Generic fluoxetine versus prozac ), the antidepressant effect of prozac and the fluoxetine may be different (Schulz-Jak, 2002, 2003; Schulz-Jak et al., 2007). Thus there is a need for further studies of the clinical effects fluoxetine in treatment of mood disorders.
The mechanism of action fluoxetine is not clearly understood. It generally believed that there is a dual mechanism of action. In the peripheral monoaminergic system, fluoxetine may act as a 5-HT1A receptor antagonist. On the other hand, in central serotonergic system it acts as a 5-HT1B receptor antagonist. The main mechanism of action SSRIs is fluoxetine 20 mg generic thought to be the inhibition of monoamine oxidase. oxidase and various dopamine, serotonin, noradrenaline reuptake transporters are all critical for the uptake of monoamines with their respective neurotransmitters into the neuronal generic fluoxetine uk cell (see also chapter on the monoamines). effect of inhibitors monoamine oxidase is explained by the role played this enzyme in the conversion of precursors that enter the cell from metabolism of monoamines to their respective metabolites.
Since fluoxetine acts on several monoamine oxidase enzymes, the inhibitory effect is presumed to be a result of inhibition the enzyme's functional activity. Moreover, it is also possible that fluoxetine inhibits monoamine oxidase, because other serotonergic drugs act by inhibiting monoamine oxidase, as seen with tryptophan depletion, an antidepressant drug (Schulz-Gastil, 2007).
Several mechanisms have been proposed to account for the actions of fluoxetine against various psychiatric disorders. These include:
An important point to remember is that fluoxetine should, under appropriate clinical conditions, be used in combination with appropriate mood stabilizers.
As mentioned earlier, fluoxetine should be used with antidepressants according to dosage recommendations.
Studies have shown that fluoxetine may be associated with some minor and transient worsening of psychiatric symptoms (e.g. agitation, irritability) during and after treatment (Stagg, 2005).
In patients who are being treated for an acute episode of depression, and when there are no other significant therapeutic choices at the time, fluoxetine should be considered (Stagg, 2005).
Because of the potential for worsening symptoms, fluoxetine should be avoided in patients who are being treated for a second episode of depression (Stagg, 2005). The main concern in this situation is that fluoxetine has a high risk of causing serotonin syndrome which has been implicated in a large number of deaths. In severe cases (serotonin syndrome usually occurring within 2–3 days of the last dose), there are symptoms such as fever, myalgia, and myalgias (e.g. muscle pain, nausea, diarrhea) (O'Connor, 1998).
Studies indicate that fluoxetine can also cause a worsening of symptoms in patients with a history of previous MAOI, or MAOI-free subjects if the MAOI was not a selective serotonin reuptake inhibitor. This may be due to inhibition of monoamine oxidase activity (Mortons, 2000).
The risk of serotonin syndrome in relation to the concomitant use of fluoxetine and other serotonergic drugs has not been established.
Studies indicate a higher risk of serotonin syndrome by administration in Digoxin generics the morning compared to evening (Schmidt-Jak et al., 2007).
The risk of fluoxetine–phenylalanine interactions has not been established.
Fluoxetine is known to possess a mild effect on plasma concentrations of tryptophan when taken with other serotonergic drugs. This may be due, in part, to the activity of MAOA enzyme (Stagg, 2005; Schulz-Gastil, 2007).
The possible interactions of fluoxetine with other drugs is described in the following sections.
Other Drugs
There are drugs, that may react with fluoxetine. There is no information available on the potential interactions of fluoxetine with various medications.
Pregnancy
In animal reproduction studies, fluoxetine showed no evidence of teratogenic effects when administered to rats or mice at doses equivalent to 0.1, 1, or 10 mg/kg/day, equivalent to 0.25, 1, or 10 mg/kg/day in humans. It did not seem to be mutagenic when administered rats at doses up to 30 mg/kg/day (Hall, 1985).
Lactation
Because fluoxetine is not known to be teratogenic in post-conceptual reproduction studies, women taking this drug during lactation should be informed of the increased risk.
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