Fluoxetine symptoms. Perhaps this review will help those who need support and stands before choosing whether Fluoksetin. Side effects of a substance Fluoksetin

Gross formula

C 17 H 18 F 3 NO

Pharmacological group of substance Fluoksetin

Nonological Classification (ICD-10)

CAS code

54910-89-3

Characteristics of the substance of Fluoksetin

Bicyclic antidepressant, SIRES.

Fluoxetine hydrochloride - white or not quite white crystalline powder, difficult to soluble in water (14 mg / ml). Molecular weight 345.79.

Pharmacology

pharmachologic effect - antidepressive, anorexigne.

Selectively inhibits the inverse seizure of serotonin, which leads to an increase in its concentration in the synaptic slit, strengthening and prolonging its action on postsynaptic receptors. Raising serotonergic transmission, the negative feedback mechanism inhibits the exchange of the neurotransmitter. With prolonged use, the activity of 5-NT 1-receptor is reduced. Also blocks the reverse seizure of serotonin in platelets. Weakly affects the reverse grip of norepinephrine and dopamine. It does not have a direct action on serotonin, m-cholinergic, H 1-hysteamic and alpha adrenoreceptors. Unlike most antidepressants, it does not cause a decrease in the activity of postsynaptic beta-adrenoreceptors.

Effective with endogenous depressions and obsessive-compulsive disorders. Improves mood, reduces tensions, anxiety and feeling of fear, eliminates dysphoria. It has an anorexigne effect, can cause loss of body weight. In patients with diabetes, it can cause hypoglycemia, when the fluoxetine is abolished - hyperglycemia. The pronounced clinical effect in depression occurs after 1-4 weeks of treatment, with obsessive-compulsive disorders - after 5 weeks and more.

Well absorbed from the gastrointestinal tract. The effect of "first passage" through the liver is weakly expressed. Flooxetine capsules and aqueous solution are equivalent in efficiency. After a single reception at a dose of 40 mg C MAX, fluoxetine is achieved in 4-8 hours and is 15-55 ng / ml, when taking the same dose for 30 days C Max fluoxetine is 91-302 ng / ml, norfluochetine - 72- 258 ng / ml. At a concentration of up to 200-1000 ng / ml fluoxetine, 94.5% is associated with blood proteins, including albumin and alpha 1-Glycoprotein. Enantiomers are equivalent, but S-fluoxetine is moved slowly and prevails over the R-form at an equilibrium concentration. Easily penetrates through the BC. In the liver, enantiomers are demolished with the participation of the isopenzy Cyp2d6. Cytochrome P450 to Norfluochetian and other non-identified metabolites, and S-Norfluocetin in activity is equal to R- and S-fluoxetine and exceeds R-Norfluoksetin. T 1/2 fluoxetine is 1-3 days after one-time reception and 4-6 days with long-term administration. T 1/2 Norfluochetina - 4-16 days in both cases, which causes a significant cumulation of substances, slow achieving their equilibrium plasma level and a long presence in the body after cancellation. In patients with cirrhosis of the liver T 1/2 fluoxetine and its metabolites extends. It is excreted within 1 week in the main kidneys (80%): unchanged - 11.6%, in the form of glucuron fluoxetine - 7.4%, Norfluoksetina - 6.8%, norflowsetin glucuronide - 8.2%, more than 20% - hypric acid, 46% - other compounds; 15% is derived to the intestine. When the kidney function is violated, the elimination of fluoxetine and its metabolites slows down. During dialysis, it is not displayed (due to the large volume of distribution and high degree of binding with plasma proteins).

There are data on the effectiveness of fluoxetine with nutritional disorders (nerve anorexia), alcoholism, disturbing disorders, including sociophobia; diabetic neuropathy, affective, incl. bipolar, disorders; Distimia, autism, panic attacks, premenstrual syndrome, narcolepsy, catalepsy, obstructive apnea syndrome in dream, kleptomania, schizophrenia, schizoaffective disorders, etc.

Application of substance Fluoksetin.

Depression (especially accompanied by fear), incl. With the ineffectiveness of other antidepressants, obsessive-compulsive disorders, nervous bulimia.

Contraindications

Hypersensitivity, the use of MAO inhibitors (in previous 2 weeks), hepatic and renal failure (creatinine clearance less than 10 ml / min), epilepsy and convulsive states (history), suicidal mood, diabetes, bladder atony, closed gloom, prostate hypertrophy glands.

Restrictions on application

Children's age (safety and efficacy are not established), myocardial infarction, incl. In history, liver cirrhrosis.

Application in pregnancy and breastfeeding

During pregnancy, it should be assigned only in case of extreme need. When using fluoxetine during pregnancy, an increase in the risk of premature births, developmental anomalies and low adaptation of newborns is noted (including breathing difficulty, cyanosis, excitability).

At the time of treatment, it should be abandoned from breastfeeding (fluoxetine penetrates breast milk of nursing women).

Actualization of information

Application of fluoxetine in the first trimester of pregnancy

A sufficient number of controlled studies to study the safety of fluoxetine in women during the first trimester of pregnancy was not carried out, and the results of some published epidemiological studies are contradictory. More than 10 cohort studies and studies type case-control did not reveal an increase in the likelihood of the formation of congenital malformations. At the same time, a prospective cohort study conducted European Network of Teratology Information ServicesIt allows you to talk about increasing the risk of developing congenital voids of the cardiovascular system in newborns, whose mothers (N \u003d 253) were used fluoxetine during the first trimester of pregnancy compared to newborn, whose mothers (N \u003d 1359) did not take fluoxetine. At the same time, a specific group of defects for the development of the cardiovascular system was not determined and it was not possible to establish a reliable causal relationship between the intake of fluoxetine during the first trimester of pregnancy and an increase in the risk of formal fetal anomalies.

[Updated 24.02.2012 ]

Application of fluoxetine in the III trimester of pregnancy

The use of inhibitors of serotonin and norepinephrine inhibitors (IZOSN), as well as SSRS, including fluoxetine, at the end of the third trimester pregnancy led to the development of complications in newborns (the duration of hospitalization increased, the duration of artificial ventilation of light and probe food). There are reports of the development of such pathological conditions as a respiratory distress syndrome of newborns, apnea, cramps, body temperature lability, hypoglycemia, a decrease or enhancement of blood pressure, vomiting, difficulty nutrition, cyanosis, hyperreflexia, tremor, nervous irritability, excitability, permanent crying. The listed disorders may be a manifestation of the toxic effects of IOPS and SSIRS, or be a consequence of their abolition syndrome.

[Updated 24.02.2012 ]

Data study of teratogenicity of fluoxetine in animals

With the introduction of fluoxetine, in doses, exceeding 12.5 mg / kg per day, pregnant females of rats, as well as in doses exceeding 15 mg / kg per day with pregnant females of rabbits (respectively, 1.5 and 3.6 times higher than the maximum dose recommended For a person - 80 mg / m2), there was no reliable data indicating the teratogenicity of fluoxetine during the organogenesis process. However, the data obtained during other tests on rats indicate an increase in the number of stillbirths, a decrease in the weight of newborns and increasing mortality of newborns, Cryats within 7 days after birth, with the introduction of fluoxetine at a dose of 12 mg / kg per day (1.5 times higher than the maximum Doses recommended for humans) during pregnancy and at a dose of 7.5 mg / kg per day (90% of the maximum dose recommended for humans) during pregnancy and lactation. At the same time, there were no signs of neurotoxicity among the surviving newborn females of rats that received 12 mg / kg fluoxetine during pregnancy per day. Fluoksetina dose 5 mg / kg per day (60% of the maximum dose recommended for humans) was defined as non-increasing mortality of newborn animals.

[Updated 24.02.2012 ]

Side effects of a substance Fluoksetin

From the nervous system and sense organs: headache, dizziness, anxiety, nervousness, lethargy, fatigue, asthenic syndrome, emotional lability, sleep disorders (insomnia, drowsiness), nightmarish dreams, motor anxiety, muscular twitching, mioclon, tremor, hyperkinosis, convulsive states, hypo-or hyperreflexia, Extrapyramidal syndrome, blindfold syndrome, ataxia, acatia, dysarthria, hyper or hyptestesia, paresthesia, neuralgia, neuropathy, neuritis, neurosis, thinking disorders, difficulty concentration of attention, amnesia, euphoria, mania or hypomania, hallucinations, depersonalization, paranoid reactions, Psychosis, suicidal tendencies, changes on EEG, stupor, coma, decrease in visibility, amblyopia, rybism, diplopia, exophthalm, mydriaz, conjunctivitis, irrit, sclerit, blufarite, xeropthalmia, light-free, glaucoma, violation of taste sensations, steaming, noise and pain In the ears, hyperacts.

