Prozac

US Brand Name: Prozac
Generic Name: fluoxetine hydrochloride
Other Forms: Prozac Weekly, Sarafem (for PMDD), oral solution
Class: Antidepressant, specifically SSRI.Read up on these sections if you haven’t done so already, because they cover a lot of information about multiple medications that I’m not going to repeat on many pages. I’m just autistic that way about not repeating myself.
FDA Approved Uses: Major Depression
Obsessive-Compulsive Disorder
Panic Disorder
Bulima Nervosa
Premenstrual Dysphoric Disorder (as Sarafem)
Prozac (fluoxetine hydrochloride) is the only SSRI (and modern antidepressant in general) approved for use by the under-18 set for depression, probably due to its long half-life and lower potency.
Off-Label Uses: Fibromyalgia
Arthritis
Chronic Fatigue
Multiple Sclerosis
Bipolar Depression
Lupus
Headaches
Irritable Bowel Syndrome (IBS)
ADD/ADHD
Premature Ejaculation

Other Brand Names: Adofen (Spain)
Alzac 20 (Guatemala)
Andep (India)
Ansilan (Colombia)
Auroken (Mexico)
Deprexin (Bahamas; Barbados; Belize; Bermuda; Curacao; Guyana; Jamaica; Dutch Antilles; Puerto Rico; Singapore; Surinam; Trinidad)
Deproxin (Thailand)
Fluctin (Germany)
Fluctine (Austria; Switzerland)
Fludac (Benin; Burkina Faso; Ethiopia; Gambia; Ghana; Guinea; India; Ivory Coast; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; South Africa; Sudan; Syria; Tanzania; Tunisia; Uganda; United Arab Emirates; Zambia; Zimbabwe)
Flufran (India)
Flunil (India)
Fluox (Germany)
Fluoxac (Mexico)
Fluoxeren (Italy)
Fluoxil (Dominican Republic)
Fluox-Puren (Germany)
Fluronin (Taiwan)
Flusac (Thailand)
Flutin (Colombia; Korea)
Flutine (Israel; Thailand)
Fluxen (Taiwan)
Fluxetil (Singapore)
Fluxetin (Singapore)
Fluxil (Bahrain; Cyprus; Egypt; Hong Kong; Iran; Iraq; Israel; Jordan; Kuwait; Lebanon; Libya; Oman; Qatar; Republic of Yemen; Saudi Arabia; Syria; United Arab Emirates)
Fontex (Denmark; Finland; Norway; Sweden)
Foxetin (Korea)
Lanclic (Korea)
Lorien (South Africa)
Lovan (Australia)
Magrilan (Singapore)
Margrilan (Bahrain; Cyprus; Egypt; Hong Kong; Iran; Iraq; Jordan; Kuwait; Lebanon; Libya; Oman; Qatar; Republic of Yemen; Saudi Arabia; Syria; Thailand; United Arab Emirates)
Modipran (Benin; Burkina Faso; Ethiopia; Gambia; Ghana; Guinea; Ivory Coast; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; Sudan; Syria; Tanzania; Tunisia; Uganda; United Arab Emirates; Zambia; Zimbabwe)
Neupax (Peru)
Nopres (Indonesia)
Nuzak (South Africa)
Oxactin (United Kingdom)
Oxedep (China; India)
Pragmaten (Ecuador)
Prizma (Israel)
Proctin (Korea)
Prodep (Benin; Burkina Faso; Ethiopia; Gambia; Ghana; Guinea; India; Ivory Coast; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; South Africa; Sudan; Syria; Tanzania; Tunisia; Uganda; United Arab Emirates; Zambia; Zimbabwe)
Prozac 20 (Korea; Malaysia; Mexico; Philippines; Taiwan; Thailand)
Rowexetina (Costa Rica; Dominican Republic; El Salvador; Guatemala; Honduras; Nicaragua; Panama)
Salipax (Bahamas; Barbados; Belize; Bermuda; Curacao; Guyana; Jamaica; Dutch Antilles; Puerto Rico; Surinam; Trinidad)
Sanzur (South Africa)
Sinzac (Taiwan)
ZAC (Indonesia)
Zactin (Australia; Singapore; Taiwan)
Zepax (Colombia)

