About Prozac
Prozac is a prescription medication used to treat major depression,
obsessive-compulsive disorder, bulimia, and sometimes other
eating disorders. As Sarafem, Prozac is prescribed to treat
very severe PMS, now called premenstrual dysphoric disorder
(PMDD). In low doses, Prozac may be used to treat fibromyalgia.
Prozac belongs to a family of antidepressants called selective
serotonin re-uptake inhibitors (SSRIs), which are thought
to improve mood by increasing the availability of a chemical
in the brain called serotonin. High serotonin levels tend
to be associated with a feeling of well-being, while depressed
individuals often have low serotonin levels.
Prozac Side Effects
Take care to avoid operating a vehicle or other heavy machinery
until you know how you react to Prozac. Prozac side effects
may include impaired thinking and motor skills, or cause blurred
vision.
Common Prozac side effects: sweating, agitation, dry mouth,
decreased appetite, somnolence (drowsiness), dizziness, insomnia,
tremor, headache, diarrhea, or nervousness.
Less Common Prozac side effects: changes in sense of taste
or vision, chest pain, constipation, dizziness, dry mouth,
unusual feeling of warmth, flushed or reddened skin, increased
sensitivity to sunlight, stomach cramps or gas, hair loss,
weight loss, weight gain, priapism, decrease in your sex drive,
increase in appetite, painful menstruation, yawning.
Tell your doctor immediately if you experience restlessness,
rash, itching, hives, fever, chills, difficulty breathing,
swelling, muscle pain, or joint pain as a result of taking
Prozac. You may be allergic to Prozac, and have to stop taking
it. These symptoms typically reverse as Prozac leaves your
body, but for some symptoms, an antihistamine or steroid may
be administered to speed recovery.
Seek medical attention if you experience flu symptoms, unsteadiness,
convulsions, increased thirst, headache, anxiety, breast swelling,
red or purple spotting on your skin, exhaustion, weakness,
or an inability to concentrate.
Serotonin Syndrome - This rare side effect is possible with medications
which affect serotonin levels, usually antidepressants. Some
medications which only mildly affect serotonin metabolism
on their own, or interfere with the metabolism of an antidepressant,
may also increase the risk of this syndrome in combination
with a medication like Prozac. The symptoms include agitation,
confusion, diarrhea, fever, lack of coordination, shaking,
shivering, sweating, trembling , twitching, or uncontrollable
excitement. If you experience several of these symptoms at
the same time, seek medical attention at once. If you cannot
be taken to a hospital or doctor immediately, call 911 for
instructions and help.
Cautions: Prozac should be used cautiously in patients with:
Parkinson's disease or a history of seizures, as it may worsen
these conditions. Prozac may not be right for patients with
brain damage or disease, or congenital brain defects; it does
not treat these conditions. Prozac dosages should be lower
for patients with liver trouble, as it will take them longer
to absorb and remove the drug from their bodies. Patients
with kidney trouble seem to process Prozac nearly the same
as people without kidney impairment. Diabetic patients may
need to adjust the dosage of their medication, Prozac may
affect their blood sugar level. Prozac may cause some weight
loss, which may be undesirable for some patients. Tell your
doctor if you have ever had an allergic reaction to Prozac,
Zoloft, Paxil, or any other medication.
Prozac Interactions
Certain medications and supplements may increase the risk of serotonin
syndrome in combination with Prozac. Serotonin syndrome may
cause confusion, restlessness, lowered coordination, shivering
or trembling, diarrhea, fever, sweating, twitching, or behaving
with an excitement you can't control. If you experience a
cluster of these symptoms, and you suspect that it may be
due to a drug interaction or overdose, seek medical attention
immediately. (This condition is very rare.)
Consult a doctor or pharmacist about mixing any medication. Be
especially careful to obtain medical advice if you are considering
Prozac treatment and currently take any of the following medications.
- Alcohol - Avoid alcohol while taking Prozac
- Appetite suppressants like Phentermine/Adipex
(fastin) or Meridia
(sibutramine).