From the side of the cardiovascular system and blood (blood formation, hemostasis): Tachy or bradycardia, extrasystolia, atrial or ventricular fibrillation, heart stop, myocardial infarction, stagnant heart failure, hyper-or hypotension, vascular dilatation, flubit, thrombophlebitis, vessel thrombosis, vasculitis with hemorrhagic rash, cerebral ischemia, brain vessel embolism, anemia, leukocytosis or leukopenia, lymphocytosis, thrombocytemy, thrombocytopenia, pancytopenia.

From the respiratory system: nasal congestion, nasal bleeding, sinusitis, larynx swelling, difficulty breathing, stridor, hyper- or hypothening, okota, cough, respiratory distress syndrome, changes in lung inflammatory or fibrous character, atelectasis, emphysema, lung swelling, hypoxia, apnea, pain in chest.

From the head of the gastrointestinal authorities: REDUCTION (rarely increase) appetite, anorexia, mouth dry, increased salivation, increasing salivary glands, thomatitis, glossitis, dysphagia, esophagitis, gastritis, dyspepsia, nausea, vomiting, incl. hematimeses, abdominal pain, acute abdomen syndrome, stomach and duodenal ulcer, gastrointestinal bleeding, meteorism, diarrhea, constipation, mellen, colitis, intestinal obstruction, increase in the level of hepatic transaminases, creatine phosphocainase and alkaline phosphatase in blood, hepatitis, Holetiasis, cholestatic jaundice, liver failure, liver necrosis, pancreatitis.

From the metabolism: Violation of adg secretion, hyponatremia, hypo-or hypercalemia, hypocalcemia, hyperuricemia, gout, hypercholesterolemia, diabetes, hypoglycemia, diabetic acidosis, hypothyroidism, swelling, dehydration.

From the urogenital system: Dysuria, stripped urination, niccountura, poly- or oliguria, albumin- and proteinuria, glucosuria, hematuria, urinary tract infections, cystitis, renal failure, hyperprolactinemia, increase and pain in lactic glands, decrease in libido, ejaculation disorder, priapism, impotence, anorgazmia , painful menstruation, meno and metrragia.

From the musculoskeletal system: Miasthenia, Miopathy, Malgy, Miosit, Arthritium, Arthritis, Rheumatoid Arthritis, Bursit, Tendosinovit, Hondrodastrophia, Osteomyelitis, Osteoporosis, Bone pain.

From the side of the skin: polymorphic rash, incl. Hemorrhagic, ulcerative lesions of the skin, acne, alopecia, contact dermatitis, photosensibilization, skin color, furunculosis, lispy, girsutism, eczema, psoriasis, seborrhea, epidermal necrosis, exfoliative dermatitis.

Allergic reactions: Razk, itching, urticaria, swelling of quinque, serum type reactions, anaphylactic and anaphylactoid reactions.

Others: loss of body weight, sweating, face hyperemia and neck with a feeling of heat, malignant neuroleptic syndrome, yawning, chills, fever, influenza-like syndrome, hypothermia, lymphadenopathy, incl. Increased almonds, pharyngitis. Female outcomes are described.

Interaction

Incompatible with MAO inhibitors, other antidepressants, furazolidone, prolley, because Causes serotonergic syndrome (chills, hyperthermia, muscle rigidity, mioclon, vegetative lability, hypertensive crisis, excitation, tremor, motorive concerns, convulsions, diarrhea, hypomanical state, nonsense, coma; death is possible. With simultaneous reception with preparations having a high degree Binding plasma proteins (oral anticoagulants, oral hypoglycemic agents, heart glycosides, etc.), it is possible to mutual displacement due to protein with a change in the concentration of the free fraction in the blood, the risk of developing side effects increases. Increases the risk of bleeding against the background of receiving warfarin. Breaks biotransformation Medicinal medicines metabolizing with the participation of the Isoenzyme Cyp2d6. cytochrome P450 (tricyclic antidepressants, dextromethorphan, etc.). Eludes T 1/2 diazepam, the effects of alprazolam will potentiate. With a simultaneous reception, it changes (increases or decreases) lithium plasma concentration in blood plasma, increases the content of phenytin (to clinical manifestations of its overdose); The level of tricyclic antidepressants (imipramine, desipramine) increases 2-10 times. Triptofan enhances the serotonergic properties of fluoxetine (assessment, motor anxiety, dysfunction of the tract). Incompatible with ethanol.

Actualization of information

Additional information about the drug interaction of fluoxetine

The use of fluoxetine in combination with Mao inhibitors, as well as within 14 days after their cancellation to avoid the risk of development of interaction. The appointment of Mao inhibitors is possible only after 5 weeks after the abolition of fluoxetine.

[Updated 24.02.2012 ]

The simultaneous use of fluoxetine and pimoside is not recommended. Clinical studies of the safety of pimoside use in combination with other antidepressants showed that their simultaneous reception can lead to the elongation of the corrected Qt interval (QTC). Despite the fact that special studies, to study the safety of the simultaneous use of pimoside and fluoxetine, were not carried out, the potential possibility of drug interaction, mainly the elongation of the Qtc interval, is a sufficient basis for limiting the combined use of these drugs.

[Updated 24.02.2012 ]

A study was conducted with the participation of 19 healthy volunteers - 6 slow and 13 rapid metabolizers on the enzyme debizokhin-hydroxylase, who took 25 mg of thiuridazine inwards once. Cmax in slow metabolizers turned out to be 2.4 times higher, AUC is 4.5 times more compared to rapid metabolizers. It is known that the activity of disbizokhin-hydroxylase depends on the level of activity of the isoenzyme system of the cytochrome P450 SYP2D6. Thus, this study has demonstrated that drugs inhibiting isoenzyme Cyp2d6., such as serotonin reverse capture electoral inhibitors, in particular fluoxetine, can increase the concentration of thiuridazine in the blood plasma. Thiuridazine has the ability to dose-dependently lengthen QTC, which causes the risk of developing life-degraded forms of ventricular arrhythmias, such as pyrutete tachycardia (Torsades de Pointes), and sudden death, the likelihood of which increases with simultaneous tioridazine with fluoxetine.

Taking into account the risk of developing life-degraded forms of ventricular arrhythmias and sudden death with simultaneous admission of thiuridazine and fluoxetine, it should be noted that such a therapeutic combination is contraindicated, and the tioridazine reception is possible after 5 weeks from the moment of the last intake of fluoxetine.

[Updated 24.02.2012 ]

Fluoxetine inhibits the activity of the cytochrome P450 Cyp2d6. And thus modifies the normal metabolic activity of the isoenzyme to the level similar to that of slow metabolizers. Other drugs whose metabolism is carried out with the participation of the isopenzy Cyp2d6., such as tricyclic antidepressants (TCCs), neuroleptics (including phenothiazines and most atypical antipsychotic drugs), antiarrhythmics (conpaphenon, frekdom, etc.) should be used in conjunction with fluoxetine with caution. In case the patient takes fluoxetine or received it over the past 5 weeks, therapy with drugs metabolizing mainly Cyp2d6. and having a narrow therapeutic range (for example, freakinide, conpaphenon, vinblastine and TCC) should begin with the lowest possible doses (the selection of the dose should occur in the same way as in the case of prescribing slow metabolizers on this isoenzyme of the cytochrome P450 system). When appointing fluoxetin, the patient already receiving drugs, metabolized by the isoenzyme Cyp2d6.The need to adjust the dose of these drugs towards its decline should be envisaged.

[Updated 24.02.2012 ]

Some patients may lengthen the T1 / 2 diazepam with simultaneous intake of fluoxetine. The combined use of alprazolam and fluoxetine was accompanied by an increase in the serum concentrations of Alprazolam, leading to the oppression of psychomotor activity.

[Updated 24.02.2012 ]

Some clinical data indicate a possible drug interaction between neuroleptics and selective seeding inhibitors of serotonin. In particular, an increase in the concentrations of haloperidol and clozapine in patients receiving fluoxetine as concomitant therapy was observed.

