Fluoxetine is a well-known antidepressant marketed all over the world with different brand or trade names like Prozac, Fontex, Sarafem etc. It is classified in the group of antidepressants named as selective serotonin reuptake inhibitors (SSRIs). To date, it is well known among the psychiatric circles that decreased amount of serotonin and norepinephrine in the synapses plays a vital role in the causation of depression. So, it inhibits the reuptake of serotonin in the synapses and increases the concentration of serotonin thus treating depression. Other drugs included in this group are citalopram, escitalopram, fluvoxamine, paroxetine, sertraline, zimelidine and dapoxetine.
What is Fluoxetine used for?
Common uses of Fluoxetine are:
- Major depressive disorder – numerous studies have shown that Fluoxetine is very effective in the management of major depression. Moreover, it decreases anxiety and improves sleep of the individuals suffering from depression. Fluoxetine is effective for the management of both the geriatric and pediatric depression.
- Eating disorders like anorexia nervosa and bulimia nervosa – for bulimia nervosa Fluoxetine is to be used for one year. Studies have shown that it decreases the purging episodes of bulimia nervosa.
- Obsessive compulsive disorder (OCD)
- Panic disorder
- Bipolar disorder – Fluoxetine is usually used for the management of depressive phase of bipolar disorder with antipsychotic agents like Quetiapine.
- Cataplexy – it is an emotional disorder characterized by sudden loss of muscle tone due to excessive crying, laughing, fear or terror.
- Binge eating – it is one of the mental illnesses characterized by excessive and frequent meals
- Alcohol dependence – Fluoxetine is used to manage the symptoms of anger, anxiety and depression the patients undergoing alcohol withdrawal.
- Body dysmorphic disorder – it is a somatoform disorder characterized by extreme worry of an individual regarding the appearance or physique of oneself.
- Premenstrual dysphoric disorder – it occurs in the luteal phase of menstruation and is characterized by unusual anger, depression or anxiety.
- Trichotillomania –it is a psychiatric condition characterized by excessive pulling out of hair due to depression or stress.
Common side effects of Fluoxetine
1. Sexual dysfunction – sexual dysfunction is the most common side effect of Fluoxetine. Although most of the sexual issues encountered by the patients during the use of this drug are reversible, however, in few odd cases they may last for months or even years after the drug is discontinued.
2. Common sexual problems face by the individuals on Fluoxetine are:
- Difficulty in sexual arousal
- Erectile dysfunction
- Anesthesia of genital organs leading to decreased sexual sensations
- Diminished sexual stimuli
- Inability to achieve orgasm
- Lack of interest of having sex
- People usually do not feel pleasure during orgasm (ejaculation anhedonia)
3. Liver impairment – Fluoxetine is excreted primarily through liver and its dose must be adjusted in the cases of liver impairment.
4. Bleeding of gastrointestinal tract – Fluoxetine increases the risk of intestinal bleeding in the chronic patients.
6. Somnolence alternating with insomnia – Fluoxetine causes drowsiness and individuals must be kept away from machinery and must not drive any vehicle while using this drug.
7. Loss of appetite – it may result in decreasing the weight of an individual using this drug.
9. Akthesia (tension within), restlessness, and anxiety are common side effects of Fluoxetine use. This is characterized by unusual and useless repetitive movements of the legs or feet by an individual using Fluoxetine.
10. Allergic reactions – the most common manifestation of allergic reactions due to this drug are urticaria and skin rash.
11. Increased suicidal tendency
12. Disorders of movement – chronic Fluoxetine use is associated with certain movement disorders like tardive dyskinesia and dystonia.
Fluoxetine side effects on children
In children the most common adverse effect of Fluoxetine is manic episodes. Another common side effect of Fluoxetine in children is the increased risk of suicidal ideation. In children and people younger than 25 years of age Fluoxetine increases the risk of suicide manifold. It is necessary to monitor the child for altered thoughts, irritability, and thoughts of self harm or suicide while on this drug.
Fluoxetine side effects on men
Sexual dysfunction is the most common side effect of Fluoxetine in men. It causes erectile dysfunction and decreases the interest in sex. Moreover, it leads to anesthesia of sexual organs decreasing the sexual stimuli. Most men lose interest and charm while having sex.
Fluoxetine side effects on women
The most common adverse effect of Fluoxetine intake is decreases urge for having sexual intercourse. It causes anorgasmia especially in women. Women are not able to reach the peak of orgasm during sexual intercourse. Women may complain of breast discharges even when not pregnant. Moreover, they may have hot flushes and other symptoms of post menopausal syndrome during the use of this drug.
Fluoxetine side effects on pregnant women
Fluoxetine increases the risk of congenital anomalies and miscarriages if taken during pregnancy. So, the women either planning to conceive or have conceived must avoid Fluoxetine. It is categorized as C type drug during pregnancy. One of the common side effects is the neonatal adaptation failure or it may be poor. It usually presents as respiratory difficulty, jitteriness and cyanosis.
Although very less amount of drug is transferred to the baby in the milk but due to the side effects of the drug, the nursing mothers are advised to avoid the use of Fluoxetine.
Fluoxetine side effects on elderly
Fluoxetine must be used cautiously in elderly because the clearance of the drug is generally decreased in elderly. Decrease clearance increases the overall side effects of the drug and may be dangerous for the elderly. Hyponatremia (decreased sodium concentration) in the plasma occurs more commonly in the elderly as compared to other age groups using the same drug.in addition to the above mentioned side effects dry mouth, nausea, weakness and fatigue are more pronounced in the elderly.