Fluoxetine capsules 10mg - Indications and Usage for Fluoxetine Capsules
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There were suicides in the adult trials, but the number was not sufficient to reach any conclusion about drug effect on suicide. It is unknown whether the suicidality risk extends to longer-term use, i.
However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that starlix novartis pharmaceuticals use of antidepressants can delay the recurrence of depression. All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, fluoxetine capsules 10mg, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases.
The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia psychomotor restlessnesshypomania, and mania, have been reported in adult and pediatric capsules being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric.
Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms.
Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, fluoxetine capsules 10mg, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to health care providers.
Such monitoring should include daily observation by families and caregivers. Prescriptions for fluoxetine tablets should be written for the smallest fluoxetine of tablets consistent with good patient management, in order to reduce the risk of overdose.
It should be noted that fluoxetine is approved in the pediatric population only for major depressive disorder and obsessive compulsive disorder. Screening Patients for Bipolar Disorder A major depressive episode may be the initial presentation of bipolar disorder. Whether any 10mg the symptoms described above represent such a conversion is unknown.
However, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar fluoxetine such screening should include a detailed psychiatric history, including a family history of suicide, bipolar capsule, and depression. It should be noted that fluoxetine tablets are not approved for use in treating bipolar depression. Clinical findings reported in association with rash include fever, leukocytosis, arthralgias, edema, carpal tunnel syndrome, respiratory distress, lymphadenopathy, proteinuria, and mild transaminase elevation.
In premarketing clinical trials, 2 patients are known to have developed a serious cutaneous systemic illness, fluoxetine capsules 10mg. In neither patient was there an unequivocal diagnosis, but one was considered to have a leukocytoclastic vasculitis, and the other, a severe desquamating syndrome that was considered variously to be a vasculitis or erythema multiforme.
Other patients have had systemic syndromes suggestive of serum sickness. Since the introduction of fluoxetine, systemic events, possibly related to vasculitis and including lupus-like syndrome, have developed in patients with 10mg. Although these events are rare, they may be serious, involving the lung, kidney, or liver. Death has been reported to occur in association with these systemic events.
Anaphylactoid events, including bronchospasm, angioedema, laryngospasm, and urticaria fluoxetine and in combination, have been reported. These events have occurred with dyspnea as the only preceding symptom. Whether these systemic events and rash have a common underlying cause or are due to different etiologies or pathogenic processes 10mg not known. Furthermore, a specific underlying immunologic basis for these capsules has not been identified.
Upon the appearance of rash or of other possibly allergic phenomena for which an alternative etiology cannot be identified, fluoxetine should be discontinued.
Serotonin Syndrome The development of a potentially life-threatening serotonin syndrome may occur capsule SNRIs and SSRIs, including fluoxetine treatment, particularly with concomitant use of serotonergic drugs including triptans and with drugs which impair metabolism of serotonin including MAOIs.
Serotonin syndrome symptoms may include mental status changes e. Potential Interaction With Thioridazine In a study of 19 healthy male 10mg, which included 6 slow and 13 rapid hydroxylators of debrisoquin, a single 25 mg oral dose of thioridazine produced a 2.
The rate of debrisoquin hydroxylation is felt to depend on the level of cytochrome CYP2D6 isozyme activity. Thioridazine administration produces a dose-related prolongation 10mg the QTc interval, which is associated with serious ventricular arrhythmias, such as torsade de pointes-type arrhythmias, and sudden death.
Concomitant use of aspirin, non-steroidal anti-inflammatory drugs, warfarin, and other anti-coagulants may add to this risk. Case reports and epidemiological studies case-control and cohort design have demonstrated an association between use of drugs that interfere with serotonin reuptake fluoxetine the occurrence of gastrointestinal bleeding. Patients should be cautioned about the risk of bleeding associated with the concomitant use of fluoxetine and NSAIDs, aspirin, or other drugs that affect coagulation see Drug Interactions, fluoxetine capsules 10mg.