[Updated 24.02.2012 ]

It is reported both of the decrease and increase in serum concentration of lithium while using fluoxetine simultaneously. In the latter case, the likelihood of the development of toxic effects of both normologic drugs and selective seeding inhibitors of serotonin is increasing. With simultaneous reception of lithium and fluoxetine preparations, it is necessary to constantly monitors the concentration of lithium in the blood plasma.

[Updated 24.02.2012 ]

Fluoksetin When taking a dose of 60 mg once or within 8 days, leads to a minor (about 16%) decrease in the clearance of olanzapine and increasing the value of Cmax.

In patients receiving fixed doses of phenytoin and carbamazepine, there was a rise of their plasma concentrations with the development of clinical manifestations of toxic effects, when adding fluoxetine as a concomitant therapy.

[Updated 24.02.2012 ]

In the study in vivo. It has been shown that the single administration of the thermopenadine (CYP3A4 substrate) against the background of fluoxetine therapy is not accompanied by an increase in serum concentrations of thermopholdin.

In the course of studies in vitro. Data indicating that ketoconazole is the effective inhibitor of the cytochrome system of the cytochrome P450 CYP3A4 - at least 100 times more active than fluoxetine and norfluoxetine prevents the metabolism of CYP3A4 substrates (such as astemisol, cisapride, muscolam). Thus, the inhibitory ability of fluoxetine with respect to the isoenfector of the cytochrome system P450 CYP3A4 is not clinically significant.

[Updated 24.02.2012 ]

Overdose

Symptoms: Nausea, vomiting, excitation, anxiety, hypologia, cramps, large epileptic seizures. Two fatal outcomes from the acute overdose of fluoxetine are described (in combination with mapproletin, codeine, templazapam).

Treatment: Washing the stomach, inttenition of activated carbon, sorbitol, ECG monitoring, symptomatic and supporting therapy, during seizures - diazepam. No specific antidote. Forced diuresis, peritoneal dialysis, hemodialysis, blood transfusion is ineffective.

Ways of administration

Inside.

Precautionary Precautions Fluoksetin

With caution to prescribe in old age, with cardiovascular diseases, lack of liver function and / or kidney. Requires careful observation of patients with suicidal inclinations, especially at the beginning of treatment. The risk of suicide in patients previously taking other antidepressants, and patients who, against the background of fluoxetin treatment, there is excessive fatigue, hypersynia or motor anxiety. In the treatment of patients with low body weight, the anorexigne properties of fluoxetine should be taken into account. When conducting electrosalproof therapy, a long epileptic seizures are possible against the background of fluoxetine. The interval between the abolition of Mao inhibitors and the beginning of the reception of fluoxetine should be more than 2 weeks, and between the abolition of fluoxetine and the reception of Mao inhibitors - at least 5 weeks.

Fluoxetine is a drug intended for the treatment of such pathological conditions as depression, manifested by anxiety and fear. Reviews of the drug fluoxetine various. This agent refers to the pharmacological group of antidepressants. The appointment of this drug is advisable to eliminate the feeling of anxiety, fear, longing and apathy, sleep normalization, improving mood, mental activity and appetite. The drug is also used for the treatment of bulimia, anorexia, alcohol dependence.

Consider the reviews of the patients who used in their treatment with the drug Fluoksetin, and the opinion of doctors about the effectiveness of this fund.

Patient reviews

"He suffered a long time from frequent headaches. It turned out to be at the reception at the neurologist, who explained that these symptoms were due to a protracted depression.

I was immediately appointed Fluoksetin. He accepted strictly according to the recommendations of the doctor, however, instead of improving the overall condition, the opposite was observed. All the time of treatment was in some kind of inhibited condition, drowsiness was present, the appetite was completely disappeared (as a result of which he was noticeably lost). The doctor said that this is the normal response of the body. However, headaches did not pass. Stopped accepting the drug after 3-4 weeks from the start of treatment. "

Natalia.

"Most recently turned to a neuropathologist for health. The doctor made a diagnosis of depression and attributed to me Fluoksetin. Takes according to the instructions. Now I feel much better, again returned to your usual rhythm of life. "

Valentina

"Fluoksetin I took from depression. I did not notice any side manifestations from the drug. After 2-3 weeks, the mood improved noticeably, began to break down less due to the smallest detail. "

Olga

"This drug was appointed to treat a depressive state. It was very hoping that the drug would return me to the usual line of life. However, against the background of admission to Fluoksetin, the situation only aggravated. It is not enough that after taking a tablet, a few hours felt nauseous, so also the mood did not improve. On the contrary, it was in a state of utter indifference to the whole surrounding, it was light on like a match, from the slightest trouble. After a few more weeks of treatment, began to notice that some colleagues simply avoid any contact with me. Drug stopped drinking. Everything normalized somewhere 2 weeks after that. The tool is not suitable for everyone. "

Oksana

"She took Fluoksetin Lananber (Austrian production). The result is satisfied. Now I plan to repeat the course of treatment, as it has passed for about 10 months. However, I can not for some reason find Fluoksetin Lannanber, and I do not decide to take the domestic yet. "

Nina

"I was prescribed fluoxetine on 1 tablet three times a day. I dug just 6 days.

During this time, the appetite decreased noticeably, but it became very bad to sleep, nightmares appeared (for which she did not complain before). In addition, I noticed that most of the products somehow felt in a different way, often felt nausea (more in the first 1.5-2 hours after taking tablets). Only for the sixth day, all this I tied with fluoxetine. Last night I did not drink a tablet, in the morning too. I absolutely do not want to take the drug, but it seems to be abolished, it should be impossible. "

Varvara

"Fluoxetine tablets saw on the recommendations of a psychotherapist to eliminate panic attacks. In the first weeks of the preparation of the drug, some drowsiness noticed, which, however, passed. In addition, the appetite decreased noticeably, which contributed to some slimming. Emotional condition improved noticeably. In parallel with fluoxetine, hormonal preparations for the purpose of the gynecologist took place. Everything was fine, however, after stopping the reception of Fluoxetin, after 3 months, tides appeared again. Apparently, this tool still affects the concentration of other drugs in the blood at simultaneous reception. The abolition syndrome did not feel, although he stopped taking the drug rather sharply (did not hit his psychotherapist on time). "

Marina

"For the first time with fluoxetin, I encountered a year ago. At that time, the psychotherapist determined my depression of a light severity. The drug really helped me cope with my problem, and quite quickly (only 6-7 weeks). It is transferred to the drug well. From the side effects disturbed periodically discomfort in the field of the upper departments of the abdomen, but I had problems with the stomach. "

Catherine

« Fluoxetine has become my faithful assistant in the fight against anxiety and dizziness. For 10 years, I regularly take it once a year, fluoxetine treatment courses for 2-3 months. During the reception of the drug, the appetite increases somewhat, from which I am typing a few extra kilograms. However, compared to the alarm, it is not a problem at all. "

Irina

"I took Fluoksetin Canon just 1 month from depression. After 2 weeks, it began to notice that the appetite was noticeably intensified. Emotional condition improved noticeably. Again she wanted to live and develop, it became much more sociable. After the end of the course of treatment, again, depressed, of course, did not fall, but I feel that I needed to still extend this drug. "

Marina

"Fluoksetin, honestly, prescribed himself. However, soon about it regretted it. Already on the second day of admission at night, blood pressure increased greatly, strong and painful convulsions appeared in their feet, there was a strong heartbeat, a feeling of fear and panic. This means must be appointed by a doctor. "

Alina

"Several years ago, heavy depression happened in my life. Certain with her managed not immediately and it demanded a lot of time and time. Now periodically pass preventive antidepressants courses. Fluoksetin is the only drug from this group, which does not cause me any unpleasant side effects. I'm completely afraid to give up these funds, since I just won't carry out the second such depression. "

Darya

"Over the past 6 months in my life there was a fairly dense mode of operation. There was practically no time to rest.

