of the dosage cycle, and lasts for 15-20 minutes, then disappears) was observed in some people. It happens when patient takes medications of short acting. Doctor can prescribe dietary modifications to solve that problem.

That phenomenon was voted as valid by psychiatric professional community. Notwithstanding that the symptoms can be different and have both physical and psychological origin, doctors are able now to detect patterns of SSRI abstinence syndrome.

Cooperation between Bryan Molloy and Robert Rathbun in 1970 at leaded to utility invention of Prozac.

Antihistamine diphenhydramine showed some antidepressant-like properties. That fact was known at that time. These scientists chose 3-phenoxy-3-phenylpropylamine (a compound structurally similar to diphenhydramine) as terminus a quo. Dozens of its derivatives have been synthesized by Molloy. A selective norepinephrine reuptake inhibitor Nisoxetine became a result of proving the physiological effects of those agents in mice.

Another Eli Lilly scientist, David Wong, trying to discover a derivative inhibiting only serotonin reuptake, suggested that series of laboratory researches dedicated to reuptake of serotonin, norepinephrine and dopamine should be prospected again. In May 1972 Jong-Sir Horng carrying out that test discovered agent which was named later Prozac. It acted as the most potent and effective selective inhibitor of serotonin reuptake of the series.

Lilly scientists claimed Prozac to be the first selective serotonin reuptake inhibitor (SSRI). But they had to issue a correction two years later,where they declared that zimelidine developed by Arvid Carlsson and colleagues had been the first SSRI.

In August 2001 Prozac patent of Eli Lilly expired that induced inflow of generic drugs onto the market. Eli Lilly rebranded Prozac as “Sarafem” for the treatment of premenstrual dysphoric disorder in attempt to reimburse loss caused with reduction of sales of Prozac in Eli Lilly.

MAIN TYPES OF ANTIDEPRESSANTS



• Tricyclics

  • Elavil(amitriptyline);
  • Anafranil(clomipramine);
  • Tofranil(imipramine)

• Monoamine Oxidase Inhibitors(MAOIs)

  • Remeron(mirtazapine);
  • Nardil(phenelzine)

• Selective Serotonin Reuptake Inhibitors (SSRIs)

  • Celexa(citalopram);
  • Lexapro(escitalopram);
  • Prozac(fluoxetine);
  • Paxil(paroxetine);
  • Zoloft(sertraline)

• Others, including Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

  • Wellbutrin(bupropion);
  • Effexor(venlafaxine)

