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Fluoxetine
Fluoxetine
N-methyl-3-phenyl-3-4-(trifluoromethyl)phenoxy-
propan-1-amine hydrochloride
CAS number
59333-67-4 ATC code
N06AB03
Chemical formula CHF3NO, HCl
Molecular weight 345.8
Bioavailability ?
Max concentration 6-8 hours
Metabolism 4-16 days ?
Elimination half-life 4-6 days ?
Excretion Kidneys 80%
Intestines 15%
Pregnancy category ?
Legal status ?
Routes of administration Oral
Fluoxetine hydrochloride (brand names include Prozac?, Symbyax? (compounded with olanzapine), Sarafem?, Fontex? (Sweden), Fluctin (Austria, Germany), Prodep (India), Fludac (India) is an antidepressant drug used medically in the treatment of depression, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder, & many other disorders. It is a selective serotonin reuptake inhibitor (SSRI), & is marketed in capsules containing 10, 20, 40 or 90 mg of active ingredient, in tablets containing 10 mg, or in a oral solution with concentration of 5 mg/5 ml (?). Dosages in the range of 20-60 mg per day r standard, with 80 mg considered a maximum. Eli Lilly is Prozac was approved by the FDA on December 29, 1987 & introduced in the US at the beginning of 1988. The drug became very popular, with millions around the world having taken the medication. In Fall 2001, Eli Lilly lost a patent dispute with Barr Laboratories & now Fluoxetine HCl is manufactured by many companies.
Fluoxetine has a wide range of published interactions, notably with monoamine oxidase inhibitors. Common side-effects include anxiety, restlessness, trembling, weakness, skin rash, anorgasmia, itching, & a decrease in sexual drive.
Compared to other popular selective serotonin reuptake inhibitors fluoxetine has a strong energizing effect. This makes fluoxetine highly effective in treatment of clinical depression cases where symptoms like depressed mood & lack of energy prevail but makes it inappropriate in cases with anxiety & restlessness.
Fluoxetine is eliminated very slowly by the body. The half-life of fluoxetine after a single dose is two days and, after multiple dosing, four days. The liver then metabolizes fluoxetine into norfluoxetine, a desmethyl metabolite, which is also a serotonin reuptake inhibitor; norfluoxetine has an even longer half-life, i.e. 8.6 & 9.3 days for single & repeated dosage respectively. Other SSRIs have, by comparison, a very short half-life - some professionals feel that it is fluoxetine is long half-life that gives it much of its therapeutic utility. Fluoxetine is a potent CYP2D6 inhibitor, which can decrease metabolism of other medications.
In December 2003 the FDA approved Symbyax to treat bipolar depression. Symbyax is a combination of fluoxetine & olanzapine.
Controversy
In the late 1990s, a backlash grew against Prozac?. Prozac? is manufacturer, Eli Lilly & Company, earned billions from its success, & became the target of numerous accusations (see David Healy affair). Lawsuits amounting to millions were instigated, alleging the drug made users feel suicidal and/or caused other serious side effects. The accusations & lawsuits have been unsuccessful in stemming the prescription & use of the medication, as well as in making the accusers some of Lilly is profits. Recently, the US FDA considered similar controversial issues regarding Prozac? & its use in children & adolescents; it issued a ''black box warning'' (its most serious warning) for Prozac? & other antidepressants (SSRI is & antidepressants of related classes) due to findings of increased suicidality in some children & adolescents on the drugs.
A more recent controversy embroiled Lilly, & a class action lawsuit has been filed after several people received in the mail free samples of Prozac? Weeklyâ„¢. The suit alleges that the samples' recipients' right to privacy was mishandled.
In August 2004 a report by the Environment Agency found trace amounts of fluoxetine in UK drinking water, although the Drinking Water Inspectorate said that it was unlikely to pose a health risk. However, the effects from ingestion of fluoxetine in drinking water has not been investigated.
In January, 2005, the British Medical Journal was leaked official Eli Lilly documents from the 1980s suggesting the a link between fluoxetine & suicide & psychosis. It was originally claimed that the documents had not been previously disclosed, & they were subsequently provided to the FDA for further investigation. However, Eli Lilly later claimed that the documents had been released in earlier litigation.http://prnewswire.com/cgi-bin/micro_stories.pl?ACCT=916306&TICK=LLY&STORY=/www/story/01-05-2005/0002770570&EDATE=Jan+5,+2005 The British Medical Journal ultimately retracted its claim that the documents had not been previously disclosed, & apologized to Eli Lilly.http://bmj.bmjjournals.com/cgi/content/full/330/7485/211-a?maxtoshow=
The resources at the end of this article present a blend of views on this drug, some of which focus on the more controversial & unscientific issues.
External links
Producer of Prozac?, Eli Lilly & Company, Inc.
Lilly is Prozac? advertising website
Prozac Truth, The Untold Story
Open Directory Fluoxetine
Prozac Information
BBC report on Prozac in drinking water