Over time, he began to notice that I was trying to surround any little things not only at work, but also at home. After the next scandal at home, I realized that you need to do something to not lose my family. It was up to the Internet, where I found reviews about Fluoxetine. Of course, it would be correct to consult a doctor, but I did not have time for it. He began to take the drug. The first week the effect was not at all, but then I began to notice that I would become a little calmer. The mood with time has improved noticeably, at home and at work everything has also come to normal. However, I think it is not to give it no longer than 1.5-2 months. "

Dmitry

"I was diagnosed with the depression of the average degree of severity. She took Fluoksetin course in 2 months. Two weeks after the start of treatment, life began to improve. The emotional state of receiving the drug has noticeably improved. No side effects noticed. True, on the second or third day there was a headache, but not confident that it was associated with the drug. "

Irina

"Beginning a second course of treatment with fluoxetine. He was attributed to me a neurologist from my irritability. During the reception of the drug, about 12 kg of weight dropped, as the appetite practically disappeared from the tablets. After 4-5 weeks of treatment, frequent diarrhea appeared. I tied this phenomenon with the drug, therefore I have finished treatment ahead of time. By the end of the first week after the cessation of treatment, irritability, insomnia, as well as obsessive ideas (often lifted) appeared again. I had to go back to receiving tablets again.

Tamara

« Bought Fluoksetin on the Board of Girlfriend. A few months after the birth began to notice that something was wrong with me. I decided that this is postpartum depression. Since my milk was not, then any medicines I could take without any concern to harm the child. However, it was still not solved for drinking this drug, because the instructions described very many sides. But it did not manage to do without medication. Began to take fluoxetine in minimal doses once a day. Two weeks later, relatives and relatives were noticed. I think I will bring a course of treatment for up to 2 months. "

Fluoxetine tablets contain 20 mg fluoksetina as well as lactose monohydrate, gelatin, corn starch, calcium stearate, povidone, silicon (Si) colloidal dioxide, talc, magnesium (Mg) Light carbonate, tropolein 0, additive E171 (TITAN (TI) dioxide, mineral oil, sugar, Yellow wax.

Form release

Tablets covered with a film of yellow color in blisters of 10 pcs, 1 or 2 blisters in the package.

pharmachologic effect

The drug is provided anorexigne action , eliminates And removes sense of depression.

Pharmacodynamics and pharmacokinetics

Fluoksetin substance - what is it?

The active substance of the drug fluoxetine hydrochloride is a potential-soluble crystalline powder of white (or almost white) color.

What is fluoxetine?

Fluoxetine is the selectively overwhelming reverse neuronal seizure of serotonin (OSS). The drug refers to the pharmacotherapeutic group " Antidepressants ”.

Pharmacodynamics

The medicine is designed to receive inside. The mechanism of its action is associated with the ability to selectively (selectively) and reversibly slowing down ons.

Antidepressant Fluoxetine influences the capture And and weakly acts on acetylcholine receptors and histamine receptors H1-type.

Along with antidepressant also has a stimulating effect. After taking tablets / capsules, the patient decreases the sense of fear, anxiety and mental tension, the mood increases, the symptoms of the dysphoria are eliminated.

Wikipedia notes that the tool does not cause ortostatic hypotension , does not possess sedative effect , not cardiotoxic .

The achievement of a resistant clinical effect with regular use of the drug leaves 3 to 4 weeks.

Pharmacokinetic parameters:

• suction in the digestive channel - good;
• bioavailability - 60% (for oral administration);
• TSMMU - from 6 to 8 hours;
• bonding with plasma proteins (including alpha (α) -1-glycoprotem and albumin) - 94.5%;
• T1 - 48-72 hours.

The liver is involved in the metabolism of the substance. As a result of its biotransformation, a number of unidentified metabolites are formed as well norfluoksetin , the selectivity and activity of which are equivalent to those for fluoxetine.

Pharmacologically inactive metabolic products are eliminated by the kidneys.

Due to the fact that the substance is derived from the body quite slowly necessary to maintain the therapeutic effect plasma concentration remains for several weeks.

Indications for use: What are the tablets and fluoxetine appoint?

Indications for the use of fluoxetine:

• (especially accompanied by fear), including in the ineffectiveness of others antidepressant ;
• (OCC);
• kinoracia (To reduce uncontrolled thrust to food, the means is used as part of complex psychotherapy).

Contraindications

The drug is not prescribed at:

• known hypersensitivity to its active substance or any of the auxiliary components;
• convulsive states in history;
• heavy liver failure and / or kidney ;
• suicidal inclinations;
• atonia bladder ;
• simultaneous use with Mao inhibitors *.

* After using Mao Fluoxetine inhibitors can be applied no earlier than after 14 days; Mao inhibitors after the end of the course of treatment with fluoxetin are prescribed not earlier than in 5 weeks.

Side effects of fluoxetine

General disorders arising against the background of the use of the drug can manifest itself in the form of hyperhydrogen, chills, heat or cold sensations, photosensitivity, neuroleptic syndrome , , lymphadenopathy , anorexia , multiform Erythema which can progress to malignant exudative or eraser layella syndrome .

Some patients have symptoms serotonin intoxication , including:

• changes in mental status ( delia , , anxiety, agitation , , , confusion of consciousness, maniacal syndrome , );
• neuromuscular pathologies ( acatia , coordination disorders, bilateral symptom Babinsky , hyperreflexia , mioclus , epileptiform seizures , (horizontal and vertical), okuluhymy crisis , presthesia , opistotonus , , muscular rigidity );
• vegetative dysfunction (hyperthermia, abdominal and headaches, diarrhea, extended pupils, tearing, , , nausea, hesitary blood pressure, hyperhydrosis, chills).

From the digestive system of the organs possible: , nausea, decreased appetite, vomiting, , , change in taste, the pain in the esophagus, dry mouth, , liver dysfunction . In isolated cases can develop idiosyncrazic hepatitis .

The TSN reactions to the reception of the tablets are manifested in the form: , headache, weakness, sleep disorders (night nonsense, pathological dreams, insomnia), dizziness, fatigue (hypersmia, drowsiness); violations of attention, processes and concentration of thinking, memory; anxiety and associated with her psychegetative syndrome , diefemia , Panic attacks, suicidal thoughts and / or attempts to deprive themselves life.

Reactions from the urogenital tract: dizuriy , urine delay, poland- and Nicturia , protein and Albuminuria , polyuria , oliguria , Imp, , decline libido (until its full loss), , increase the mammary glands and their soreness, ejaculation disorders, anorgazmia , priapism , , metro- and Menorragia , painful menstruation.

The likelihood of development is not excluded:

• immunopathological and allergic reactions ;
• malgia , artralgia , hondrodastrophia , appearance of pain in the bones, , and a number of other side effects from the bone-muscular apparatus;
• vasodilatia ;
• postural hypotension ;
• tide ;
• feelings of heartbeat;
• metabolic disorders (including hyponatremia. , hypocalcemia. , hyper- or hypokalemia Violation of secretion , , hypercholesterolemia , Hyperuricemia , swelling, diabetic acidosis , dehydration, );
• skin reactions (including polymorphic rash , , ulcerative lesions of skin cover, girustism , , furunculeza , exfoliative dermatitis etc.).

Termination of treatment with the drug can provoke cancellation syndrome , the main signs of which are: disorders of sensitivity, dizziness, sleep disorders, asthenia, nausea and / or vomiting, assessment, headache, tremor.

Reviews about side effects indicate that the drug with uncontrolled reception is addictive. In some cases, the addiction is so strong that a person needs help from a specialist for her treatment.

Other adverse reactions that patients mention in responses are strong drowsiness, tremor, convulsions, decline in appetite, nausea. Nevertheless, there are people who have any undesirable effects on the background of treatment at all.

Instructions for use of fluoxetine

Tablets take inside. Meals for the assimilation of the drug does not affect.

To relieve depressive symptoms, the medicine should be drunk 1 time per day, in the morning hours, at a dose of 20 mg. When clinical need after 3-4 weeks after the start of therapy, the multiplicity of receptions increase to 2 p. / Day. (Tablets are taken in the morning and in the evening).

Patients, with an insufficient response to treatment in a dosage of 20 mg / day., In some cases, the daily dose is gradually increased to 60-80 mg. In this case, it is necessary to share it on 3-4 receptions. The highest dose for the people of elderly and senile age - 60 mg / day.

Dosage at Bulimic neurosis - 60 mg / day. (Tablets take 3 r. / day. On one), with OCC - depending on the severity of clinical symptoms - from 20 to 60 mg / day.

It must be borne in mind that the increase in the dose can increase the severity of side effects.

Supporting dose - 20 mg / day.