Anxiety and Insomnia In U. Altered Appetite and Weight Significant weight loss, especially in capsule depressed or bulimic patients may be an undesirable result of treatment with fluoxetine. Weight loss was reported in 1. Patients treated with fluoxetine trileptal purchase online mg on average lost 0.
Weight change should be monitored during therapy. In many cases, this hyponatremia appears to be the result of the capsule of inappropriate antidiuretic hormone secretion SIADH. Also, patients taking diuretics or who are otherwise volume depleted may be at greater risk see Geriatric Use.
Discontinuation of fluoxetine should be considered in patients with symptomatic hyponatremia and appropriate medical intervention should be instituted. Signs and symptoms of hyponatremia 10mg headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, fluoxetine capsules 10mg, fluoxetine may lead to falls. No patients reported convulsions in U. The percentage appears to be similar to that associated with other marketed drugs effective in the treatment of major depressive disorder.
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Fluoxetine should be introduced capsule care in patients with a history of seizures. Use in Patients With Concomitant Illness Clinical experience with fluoxetine in patients with concomitant systemic illness is limited.
Caution is advisable in using fluoxetine in patients with diseases or conditions that could affect metabolism or hemodynamic responses. Fluoxetine has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease.
Patients with these diagnoses were systematically excluded from clinical studies during the product's premarket testing. However, the electrocardiograms of patients who received fluoxetine in double-blind trials were retrospectively evaluated; no conduction abnormalities that resulted in heart capsule were observed.
In subjects with cirrhosis of the liver, the clearances of fluoxetine and its active metabolite, norfluoxetine, were decreased, thus increasing the elimination half-lives of these fluoxetine.
A lower or less frequent dose should be used in patients with cirrhosis. In patients capsule diabetes, fluoxetine may alter glycemic control. Hypoglycemia 10mg occurred during therapy with fluoxetine, and hyperglycemia has developed following discontinuation of the drug.
Interference 10mg Cognitive and Motor Performance Any psychoactive drug may impair judgment, thinking, or motor skills, fluoxetine capsules 10mg, and patients should be cautioned about operating hazardous machinery, including automobiles, fluoxetine capsules 10mg, fluoxetine they are reasonably certain that the drug treatment capsules not affect fluoxetine adversely, fluoxetine capsules 10mg. Discontinuation of Treatment With Fluoxetine During marketing of fluoxetine and other SSRIs and SNRIs serotonin 10mg norepinephrine reuptake inhibitorsthere have been spontaneous reports of adverse events occurring upon discontinuation of these capsules, particularly when abrupt, including the following: While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.
Patients should be monitored for these symptoms when discontinuing treatment with fluoxetine. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible.
If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but fluoxetine a more gradual rate.
Information for Patients Prescribers or capsule health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with fluoxetine tablets and should fluoxetine them in its appropriate use.
The prescriber or health professional should instruct patients, their 10mg, and their caregivers to read the Medication Guide and should assist them in understanding its contents.
Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is 10mg at the end of this document. Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking fluoxetine tablets. Clinical Worsening and Suicide Risk Patients, their capsules, and their caregivers should be encouraged to be capsule to the emergence of anxiety, agitation, fluoxetine capsules 10mg, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia psychomotor restlessnesshypomania, fluoxetine capsules 10mg, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment 10mg when the dose 10mg adjusted up or down.
Families and caregivers of patients should fluoxetine advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient's prescriber or health professional, especially if they are severe, abrupt fluoxetine onset, or were not part of the patient's presenting symptoms.
Symptoms such as these may be associated with an increased risk for suicidal fluoxetine and behavior and indicate a need for very close monitoring and possibly changes in the medication. Serotonin Syndrome Patients should be cautioned about the risk of serotonin syndrome with the concomitant use of fluoxetine and triptans, tramadol or capsule serotonergic agents. Because fluoxetine may impair judgment, thinking, or motor skills, patients should be advised to avoid driving a car or operating hazardous machinery until they are reasonably certain that their performance is not affected, fluoxetine capsules 10mg.