- Benzodiazepines (a class of antidepressants, anti-panic agents,
and muscle relaxants) such as Ativan
(lorazepam), Valium (diazepam),
Halcion (triazolam), Restoril (temazepam), Librium(chlordiazepoxide),
Xanax (alprazolam),
Tranxene-SD (clorazepate), Paxipam (halazepam), ProSom (estazolam),
Klonopin (clonazepam)
- Prozac may increase blood levels of certain of these drugs,
and may cause them to stay in the body longer.
- Beta Blockers - Drugs like Inderal
(propranolol), Lopressor (metoprolol), Tenormin (atenolol),
and others may build up in the body to toxic levels when combined
with SSRIs.
- BuSpar (buspirone)
- Clozaril (clozapine)
- Cough medicine (dextromethorphan)
- Coumadin (warfarin) - may cause bleeding problems when used
with Prozac. Your doctor may prevent this by adjusting the dosage
of one of these medications.
- Crystodigin (digitoxin)
- Desyrel (trazodone)
- Dilantin (phenytoin)
- Effexor (venlafaxine)
- When used with Prozac, increases the chance of developing serotonin
syndrome. Do not use Effexor within 5 weeks of stopping Prozac
treatment.
- Haldol (haloperidol)
- Heart Medicine (digitalis glycosides) - Your doctor may adjust
your dosage of either the heart medication or the Prozac, as they
may interfere with each other's levels in the blood.
- Hismanal (astemizole) - May alter your heartbeat if used with
Prozac.
- Lithium (Eskalith)
- Manarex (moclobemide) - This medication should not be mixed
with Prozac, and you should allow 7 days following the use
of Manarex before starting Prozac. Allow 5 full weeks after stopping
Prozac before beginning use of Manarex. Serious side effects,
including serotonin syndrome can develop.
- MAO inhibitors - Prozac must never be mixed with MAO (monoamine
oxidase) inhibitors, a class of antidepressants and antisenility
drugs, such as Eldepryl (selegiline), Furoxone (furazolidone),
Nardil (phenelzine), Marplan (isocarboxazid), or Parnate (tranylcypromine).
Never use Prozac within 2 weeks of stopping an MAO inhibitor,
wait for 5 weeks after stopping Prozac to begin use of an MAO
inhibitor. This drug interaction could prove fatal.
Patients over 65 should allow a longer wait period between using
Prozac and an MAO, as Prozac may stay in their system longer than
in other patients.
- Migraine medications of the triptan class such as Amerge
(naratriptan), Imitrex
(sumatriptan), Maxalt (rizatriptan), or Zomig (zolmitriptan)
can cause coordination difficulties when mixed with SSRIs.
- Orap (pimozide)
- Parlodel (bromocriptine) should be mixed
cautiously with Prozac.
- Sedatives like Fioricet
(butalbital, acetaminophen, and caffeine), Fiorinal, Phenobarbitol,
Seconal, or other barbiturates.
- Selective serotonin reuptake inhibitors (SSRIs) of any other
type, like Celexa (citalopram),
Paxil (paroxetine), Luvox (fluvoxamine), or Zoloft (sertraline).
- Serzone (nefazodone)
- Sinemet (carbidopa, levodopa)
- Sleep medication like Ambien
(zolpidem), Sonata (zaleplon),
or over the counter sleeping pills should be used with fluoxetine
only as, and if, advised by your doctor.
- Street drugs such as LSD, Ecstasy (MDMA), or marijuana. These
drugs also affect serotonin levels in the brain and may react
strongly with an SSRI like Prozac. Do not combine.
- Talwin (pentazocine)
- Tambocor (flecainide)
- Tegretol (carbamazepine)
- Thioridazine (Mellaril) - Severe Prozac interactions can occur
with this medication. Prozac should not be taken sooner
than two weeks after thioridazine, and Prozac treatment
should be stopped for five weeks before taking thioridazine.
This drug reaction could be suddenly fatal. Individuals
with liver problems or who are over 65 should allow a longer
wait period between using Prozac and thioridazine, as Prozac
may stay in their system longer than in other patients.
- Tranquilizers such as Haldol (haloperidol) or Thorazine (chlorpromazine)
may cause oversedation.