When does the drug begins to act?

A significant improvement in the state is usually observed after 2 weeks of systematic drug intake.

How long should fluoxetine be taken?

To eliminate depressive symptoms leaves from six months.

With obsessive manic disorders (NMR), the drug is given for 10 weeks. Further recommendations depend on the results of treatment. If the clinical effect is absent, the fluoxetine treatment scheme is revised.

If there are positive dynamics, therapy continues with the use of an individually selected minimum maintenance dose. Periodically, the patient's need for further treatment should be revised.

Long - more than 24 weeks in patients with NMR and more than 3 months in patients with nervous Bulimia - not studied.

After the completion of the treatment with fluoxetin, the active substance circulates in the body for another 2 weeks, which should be taken into account when the treatment or appointment of other drugs should be taken into account.

Patients lack of liver / kidney function , older people with concomitant diseases, as well as patients taking other medicines, prescribe a half dose of the drug. In some cases, the patient is advisable to translate to an intermittent reception.

If, after a decrease in the dose / discharge of the drug, the patient's condition deteriorates, it is necessary to return to the treatment of the previous effective therapeutic dose. A gradual dose decrease is resumed after the appearance of positive dynamics.

If compared Fluoksetin. and Fluoksetin Lananber or Fluoksetin. and Fluoksetin Ozone then we can conclude that in the instructions for use Fluoksetina Lannanber and Fluoksetina Ozone Recommendations similar to those listed above are given.

Overdose

The fluoxetine overdose is accompanied by: nausea / vomiting, cramps, hypologia, anxiety, excitation, with large epileptic seizures.

High dose of drug in combination with , temopamom may result in death.

Victim from overdose should be rinsed the stomach, give , enterosorbent. and - during cramps - . Monitoring of respiratory activities and parameters characterizing the functional state of the heart is also important. In the future, they conduct symptomatic and supporting therapy.

Peritoneal dialysis , blood transfusion, , forced diuresis ineffective.

Interaction

Enhances effects hypoglycemic drugs , ethanol , diazepama , .

Twice increases plasma concentration tricyclic antidepressants , phenitina , , maprotilina . When appointing fluoxetine in combination with tricyclic antidepressants , the dose of the latter should be reduced by 50%.

It can provoke an increase in the plasma concentration of Li +, which in turn increases the likelihood of developing its toxic effects. In the case of simultaneous use, it is recommended to keep control of Li + concentration indicators in the blood.

Application as a supplement to electrosculation therapy may cause long-term development epileptic seizures .

The serotonergic effects of the drug are enhanced in combination with tryptophan . Probability of development serotonin intoxication Increases in the case of simultaneous reception with the means overwhelming the Mao enzyme.

The likelihood of adverse reactions and amplification of oppressive action on the central nervous system increases in combination with drugs that oppress the CNS.

Reception with preparations that are characterized by a high degree of binding to proteins can provoke an increase in the plasma concentration of unrelated (free) means, as well as an increase in the likelihood of unwanted effects.

Terms of sale: How does fluoxetine leave - according to the recipe or not?

Buy without recipe fluoxetine is impossible.

Storage conditions

Tablets should be stored at temperatures below 25 ° C.

Shelf life

special instructions

In the treatment of patients with low body weight when prescribing the drug should be considered anorexigne effects .

Diabeticians during treatment with fluoxetin can develop hypo-, and after the abolition of the drug - hyperglycemia . With this in mind, it is recommended to make changes to the dosing mode. and / or hyoglycemic products For oral administration. Before improving the clinical picture, patients with diabetes Must be under the permanent supervision of the doctor.

During the treatment period, it is necessary to refrain from activities of activities that require high velocity psychomotor reactions and increased attention.

The tablet includes lactose, so they should not be taken when galaktosemia , lactase insufficiency , glucose / Galactose absorption syndrome .

Like others antidepressants Fluoxetine can cause affective disorders (maims or hypologia).

The central organ of metabolism of the drug is the liver, kidney is responsible for the excretion of metabolites. Patients with liver pathologies should be prescribed low or alternative daily doses.

For renal failure (CLCR less than 10 ml / min.) After 2 months of treatment with a dose of 20 mg / day. The plasma concentration of fluoxetine / norfluoxetine is the same as in patients with healthy kidneys.

Depression It is associated with an increase in the risk of suicidal thoughts and attempts to deprive itself. The risk is preserved until complete remission. The clinical experience of using the drug shows that the risk of suicide increases, as a rule, in the early stages of recovery.

Patients with mental illness and depressed syndrome must be under constant supervision. During placebo-controlled studies in the group of patients receiving antidepressants, it was found that the risk of suicidal behavior is most high in people younger than 25 years.

Special surveillance also require patients who were translated into a lower / high dose.

The use of fluoxetine is associated with the development akatiysia Subjective signs of which is the constant need to be in motion, as well as the inability to sit or stand. These phenomena are especially expressed in the first weeks of treatment. Patients who have developed similar symptoms are prescribed in a minimum effective dose.

With a sudden termination, about 60% of patients develop symptoms of cancellation. The probability of their appearance depends on the dose used, the duration of the course, as well as the level of dose reduction. The dose is recommended to reduce the titration method for 7-14 days.

There are reports of the appearance during the treatment period of subcutaneous hemorrhages, such as purpura or ekhimozia . Therefore, patients hosting Lenuxin , .

What is better: Prognise or fluoxetine?

The active substance of the drug Prozak is fluoxetine. Therefore, when choosing in favor of this or that means, the decisive factors are the price and subjective sensations. The cost of fluoxetine is significantly lower than the cost of its analog.

For children

It does not apply to the treatment of patients under the age of 18.

A nineteen century clinical study showed that suffering from depression children 8-18 years old Application of fluoxetine causes a decrease in growth and body weight. Effects The drug on achieving normal growth in adulthood has not been studied.

At the same time, it is impossible to exclude the likelihood of growth delay in the pubertal period.

Fluoxetine and alcohol

Drink alcohol during the treatment of fluoxetine is contraindicated.

Fluoksetin for weight loss

Fluoxetine is often prescribed when bulimic syndrome - mental syndrome, which is accompanied by the lack of a sense of saturation and uncontrolled overeating.

The use of the drug reduces the appetite and remove the constant feeling of hunger.

Thus, it can be concluded that the fluoxetine can only get rid of the excess weight if the cause of its set is appetite.

However, the drug is not intended for weight loss, its main purpose - treatment depression . Reducing appetite and weight loss are side effects.

The medicine is quite powerful, and the body often responds to its reception. anaphylactic reactions and systemic disorders with the involvement in the pathological process of lungs, skin, kidneys and liver.

How to take fluoxetin for weight loss?

At the initial stage, weight loss tablets are accepted in the minimum dosage - one once a day. With good tolerance, you can go to the reception of two tablets - one drink in the morning, the second - in the evening.

Maximum allowable dose - 4 tab. / Day.

The drug begins to act 4-8 hours, the removal of fluoxetine from the body goes about a week.

Antidepressants are traditionally surrounded by halo of something dangerous and frightening. This fate and fluoxetine, which gathered around himself many myths and delusions, most popular of whom were considered on this page.

Dependence on antidepressants is the most sore subject when it comes to getting rid of those or other mental problems. In society there is an opinion that antidepressants are a certain drug, once used by which they sit down forever and slowly go to the degradation of the person.

In fact, everything is not so scary.

The root cause of such a delusion lies in the fact that a person often does not see the difference between antidepressants and their groups, and anxiolytics (tranquilizers).

Anxiolitics - a group of drugs, which has a sedative and pronounced anti-taking effect. The most famous similar drug in the West - "Valium", in Russia - "Fenazepam". These drugs truly cause the development of drug addiction, but have nothing to do with antidepressants. Free circulation of anxolytic drugs in the Russian Federation is limited. This does not mean that they are unrealistic to buy them. But at least it is definitely impossible to do in ignorance.

Antidepressants - Medical preparations of a completely different principle of action. Antidepressants are divided into groups - tricyclic antidepressants, Mao inhibitors, SIRES - to which fluoxetine and others belong. This site does not set the task to explain the principle of operation of each of the groups of antidepressants. Therefore, we will limit ourselves to only the explanation that the most potent and severe patients with antidepressants are tricyclic. At the same time, selective inhibitors of serotonin reverse seizure (SIRES) are a group of sufficiently soft and easily portable drugs. None of the preparations of the SIRES group does not cause drug addiction.