Prozac

Prozac is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. Prozac is approved for the treatment of major depression (including pediatric depression), obsessive-compulsive disorder (in both adult and pediatric populations), bulimia nervosa, anorexia nervosa, panic disorder and premenstrual dysphoric disorder
You should NOT use Prozac if:
• you are allergic to any ingredient in Prozac;
• you are taking or have taken a monoamine oxidase inhibitor (MAOI) (e.g., phenelzine), selegiline, or St. John’s wort within the last 14 days;
• you are taking a fenfluramine derivative (e.g., dexfenfluramine), an H1 antagonist (e.g., astemizole, terfenadine), nefazodone, pimozide, a serotonin norepinephrine reuptake inhibitor (SNRI) (e.g., venlafaxine), sibutramine, thioridazine, or tryptophan
Contact your doctor or health care provider right away if any of these apply to you.
What does my physician need to know prior I start to use Prozac?
You should tell about any of these conditions:
• if you are pregnant, planning to become pregnant;
• lactation;
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement;
• if you have allergies to medicines, foods, or other substances;
• if you or a family member has a history of bipolar disorder (manic-depression), other mental or mood problems, suicidal thoughts or attempts, or alcohol or substance abuse;
• if you have a history of seizures, heart problems, liver problems, severe kidney problems, stomach or bowel bleeding, diabetes, or metabolism problems;
• if you are dehydrated, have low blood sodium levels, or drink alcohol;
• if you will be having electroconvulsive therapy (ECT)
What medicines may interplay with Prozac?
Some medicines may interact with Prozac. Tell your health care provider if you are taking any other medicines, especially any of the following:
• Anorexiants (e.g., phentermine), fenfluramine derivatives (e.g., dexfenfluramine), linezolid, MAOIs (e.g., phenelzine), metoclopramide, nefazodone, selegiline, serotonin 5-HT1 receptor agonists (e.g., sumatriptan), sibutramine, SNRIs (e.g., venlafaxine, St. John’s wort, trazodone, or tryptophan because severe side effects, such as a reaction that may include fever, rigid muscles, blood pressure changes, mental changes, confusion, irritability, agitation, delirium, and coma, may occur;
• Anticoagulants (e.g., warfarin), aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen) because the risk of bleeding, including stomach bleeding, may be increased;
• Diuretics (e.g., furosemide, hydrochlorothiazide) because the risk of low blood sodium levels may be increased;
• Tramadol because the risk of seizures may be increased;
• Cyclobenzaprine or H1 antagonists (e.g., astemizole, terfenadine) because severe heart problems, including irregular heartbeat, may occur;
• HIV protease inhibitors (e.g., ritonavir) because they may increase the risk of Prozac’s side effects;
• Cyproheptadine because it may decrease Prozac’s effectiveness;
• Aripiprazole, benzodiazepines (e.g., alprazolam), beta-blockers (e.g., propranolol), carbamazepine, clozapine, dextromethorphan, digoxin, flecainide, haloperidol, hydantoins (e.g., phenytoin), lithium, norepinephrine reuptake inhibitors (e.g., atomoxetine), phenothiazines (e.g., chlorpromazine, thioridazine), pimozide, propafenone, risperidone, tricyclic antidepressants (e.g., amitriptyline), or vinblastine because the risk of their side effects may be increased by Prozac
This may not be a complete list of all interactions that may occur. Also tell them if you smoke, consume alcohol or caffeine drinks, use illegal drugs. Some items may interplay with Prozac. Check with your health care provider before you start, stop, or change the dose of any medicine.
Prozac administration
Use Prozac as directed by your doctor. Check the label on the medicine for exact dosing instructions.
You should read MedGuide given to you by the pharmacist with each prescription and refill carefully.
Take Prozac orally with or without meals.Taking Prozac at the same time each day will help you remember to take it. Continue to take Prozac even if you feel well. Do not miss any doses. Do not suddenly stop taking Prozac without checking with your doctor. Side effects may occur. They may include mental or mood changes, numbness or tingling of the skin, dizziness, confusion, headache, trouble sleeping, or unusual tiredness. You will be closely monitored when you start Prozac and whenever a change in dose is made.
Missing a dose
If you miss a dose, take it as soon as possible. If it is almost time for your next dose, take only that dose. It is prohibited to take double or extra doses.
Side effects caused with Prozac
The following side effects that usually do not require medical attention:
• Anxiety;
• decreased sexual desire or ability;
• diarrhea;
• dizziness;
• drowsiness;
• dry mouth;
• increased sweating;
• loss of appetite;
• nausea;
• nervousness;
• indigestion;
• trouble sleeping;
• weakness.
You should report to your prescriber about those side effects as soon as possible:
• Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue);
• bizarre behavior;
• black or bloody stools;
• chest pain;
• confusion;
• exaggerated reflexes;
• excessive sweating;
• fast or irregular heartbeat;
• fever, chills, or sore throat;
• hallucinations;
• increased urination;
• joint or wrist aches or pain;
• loss of coordination;
• new or worsening agitation, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, restlessness, or inability to sit still;
• persistent or severe ringing in the ears;
• persistent, painful erection;
• red, swollen, blistered, or peeling skin;
• seizures;
• severe or persistent anxiety or trouble sleeping;
• significant weight loss;
• stomach pain;
• suicidal thoughts or attempts;
• tremor;
• unusual bruising or bleeding;
• unusual hoarseness;
• unusual or severe mental or mood changes;
• unusual swelling;
• vision changes;
• worsening of depression.
What should I watch for while taking Prozac
You should not drive, use machinery or do anything that needs mental alertness until you know how Prozac affects you due to you may feel faintness. If you are an aged patient do not sit or stand up quickly to reduce the risk of faintness. Alcohol can make you more dizzy, increase flushing and rapid heartbeats. Avoid alcoholic drinks.
Check with your doctor before you use medicines that may cause drowsiness (e.g., sleep aids, muscle relaxers) while you are taking Prozac; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
Several weeks may pass before your symptoms improve. Do NOT take more than the recommended dose, change your dose, or take Prozac for longer than prescribed without checking with your doctor.
Children and teenagers who take Prozac may be at increased risk for suicidal thoughts or actions. Adults may also be affected. The risk may be greater in patients who have had suicidal thoughts or actions in the past. The risk may also be greater in patients who have had bipolar (manic-depressive) illness, or if a family member has had it. Watch patients who take Prozac closely. Contact the doctor at once if new, worsened, or sudden symptoms, such as depressed mood; anxious, restless, or irritable behavior; panic attacks; or any unusual changes in mood or behavior, occur. Contact the doctor right away if any signs of suicidal thoughts or actions occur.
Diabetes patients – Prozac may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.
Serotonin syndrome is a possibly fatal syndrome that can be caused by Prozac. Your risk may be greater if you take Prozac with certain other medicines (e.g., “triptans,” MAOIs). Symptoms may include agitation; confusion; hallucinations; coma; fever; fast or irregular heartbeat; tremor; excessive sweating; and nausea, vomiting, or diarrhea. Contact your doctor at once if you have any of these symptoms.
If your doctor tells you to stop taking Prozac, you will need to wait for several weeks before beginning to take certain other medicines (e.g., MAOIs, nefazodone, thioridazine). Ask your doctor when you should start to take your new medicines after you have stopped taking Prozac.
Prozac may rarely cause a prolonged, painful erection. This could happen even when you are not having sex. If this is not treated right away, it could lead to permanent sexual problems such as impotence. Contact your doctor right away if this happens.
Caution is advised when using Prozac in CHILDREN; they may be more sensitive to its effects, especially increased risk of suicidal thoughts or actions.
Prozac should be used with extreme caution in CHILDREN younger than 7 years old; safety and effectiveness in these children have not been confirmed. Prozac may cause weight changes. CHILDREN and teenagers may need regular weight and growth checks while they take Prozac.
PREGNANCY and LACTATION: Prozac may cause harm to the fetus if it is used during the last 3 months of pregnancy. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Prozac while you are pregnant. Prozac is found in breast milk. Do not breast-feed while you are taking Prozac.
Prozac Storage
Store in a dry place at 20-25 degrees C (68-77 F).