- Tricyclic antidepressants such as Elavil
(amitriptyline), Asendin (amoxapine), Anafranil (clomipramine),
Pertofrane or Norpramin (desipramine), Sinequan
(doxepin), Tofranil (imipramine), Aventyl or Pamelor
(nortriptyline),
Vivactil (protriptyline), and Surmontil (trimipramine),
may increase the risk of side effects from Prozac. The use
of Prozac with Elavil, Anafranil, or Tofranil can increase
the chance of developing serotonin syndrome.
- Tryptophan or 5-HTP (Contained in certain amino acid supplements
or by itself) - This supplement may increase the risk of
serotonin syndrome when mixed with Prozac.
- Ultram (Tramadol)
- Wellbutrin/Zyban (bupropion)
- May increase the risk of serious side effects, such as
seizure, from bupropion.
- Velban (vinblastine)
Be particularly careful about mixing Prozac with any prescription
antidepressant, antipsychotic, or antianxiety medication.
Check with your doctor or pharmacist about mixing Prozac with
any central nervous system depressant (any medication that
'may cause drowsiness'), even if it's an over the counter
medication.
Prozac Dosages
The following dosages are average prescription recommendations
for Prozac. If you doctor has prescribed a different amount,
take that amount and follow the dosage instructions that come
with your Prozac prescription. Doses below are for adults,
doses for children must be determined on an individual basis
by a doctor.
- Depression or Obsessive-Compulsive Disorder - 20mg once per
day is the usual starting dose. Dosage will rarely exceed
80mg per day. Once the condition is under control, your
doctor may switch you to Prozac Weekly, at a usual dose
of a 90mg capsule taken once a week.
- Bulimia Nervosa - 60mg once per day is the usual dose. Dosage
will rarely exceed 80mg.
- Premenstrual Dysphoric Disorder (aka PMS) - 20mg once per day
is the usual starting dose. Dosage will rarely exceed 80mg
per day.
Miss a dose? Skip it and return to your regular dosing schedule.
Do not take double doses of Prozac.
When switching to Prozac Weekly from a daily dose, the manufacturer
suggests waiting a week after stopping the daily dose to begin
taking the Prozac Weekly dose. Taking Prozac Weekly within
a week of ending a daily regimen can cause blood levels of
Prozac to increase beyond the usual concentration.
Prozac Directions
It may take up to four weeks for Prozac to clear up depression,
and up to six months to ensure that the condition will not
return. It may take five weeks before Prozac begins to be
effective for obsessive-compulsive disorder. Prozac may begin
to positively affect the symptoms of bulimia nervosa within
a week, but it may be up to four weeks before the condition
goes away.
Store Prozac away from heat and light, but do not freeze it. Store
in a dry location; avoid storing it in the bathroom, near
sinks, or other areas where it may become damp. Do not use
after the expiration date. Do not crush Prozac Weekly tablets.
Keep Prozac away from children; both when storing it, and when
discarding any unused medication.
Take Prozac with food if you find that it upsets your stomach.
Prozac and Pregnancy
Prozac has not been studied for safety in pregnant or nursing mothers.
Consult your doctor if you plan to become pregnant or breastfeed
during treatment.
Prozac and Children
Prozac has been studied in some children aged 7-18. Prozac appeared
to be helpful in treating obsessive compulsive disorder and
depression among this age group, but there is an increase
in certain side effects. Children seem more likely to experience
restlessness, agitation, excitement, and difficulty sleeping
when treated with Prozac. More study is indicated, but Prozac
is sometimes prescribed to young people in limited doses.
Prozac and Seniors
Studies have not indicated that Prozac causes different side effects
or reactions in the elderly than in the general adult population;
however, Prozac may stay in the body longer. Elderly patients
may need a lower, or less frequent prescription dose.
Prozac and Sarafem are trademarks of Eli Lilly and Company
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The information contained in this document is provided for educational purposes
and information only. It is not a
substitute for consultation with a physician or Health professional, either to diagnose
symptoms or prescribe treatment. Any dosages mentioned are general
guidelines only, please follow the directions of your doctor or
pharmacist exactly when taking medication. We have made every effort to
ensure that this information is accurate, but only your doctor,
physician or Health professional can say
if a medication, a drug alternative or drug combination, is safe for you. Information
intended for US residents only.
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