Regarding the cancellation syndrome. In a pure theory, it is almost every drug, whose impact on the body is at least a little stronger than polyvitamins. Even the means of control of hypertension (medications familiar to many people and usually perceived in society without feasible) can not be drastically stopped accepting - it is necessary to smoothly and gradually reduce the dose. So in the instructions for fluoxetine, it is clearly spelled out that when leaving the course you need to gradually reduce the dosage. First bring the drug consumption to a minimum indivisible dose (usually one capsule is 20mg). Then to increase the intervals between the methods of the drug - from daily to once every 2 days, then up to once every 3 days, then up to 1 capsule a week, and then completely stop receiving. A clear following instruction guarantees the absence of any manifestations of cancellation syndrome.

But it is worth noting another moment - the half-life of fluoxetine from the body is 16 days. Thus, sharply throwing the reception of this drug will not work with all the desire. Even if, contrary to the recommendations from the instructions, throw it in one day - the concentration of the active substance in the blood will be smooth and gradually decrease for 16 days, providing a soft way out of the course. Even with a hot desire to harm its body, it will not work - a long half-life plays the role of the "protection from the fool".

Fluoksetin and sexual function

Another popular myth says that fluoxetine and other symospress group antidepressants negatively affect the libido, reduce sexual attraction, lead to the onset of impotence in men.

Yes, indeed, the use of fluoxetine can lead to impotence. But it is important to remember that this is just one of the many possible side effects, and far from the most common has this preparation. It can manifest itself, and maybe not. By the way, fluoxetine has an opposite side effect - "spontaneous erection". Well, it is so, by the way. About its existence of critics of antidepressants to remember for some reason not accepted :).

And even if you were lucky to be among the "lucky ones", which manifests the aforementioned side effect - there is no reason to panic. Impotence from fluoxetine wears temporary nature, and it can go through itself during the course (this is absolutely normal phenomenon - the body adapts and some side effects that manifested at the beginning simply disappear over time) and in any case guaranteed to pass A few days after the termination of the use of fluoxetine drugs.

It comes to pay attention to the fact that fluoxetine is not some sweet candy taken by a person just as influenced by the momentary waters. This is a serious medical drug used to get rid of noticeably reduced the quality of life of ailments: neuroses, depression, disturbing disorders.

Let's compare the real with real. What is worse - a small chance to gain temporary impotence for some time from fluoxetine, or constantly in the background to suffer from chronic depression? And incomprehensible neurosis, it is necessary to assume that sexual function is only enhancing? When sociophobia and accompanying difficulties with communication with communication and tying dating, do you so much the fact that you do not have the slightest problems with the erection?

There is such a concept - "Little Evil." And in this case, the risk of reversible side effects is a smaller evil compared to an alternative.

As for the influence of fluoxetine on sexual attraction, it is absent. With one reservation - fluoxetine strongly reduces the neurotic needs, whether it is a compulsive overeating, thrust for alcohol or striving for sexual proximity as a while forgotten for a while forgotten. It is necessary to see the difference between a healthy sexual activation (which will not be injured in any way) and neurotic reactions that will come to no, along with the neurosis itself.

Fluoxetine and weight loss

Oddly enough, in addition to his fluoxetine, he found popularity as a means for weight loss. It is worth starting to type the word "fluoxetine" in Google, as a search engine helpfully tells you - "fluoxetine for weight loss."

And indeed, the ex-side effect of Fluoksetina became very in demand among young girls who wish quickly and without the slightest application effort to reset extra kilograms.

Yes, Fluoxetine really helps to lose weight, but it makes it extremely inefficient and too big price.

More information about the possibilities of using fluoxetine for weight loss is painted.

Finally, I would like to once again pay attention to the fact that the "Loss of Weight" in the instruction on the fluoxetine is first side effect. And no side effect can manifest with 100% probability. If you search the Internet, you can find a lot of feedback from those under the influence of Fluoxetin not lost at all. Or even recovered a little.

Mortality against the background of use of fluoxetine

The greatest fears in humans are caused by the fact that fluoxetine allegedly provokes aggression and strengthens suicidal moods. But is it really?

Fluoksetin and aggressive behavior

The easiest way to deal with aggression. The myth that Fluoksetin provokes aggressive behavior went after it turned out that some of the American mass killers at some stage of their lives were taught "Prose". Including the prose of "sat" for the appointment of a doctor, several adolescents, arranged shooting in their classmates in American schools.

What can I say about this? There is a rough speculation of statistical data from the same series that "according to statistics 100% of people who have eaten the cucumbers die" and the next of this withdrawal "cucumbers is poison."

Indeed, some of the people who have switched the features of the law of people took drugs of fluoxetine. But it would be surprising if from tens of millions of people received recipes on the "Prose" of people would not have any, or bank employee, or a Mexican, or a representative of any other social group, would not?

Indeed, the commission of such an act of unmotivated aggression as a massive shot of other people testifies to the presence of some kind of disorder of his psyche, as the correction of which he was discharged from the group of antidepressants.

But where is the relationship between the use of fluoxetine and the attacks of aggression? Without attracting for the ears it is impossible to find it in the above facts. In Russian psychiatric practice, there are no cases when it would be possible to say that the admission of antidepressants of the SSRS group provoked in patients with aggression.

In addition, you should not forget that in the US, judicial practice is very developed and any, even the most tragic case is made to furnish with the maximum benefit for yourself. Hence the accusations of various reasons and drug producers, and to the developers of computer games, and other companies that can at least try to sue solid cash compensation.

The famous mass killer of recent years Anders Breivik did not accept antidepressants. Maniac Andrei Chikatilo never appealed to psychiatrists with complaints of his condition. The Moscow Arrow Andrei Vinogradov was discharged, but he arranging the course shortly before sad events, whose culprit became.

Fluoksetin and suicide risk

But the influence of fluoxetine on the risk of suicide is a much more ambiguous moment. Indeed, a certain amount of suicides were documented among the patients who took fluoxetine. Their loved ones argue that in some cases the deceased did not demonstrate the presence of suicidal inclinations before the use of this drug.

The opinions of specialists on this score diverge. The insufficiency of the statistical base. In addition, the absence of suicidal inclinations in cases where the deceased did not tell his wife, parents, friends, and even attending a doctor, cannot be taken for the immutable truth. Did not say - does not mean that he did not think.

But nevertheless, among the competent experts, it is believed that in the presence of suicidal mood, fluoxetine can indeed increase the risk of suicide. This does not contradict the nature of the drug. Under the influence of Fluoksetina, a person becomes calmer and more confident in himself. Another thing is that someone lacked this confidence in order to return to a full-fledged life and realize yourself, and someone - to reduce the scores with life.

The presence of suicidal thoughts is the strictest to receive drugs of fluoxetine and in no case cannot be neglected. Moreover, in the presence of suicidal inconsistencies, any psychiatric treatment should occur only in a hospital, under the clock observation of specialists.

And at the same time, if a person initially had no suicidal inclinations, then they will not appear on the use of fluoxetin.

Summing up the above, you can say: fluoxetine is potentially fatal danger to persons with already existing suicidal inclinations.But it is not capable of provoking such inclinations by itself and its use does not attend the threat of life not inclined to suicide patients.

Who beneficially outlining fluoxetine?

Having reached this point, the visitor site probably has already wondered "but if Fluoksetin is such a wonderful drug, then why is so much dirt and rumors hung around it?".

And the explanation of this is very simple - money. Big money. No, even so - very big money.

The fact is that in industrial production, the active substance of antidepressants of the SSRS group is worth a penny, without exaggeration. The sale of the final drug in large volumes (and the volume of market consumers of antidepressants is calculated by hundreds of millions of people) according to the well-known market prices gives the manufacturer of super-profile. There are several different pharmacological concerns on the market at the same time, each of which has sufficient financial resources and motivation to unleash the information war and sink their competitors, or at least try. What we observe.