Prozac’s pros and cons:
Pros: Prozac’s long half-life makes the issue of med compliance a little less of a big deal, hence the approval for depressed teenagers. It also has studies backing it up for PMDD, by Lilly and independent researchers, including the Amen clinic, where I’m treated. You can see at the Amen Clinic’s case studies in practice the more common form of PMDD that responds to SSRIs will respond to whichever SSRI you get along with the best. Prozac Weekly does have an advantage for certain forms of PMDD.

Cons: That really long half-life means it takes forever to wean yourself off of Prozac (fluoxetine hydrochloride) to avoid SSRI discontinuation syndrome. But only if the discontinuation syndrome hits you hard, which is fairly uncommon with Prozac (fluoxetine hydrochloride). In fact some more enlightened doctors will prescribe the liquid form to help wean patients off of other SSRIs and Effexor (venlafaxine). The sexual side effects, though, are pretty bad. For being the weakest of the SSRIs the side effects are pretty gnarly.

Prozac’s side effects:

Typical Side Effects: The usual for SSRIs – headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation, weight gain, loss of libido. Most everything but the weight gain and loss of libido usually goes away within a couple of weeks. With Prozac (fluoxetine hydrochloride) it’s a coin toss as to losing or gaining weight. Sometimes it will just kill your appetite.

For tips on how to cope with these side effects, please see our side effects page.
These aren’t all the side effects possible, just the most popular ones.

Not So Common Side Effects: Rash, ‘flu-like symptoms, anger/rage.
These may or may not happen to you don’t, so don’t be surprised one way or the other.

Freaky Rare Side Effects: Bleeding gums, amnesia, anti-social reaction (oh, come on, like we’re not anti-social already), herpes (again, blaming the med for an STD), excessive hair growth, engorged breasts, involuntary tongue protrusion (in one 77-year-old woman who stopped sticking her tongue out at everyone after they stopped giving her Prozac (fluoxetine hydrochloride)).

You aren’t going to get these. I promise.

Interesting Stuff Your Doctor Probably Won’t Tell You: Prozac (fluoxetine hydrochloride) has been found to make a lot of other drugs work better. Great, huh? Not always, as with some meds it can be to the point of overdose. But it was that effect that lead to the breakthrough of the antipsychotic & antidepressant cocktail to treat bipolar depression. Anyway, Tegretol (carbamazepine) could suddenly get toxic on you and Xanax (alprazolam) could knock you out if you add Prozac (fluoxetine hydrochloride) to them, or add them to Prozac (fluoxetine hydrochloride), so be careful and always check your drug-drug interactions! A big part of this is the usual pharmacokinetic stuff of liver enzymes being able to deal with only so much, and Prozac (fluoxetine hydrochloride) gives your liver a bit of a workout. But that doesn’t explain the entire effect of all of the drug-drug interactions. There’s some pharmacodynamic (how meds work in your brain) stuff going on as well.
Prozac (fluoxetine hydrochloride) isn’t such a hot idea for anyone with diabetes, and not because of potential weight gain, rather it messes with your glycemic control.

Prozac’s Dosage and How to Take Prozac: I’m just going to cover the dosages for adults. Even though Prozac (fluoxetine hydrochloride) is the only modern antidepressant approved for kids, with kids it’s still a lot trickier.

Depression – 20mg in the morning, increasing by 20mg a day after at least a week, taken either in the morning or at noon until a maximum of 80mg a day is reached.

OCD & Bulima – 20mg in the morning, increasing by 20mg a day after at least a week, taken either in the morning or at noon until a maximum of 60mg a day is reached.

Panic – 10mg in the morning. Increase to 20mg, either all in the morning or split into morning and noon. Hold there for awhile before increasing. Although you can go up to 60mg a day, few people responded to anything above 20mg a day.