Patients should be advised to inform their physician if they are capsule or plan to take any prescription or over-the-counter drugs, or alcohol. Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during capsule. Patients should be advised fluoxetine notify their 10mg if they are breast-feeding an infant.
Patients should be advised to notify their physician if they develop a rash or hives. Laboratory Tests There are no specific laboratory tests recommended. Drug Interactions As with all fluoxetine, the potential for interaction by a variety of mechanisms e. Coadministration of fluoxetine with other drugs that are metabolized by CYP2D6, including certain antidepressants e.
Therapy with medications that are predominantly metabolized by the CYP2D6 capsule and that have a relatively narrow therapeutic index see list below should be initiated at the low end of the dose range if a patient is receiving fluoxetine concurrently or has taken it in the previous 5 weeks. If fluoxetine is added to the treatment regimen of a patient already receiving a drug metabolized by CYP2D6, the fluoxetine for decreased dose of the original medication should be considered. Drugs with a narrow therapeutic index represent the greatest concern e.
Drugs Metabolized by Cytochrome CYP3A4 In an in vivo interaction study involving coadministration of fluoxetine with single doses of terfenadine a CYP3A4 substratefluoxetine capsules 10mg, 10mg increase in fluoxetine terfenadine concentrations occurred with concomitant fluoxetine. In addition, in vitro studies have shown ketoconazole, a potent inhibitor of CYP3A4 activity, to be at least times more potent than fluoxetine or norfluoxetine as an inhibitor of the metabolism of several fluoxetine for this enzyme, fluoxetine capsules 10mg, including astemizole, cisapride, fluoxetine capsules 10mg, and midazolam.
These data indicate that fluoxetine's extent of inhibition of cytochrome CYP3A4 activity 10mg not likely to be of clinical significance.
Nonetheless, caution is advised if the concomitant administration of fluoxetine and such fluoxetine is required. Anticonvulsants Patients on stable doses of phenytoin and carbamazepine have developed elevated plasma anticonvulsant concentrations and clinical anticonvulsant toxicity following initiation of concomitant fluoxetine treatment.
Keppra for anxiety disorder of blood levels of haloperidol and clozapine has been observed in patients receiving concomitant fluoxetine.
Clinical studies of pimozide with other antidepressants demonstrate an increase in drug interaction or QTc prolongation. While a specific study with pimozide and fluoxetine has not been conducted, the potential for drug interactions or QTc prolongation warrants restricting the concurrent use of pimozide and fluoxetine.
Coadministration of alprazolam and fluoxetine has resulted in increased alprazolam plasma concentrations and in further psychomotor performance decrement due to increased alprazolam levels. Lithium There have been reports of both increased and decreased lithium levels when lithium was used concomitantly with fluoxetine. Cases of lithium toxicity and increased serotonergic effects have been reported.
Lithium levels should be monitored when these drugs are administered concomitantly. Tryptophan 10mg patients receiving fluoxetine in combination with tryptophan experienced adverse reactions, fluoxetine capsules 10mg, including agitation, fluoxetine capsules 10mg, restlessness, and gastrointestinal distress.
Other Drugs Effective in the Treatment of 10mg Depressive Disorder In 2 studies, previously stable plasma levels of imipramine and desipramine have increased greater than 2 to 10 fold when fluoxetine has been 10mg in combination.
This influence may persist for 3 weeks or longer after fluoxetine is discontinued. Serotonergic Drugs Based on 10mg mechanism of action of SNRIs and SSRIs, including fluoxetine, and the potential for serotonin syndrome, caution is advised when fluoxetine is coadministered with other drugs that may affect the serotonergic neurotransmitter systems, such as triptans, linezolid an capsule which is a reversible non-selective MAOIlithium, tramadol, or St.