Moreover, even the manufacturer of the prosecutor, the ELI Lilly concern, is no longer profitable to maintain a positive reputation as its product. Fluoksetin, which entered retail sale in 1987, was released from under patent protection in 2001. From this point on, Eli Lilly no longer has a monopoly on the release of fluoxetine drugs under its trademark, and all the existing prozak generics are automatically moving from the category of counterfeit that is subfredient in factories in the third world countries, in a fully legal product that has the right to produce any pharmacological company under With your brand. Cheap and not inferior in quality of the original generic undermine the demand for the position. And, despite the fact that the manufacturer still has good profits from his sales, they do not go to any comparison with what was before, while the patent was still acted. In such a situation, the new product is strategically to bring to the market - and remove all cream already with its sales, until again, the date of patent protection.

But in addition to possessing the main financial force of pharmaccorers, there are also supporters of non-drug deliverance from psychologists and psychoanalysts. The cost of one session of psychoanalysis in the United States reaches $ 250 - and this is not the limit. At the same time, one client can go to sessions for years, and the effect of them can be extremely insignificant, at the level "still better than nothing." Psychologists and psychoanalysts are generally not responsible for the effectiveness of the procedures they spend, they are able to guarantee maximum harm from them.

Is it really that this is the psychoanalyst, who is accustomed to that customers go to $ 250 for every 60 minutes, that a significantly cheaper drug has appeared on the market, allowing the patient's problems to quickly and effectively, after which he returns to Healthy full-fledged life and loses interest in psychoanalysis and those engaged in specialists? I think not very. People always do not like to progress from their hands the familiar sources of stable income from their hands. What can a psychoanalyst make in this situation? That's right, all the forces contribute to the spread of the reputation of "dangerous" and "having many negative side effects" in the dismissal medicinal substance, in the counterweight, one can offer its own services - 100% safe, and it does not matter that at the same time they do not give a desired result.

Summing up the above, I want to say that around the antidepressants in general and fluoxetine in particular simply there are no use of information sources unmanaged in someone. What to do? Always and first of all think your head. And more often wondering the question "Who is profitable?".

Fluoxetine refers to antidepressants inhibiting serotonin reverse seizure (serotoninergic antidepressants, serotonin reverse capture inhibitors). The medicine is effectively in the treatment of depression and alarming disorders - raises the mood, weakens the sense of tension, anxiety, fear.

The main advantage of fluoxetine before traditional tricyclic antidepressants (so-called classical antidepressants) is to reduce side effects due to the electoral mechanism of action. When using fluoxetin is better transferred and, according to many studies, has greater efficiency compared to classical antidepressants, although the results of the comparison are not completely unambiguous.

Advantages and disadvantages of serotonergic antidepressants

The advantages of antidepressants, selectively overwhelming the reverse seizure of serotonin:

• effective therapy and disturbing, and depressive symptoms;
• security;
• minimum cardiovascular risk;
• lack of addiction;
• the possibility of long-term therapy;
• preventive therapy - prevention of disorders;
• voluntary adherence to the patient prescribed treatment regime when taking the drug;
• the effect is maintained until the treatment continues;
• long-term treatment allows you to avoid relapses.

Anxiety disorders are often accompanied by addiction on alcohol and psychoactive substances. In such cases, it is not recommended to assign benzodiazepines, and antidepressants, selectively overwhelmingly inverse seeds of serotonin, become drugs of the main line in the treatment of depression, since they do not cause drug addiction.

Disadvantages of serotonergic antidepressants:

• sexual side effects;
• sometimes there is a need to gradually increase the dose to the maximum amount to achieve the therapeutic effect;
• difficulties may arise in determining the early start of the reaction to the treatment carried out;
• slow, gradual improvement for weeks or months;
• often the occurrence during the first two to three weeks of receiving the phenomena of hyperstimulation is irritability, insomnia, nervousness, strengthening of anxiety and panic symptoms.

The disadvantage of non-medical nature is the smaller economic availability of drugs of this group (price), as they are accepted for a long, as well as the lack of injection forms in most drugs.

pharmachologic effect

Selectively blocks the reverse neuronal seizure of serotonin (5-hydroxytriptamin) in the synapses of neurons of the central nervous system. Suppression of the reverse seizure of serotonin increases the concentration of this neurotiator in the synaptic slit, enhances and prolongs its impact on postsynaptic receptor sections.

Fluoxetine has a low affinity for α1, α2, and β-adrenergic, serotonin, dopaminergic, muscarinov, H1-histamine and gamkery receptors.
Improves mood, weakens fear, anxiety, voltage, eliminates the dysphorous, reduces appetite. It causes reduction of exhaust-compulsive disorders.

Not cardiotoxic. Does not show sedative, sleeping pills, orthostatic hypotension.
The effect of treatment occurs within 7 - 14 days after receiving the drug.

Medicinal forms

Fluoxetine is produced in capsules.

Structure

The content in one capsule of fluoxetine hydrochloride - 22.36 mg, which corresponds to fluoxetine 20 mg. This is the active medication.
Additional substances: Corn preheatinized corn starch, dimethicone.
The composition of the capsule housing: gelatin, titanium dioxide, iron oxide yellow dye.
The capsule cover contains gelatin, dye blue patented V, titanium dioxide, dye iron oxide yellow.

Indications

Ossessive compulsive disorders.
Depression of various origins.
Premenstrual dysphoria.
Bulimic neurosis.

Contraindications

Hypersensitivity to medication components.
Heavy kidney function disorders (QC less than 10 ml / min) and liver.
Simultaneous reception of monoaminoxidase inhibitors and within 14 days after their cancellation, thiuridazine, pimoside.
Atony bladder.
Children's age up to 18 years.
Pregnancy.
Lactation.
With caution: suicidal mood, epilepsy, diabetes, excessive weight loss, Parkinson's disease.

Purpose for pregnancy and during lactation

Contraindicated in the period of breastfeeding and during pregnancy.

Method of application and dosing

Regardless of meals, inside.
Depression
The initial dose is 20 mg once a day in the morning. Dose can be increased to 40 - 60 mg / day. Then it must be divided into two - three receptions. On the day the maximum dose - 80 mg of medication.
Obsessive-compulsive disorders
Fluoksetin at 20 - 60 mg per day.
Bulimic neurosis
The dosage of 60 mg per day is divided into two - three receptions.
Premenstrual dysphoric disorders
Fluoksetin at 20 mg per day.
In old age, with liver diseases, therapy begins with 1/2 dose.
For patients with disorders, the kidney function diminish the dose and increase the interval between the reception of the drug.
Course of treatment - 3 - 4 weeks.

Side effects

Dizziness, headache, increased fatigue, asthenia, sleep disorders, motor arousal, tremor, assessment, strengthening suicidal tendencies, anxiety, mania or hypomania.

Reducing appetite, dry mouth or hypersalization, nausea, vomiting, violation of taste ,.
Allergic reactions in the form of skin rash, itching, urticaria, Malgia, arthralgia, fever.

Urinary incontinence, urine delay, dysmenorrhea, vaginitis, reduced sexual attraction, violation of sexual function in men (deceleration of ejaculation).
Enhanced sweating, tachycardia, violation of visual acuity, weight loss, lung, kidney or liver disorders, vasculitis.

Overdose

Symptoms: nausea, vomiting, motor anxiety, excitation state, convulsive disorders, violation of the cardiovascular system.
Treatment: Specific antidote was not found. Symptomatic therapy is carried out, the stomach washing, the purpose of activated carbon, during convulsions - the purpose of tranquilizers, maintaining cardiac activity, respiration.

Cautions, therapy control

Suicidal risk

When depressed, there is a possibility of suicidal attempts that can be maintained before the onset of remission. As in the case of other preparations of close pharmacological action (antidepressants), certain cases of suicidal behavior were described during fluoxetine therapy or after its end.

An analysis of the combined studies of the appointment of antidepressants in mental disorders revealed an increased risk of suicidal thoughts and / or suicidal behavior in young patients (younger than 25 years old).

Drug therapy with high risk patients should pass under careful medical control.

Cardiovascular effects

Caution is prescribed to patients with congenital lengthening syndrome Qt interval, acquired Qt interval lengthening syndrome (for example, while prescribing fluoxetine with drugs extending the QT interval), if there is a history of instructions for an increase in the duration of the QTU interval of the patient's relatives, with other clinical conditions that predispose To the development of arrhythmias (for example, with hypokalemia or hypomagnemiology) or with an increase in fluoxetine exposure (for example, with a reduced liver function).

Skin rash

It is reported that the appearance of skin rash, anaphylactic reactions and systemic disorders occurring in progression, sometimes with the involvement in the pathological process of liver, kidneys, skin, lungs in patients who took fluoxetine.