Like any SSRI I recommend starting out with half the recommended dosage (except for Panic, that’s as low as you can get) and then increasing to 20mg after a week. If you don’t feel anything go up to 30mg, but stay there until you’ve given it a try for a month, otherwise it’ll just be a pain in the ass to stop it. Even at 30mg you’ll know after a month if it’s going to do something for you.

Prozac Weekly – You just take the one capsule a week for everything. That’s it.
Days to Reach a Steady State: Four to five weeks.
When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.

How Long Prozac Takes to Work: Like all SSRIs anywhere from a couple days to over a month. If you don’t feel any positive benefit after six weeks, then you should talk to your doctor about either another SSRI or trying a med that hits another neurotransmitter. Because of the long time it takes to reach a steady state, you might want to give Prozac (fluoxetine hydrochloride) a full two months. Just don’t keep upping the dosage every week until then, otherwise it will be much harder and take much longer to stop taking Prozac.

Prozac’s Half-Life & Average Time to Clear Out of Your System: Prozac (fluoxetine hydrochloride) has the longest half-life of any med I’ve written up, 9.3 days. That’s why there’s such an animal as Prozac Weekly. Thus it takes 45 days to clear out of your system.

How to Stop Taking Prozac: Your doctor should be recommending that you reduce your dosage by 10-20mg a day every week if you need to stop taking it, if not more slowly than that. For more information, please see the page on how to safely stop taking these crazy meds. Unlike other medications, the time to step down from Prozac isn’t based on half-life, it’s based on anecdotal evidence. In other words, people’s experiences. Now, if you start to experience SSRI discontinuation syndrome once you’re down around 30-40mg a day, then you will have to look at reducing your dosage by 10mg a day every month. But only if you’re prone to the worst effects of discontinuation syndrome. Which is unusual with Prozac (fluoxetine hydrochloride). Here’s where you really have to balance the suckiness of what you’re dealing with in the way of side effects or whatever vs. SSRI discontinuation syndrome. And if you’re taking Prozac Weekly you’ll have to switch to the regular flavor to step down, as weekly is one size fits all. However, that extra-long half-life tends to make discontinuation less harsh, so you’ll probably be able to to get off of Prozac (fluoxetine hydrochloride) a lot sooner. In fact switching to Prozac (fluoxetine hydrochloride) from another SSRI or Effexor (venlafaxine) is a good way of dealing with the discontinuation syndrome of the meds with the shorter half-lives. As Prozac comes in a liquid form, you can always switch to that to wean yourself off the last bit really slowly, mg by mg.

If you’ve worked your way up to a particular dosage, it’s usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.

How Prozac Works In Your Brain: Like all SSRIs Prozac (fluoxetine hydrochloride) doesn’t make you produce more serotonin, rather it makes your neurons soak for a longer period of time in the serotonin you already produce. Serotonin is one of the big three neurotransmitters responsible for depression, along with norepinephrine and dopamine. My wild-ass guess / rule of thumb is that imbalances of one or more of the three are responsible for 80% of the depression issues. It’s all just a matter of figuring out exactly the extent of the tweaking and what neurotransmitters you exactly need to tweak. Prozac (fluoxetine hydrochloride) is the weakest of the SSRIs, and has the longest half-life, a combination that makes it the best SSRI to start with and the only one approved for use with kids.

Chances Prozac Will Work and How Prozac Compares to Other Meds: If you read the PI sheet you’ll just see that for Major Depressive Disorder Prozac (fluoxetine hydrochloride) produced a significantly higher rate of response and remission. But no hard numbers are given. Why? Because “significant” means somewhere in the neighborhood of 20%. That doesn’t look to good. So you have about a 1 in 5 chance of it, or any SSRI, doing its job. Part of the problem is that serotonin isn’t always the issue with someone’s depression. I’ll be covering how to figure out which chemicals and/or voltage channels you need to be tweaking in your brain in a future article to try to avoid the med-go-round. Another part of the low response rate is that sometimes these are the wrong meds entirely. SSRIs are for serious depression. Milder depression may require a milder medication, such as trazodone, or no medication at all.

For OCD there are some hard numbers:

TABLE 1 Outcome Classification (%) on CGI Improvement Scale for Completers in Pool of Two OCD Studies
Prozac
Outcome Classification Placebo 20 mg 40 mg 60 mg
Worse 8% 0% 0% 0%
No change 64% 41% 33% 29%
Minimally improved 17% 23% 28% 24%
Much improved 8% 28% 27% 28%
Very much improved 3% 8% 12% 19%

You can see for yourself what 40mg a day of Prozac (fluoxetine hydrochloride) will do.

For Panic/Anxiety two studies in the PI sheet with patients taking 20-60mg a day had 42% and 62% of the people taking Prozac (fluoxetine hydrochloride) being free from panic attacks at the end of 12 weeks.

For PMDD, more hard numbers:

TABLE 2 Percentage of Patients Moderately and Markedly Improved (>50% and 75% Reduction, Respectively, From Baseline Luteal Phase VAS Total Score)
Improvement n Placebo n Fluoxetine 20 mg n Fluoxetine 60 mg
Moderate 94 11% 95 37% 85 38%
Marked 94 4% 95 6% 85 18%

Finally for Bulima we get the same weasel wording as with Major Depressive Disorder, “significant improvement.”

I’ll be back with some comparisons to other meds.

Comments: First approved by the FDA to treat depression in December of 1987.
You know what can really suck? When you’ve got someone who is all bipolar and hypersexual in a relationship with someone who has Major Depressive Disorder and takes Prozac (fluoxetine hydrochloride) for it, only to have her libido and all sexual response completely eliminated. Can you spell “issues”? I knew you could.

And in other Prozac (fluoxetine hydrochloride) experiences, Mouse was in the Clinical Trials for Prozac (fluoxetine hydrochloride), way back when it was the first SSRI in the US (Luvox (fluvoxamine maleate) predates it in Europe). If and when she feels up to it, and her memory is together enough, she can report her side effects that give you the odds as to what your side effects will be. I’ll bet folding money that hers was the anti-social reaction reported above. They probably couldn’t believe that someone was that anti-social and it had to be the drug that caused it.

Prozac (fluoxetine hydrochloride) is the only SSRI and modern antidepressant above for use for anyone under 18, and for good reason. Its long half-life makes compliance less of an issue. If your kid happens to miss a day’s dose now and then, it’s not that big a deal. Whereas with Paxil (paroxetine hydrochloride) and Effexor (venlafaxine) missing doses for even one day can start the hell that is SSRI discontinuation syndrome, and they have the worst instances of it. The syndrome is bad enough for adults, but would be beyond a nightmare for kids. See the SSRI page for more details on the vicious cycle kids can get into and how Prozac (fluoxetine hydrochloride) avoids it with its long half-life. Also by being the weakest of the SSRIs Prozac (fluoxetine hydrochloride) keeps kids from getting too much serotonin, which is also a huge problem. Serotonin syndrome is potentially fatal, and while giving kids a med like Paxil (paroxetine hydrochloride) is unlikely to be fatal in of itself, it will be suck-ass enough to cause the kids either start or ramp-up self-injurious or suicidal behavior because they are now feeling a hell of a lot worse from the meds they’re taking that everyone tells them are supposed to be making them feel better.

Hell, even with adults Prozac (fluoxetine hydrochloride) is the best med to start with if serotonin is the prime suspect in the chemical imbalance for the very same reasons. While its side effects may suck more than the other SSRIs, even for being the weakest SSRI on the market, if you’re doing the med-go-round method of figuring out which way to fix your brain (and that’s still pretty much the standard way of doing it, unfortunately), trying Prozac (fluoxetine hydrochloride) first is the safest way to go. The discontinuation syndrome sucks so much less with Prozac (fluoxetine hydrochloride). The risk of making things much worse is far lower with Prozac (fluoxetine hydrochloride).

You have two ways to go when choosing your first SSRI:

Fewer side effects and faster effect – then you want Lexapro (escitalopram oxalate).

Less chance of just plain messing you up – you want Prozac (fluoxetine hydrochloride).

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