Electrosusproy therapy (EST)

There is information about increasing the duration of convulsion in patients on the treatment of fluoxetine and receiving EST.

Epileptic seizures

Appoint patients who had previously noted epileptic seizures, with caution.

Mania

If the patient is in a manic state, the medicine is not taken.

Acatisia / Psychomotor Angry

The use of the drug leads to the development of acatysis, which is manifested by subjectively unpleasant sensations or nonsense, the need for a constant movement, often without the possibility of sitting or standing still. Most often, such phenomena are observed during the first few weeks of treatment. Patients whose symptoms are observed, the increase in the dose of fluoxetine is undesirable.

Tamoxifen.

The drug reduces the concentration of endoxphen, one of the most important active metabolites of tamoxifen. In the treatment with tamoxifen, fluoxetine is not prescribed.

Loss of body weight

In patients, the loss of body weight was noted, however, it is usually proportional to the initial middle mass of the body.

Hyponatremia

Cases of hyponatremia were noted in the age patients and in patients who took diuretics due to the reduction of circulating blood.

Glycemic control

During treatment with fluoxetin, it may be necessary to adjust the doses of insulin and / or hypoglycemic drugs.

Hepatic / renal failure

Patients with explicit liver disorders are prescribed or lower doses of medication, or every other day. Purpose of fluoxetine at a dose of 20 mg / day for two months to patients with impaired kidney function (creatinine clearance< 10 мл/мин), проходящим гемодиализ, не выявило различий концентрации флуоксетина и норфлуоксетина в плазме крови между больными и здоровыми людьми.

Midryaz

Careful to prescribe patients with high intraocular pressure or with the danger of acute closed gloomy.

St. John's wort

It is possible to develop pharmacodynamic interaction between fluoxetin and means containing the John's jungle.

Symptoms cancel

Often, when therapy is discontinued, especially with a sharp cancellation, the abolition syndrome was observed. In 60% of patients there were side effects when canceling treatment. Most often reported dizziness, sensory disorders (including paresthesia), sleep disorders (deep sleep, insomnia), asthenia, anxiety, excitation, nausea and / or vomiting, tremor and headaches.

In most cases, these phenomena are terminated independently within 14 days, but sometimes they were long, within 2 - 3 months and more. Therefore, the abolition of treatment with fluoxetin is gradually carried out for one to two weeks, depending on the patient's condition.

In rare cases, the development of serotonin syndrome or malignant neuroleptic syndrome (hyperthermia, extrapyramidal neurological disorders and catatonic manifestations, muscular voltage) was reported on the development of a fluoxetine.

Since these syndromes can lead to a threatening life of a state, fluoxetine treatment is terminated in the case of a combination of symptoms - hyperthermia, rigidity, myoclone, disorders of the vegetative nervous system with the development of fluctuation of indicators of life functions, changes in mental condition, including confusion, irritability, extreme excitement with possible Development of delirium and coma, and assign appropriate therapy.

Increased bleeding

Fluoxetine can increase the tendency to bleeding, including in the region of the gastrointestinal tract. In this connection, caution is recommended when prescribing the drug to patients simultaneously receiving anticoagulants and / or drugs, which can change the properties of platelets (for example, non-steroidal anti-inflammatory drugs, acetylsalicylic acid), or patients who already have increased bleeding.

Interaction with other medicines

It is impossible to use the drug simultaneously with MAO inhibitors, since it is possible to develop serotonin syndrome (hyperthermia, chills, increased sweating, myoclonus, hyperreflexia, tremor, diarrhea, violation of movement coordination, vegetative lability, excitement, nonsense and coma).

Triptophan enhances the serotonergic properties of the drug (enhancing the agitation, motor anxiety, disorders from the gastrointestinal tract).
When applied with drugs containing John's wortradly (Hypericum Performatum), a serotonergic effect may occur, an increase in unwanted effects.

Increases the concentration of tricyclic antidepressants, phenytoin, maprotylin, and trazodon twice in plasma. It is necessary to reduce the dose of these drugs by 50% while using fluoxetine simultaneously. Enhances the effects of alprazolam, diazepam, ethanol, hypoglycemic drugs.

The simultaneous intake of fluoxetine with alcohol or with central action preparations causing the oppression of the function of the central nervous system, enhances their effect and increases the risk of developing side effects.

Drugs containing lithium should be used with caution due to a possible increase in the concentration of lithium and the risk of developing toxic effects.
Against the background of electrosculation therapy, the development of long-term convulsions is possible.

With simultaneous use with drugs with a high binding of proteins, especially with anticoagulants and digitoxine, it is possible to increase the concentration in the plasma of free (unrelated) drugs and an increase in the risk of developing adverse effects.

Fluoxetine is released by a doctor's prescription. During treatment, the drug should refrain from taking alcoholic beverages and occupations of potentially hazardous activities that require increased attention and speed of mental and motor reactions.

Fluoxetine is produced by Russian pharmaceutical companies of FP Obolenskoye, Alci Pharma, the production of medicines, ozone, Medisorb, Tiokom, Canonfarma Production, as well as Foreign enterprises Apotex Inc. (Canada), New Farm Inc. (Canada), Hexal AG (Germany), Lannanber (Austria ).

Analogs of the drug

Commercial names of drugs containing fluoxetine as an active substance, the following: fluoxetine, proven (India), PRESS (USA), Proflude (Russia).
The group of selective selection inhibitors of serotonin also includes:

• cytalopram (trade name of cipramil);
• escitalopram (escitalopram);
• fluvoxamine (Avoxin, Fevarin);
• paroksetin (Paxilla);
• sertraline (gold, stimulus);
• venlafaxin.

The mechanism of action of these drugs is the same and is associated with the impact on a serotonin conveyor, and clinically significant differences between them relate mainly to the half-life (time during which the concentration of the drug in the body decreases by 50%, tons) and the features of drug interactions.

The half-life of fluoxetine is about 330 hours, while the remaining drugs of this group it is 15 to 30 hours. This indicator is extremely important if the patient is translated from the reception of serotonin selection inhibitor to the drug of another group, as well as to estimate the forecast in the case of The development of serious adverse adverse reactions requiring immediate cancellation of serotonergic antidepressant.

Another difference among the analogues of fluoxetine is the different degree of selectivity for suppressing the reverse seizure of serotonin. The most selective in this regard by Escitalopram, hereinafter - cytalopram, sertraline, fluvoxamine, paroxetine and fluoxetine.

Sertraline and Venlafaxin are the only of modern antidepressants who have an evidence-based basis towards lengthening remissions in depressive disorders.

Inhibitors of serotonin reverse seizure in premature ejaculation therapy

Special literature provides data on the possibility of using various psychotropic drugs for the treatment of men who have premature ejaculation. From drugs that can increase the duration of sexual intercourse are used including antidepressants related to the group inhibitors of serotonin reverse seizure. This is due to the fact that in the pathogenesis of premature ejaculation, the role of central serotonergic regulation mechanisms is confirmed. For the treatment of premature ejaculation, sertalin, paroxetine, clomipramine (trade names Anafranil, Clofranil), fluoxetine, cytalopram, fluvoxamine, escitalopram, buspid, dapoxetine are used.

Listed antidepressants are accepted daily on a regular basis. The exception is a dapoxetine that applies "on demand" a few hours before intercourse. Research noted that Paroksetin has the strongest effect on ejaculation. The appointment of clomipramine, Paroksetina, sratrolin, fluoxetine for 4 to 6 hours before intercourse effectively and is well tolerated, but causes a smaller retention of ejaculation than with daily treatment.

The use of serotonergic antidepressants is recommended to young people with premature ejaculation from the beginning of sexual life and with a disease acquired when the causal factors are eliminated, but the problem still exists.

Some authors argue that the effectiveness of drugs of this group in increasing the duration of sexual intercourse, combined with their low side effects profile, puts them in the first line of the therapy for premature ejaculation both in daily reception and when using "on demand". However, the importance of drugs of this group seems to should not be exaggerated, since the cessation of their use in men with lifelong premature ejaculation leads to the restoration of the ejaculatory threshold that existed before the treatment for 5 to 7 days.

Attention! Description of the drug is a simplified and supplemented version of the official instructions for use. Information about the preparation is provided solely with an informational purpose and should not be used as a guide to self-medication.