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Generic Name: Fluoxetine
Brand Name(s):
Information updated: April 1, 2000
Overview
Prozac was the first of a new generation of antidepressants to come on the
market. It works by enhancing the action of a brain chemical called serotonin.
In a few short years this drug has become so popular that, in addition
to becoming the most prescribed antidepressant on the physicians' hit parade of
drugs, it has become a household name.
Prozac has been featured on the
covers of newsmagazines and has even been the subject of a best-selling book
(Listening to Prozac).
This success comes largely because Prozac is less
likely to cause typical side effects associated with older medications.
Tricyclic antidepressants like Elavil, Tofranil, Sinequan and Pamelor
can produce dry mouth, constipation, dizziness, weight gain, and a sluggish or
lethargic feeling. Prozac does not.
If anything, it has a slight stimulant
action.
Prozac is used in the treatment of depression; it is also
approved for treating obsessive compulsive disorder.
Psychiatrists
continue to experiment with the use of this medication for eating disorders and
other problems.
Side Effects and Interactions
Side effects associated with Prozac include
headache, nervousness, agitation, insomnia, tremor, fatigue, rash,
lightheadedness, drowsiness, dizziness, depersonalization, nausea, upset
stomach, diarrhea, loss of appetite, stomach pain, sweating and dry
mouth.
Somewhat less common adverse reactions include impaired
concentration and memory, weird dreams, lowered libido, loss or delay of orgasm,
abnormal ejaculation, dry skin, constipation, hair loss and itching. Report any
symptoms to your physician promptly.
Uncommon but very serious side
effects to be alert for are rash with flulike symptoms such as chills, fever or
sore throat, anemia, breathing problems, severe allergy, or seizures.
Prozac interacts with a number of other medications. Anyone taking other
antidepressants, especially drugs such as Nardil, Marplan or Parnate should stop
such a medicine at least two weeks before starting on Prozac.
If Prozac
was taken first, five weeks should elapse before starting on one of these other
medicines, because Prozac can last in the body a long time.
Tricyclic
antidepressants like Elavil
or Tofranil and even Anafranil for obsessive-compulsive disorder may have
stronger actions and more pronounced toxicity when they are combined with
Prozac.
If such a combination is prescribed, the physician should
monitor blood levels of the medications.
The same is true of the
antipsychotic drug Haldol.
If the amino acid tryptophan ever becomes
available in this country again, it should not be taken with Prozac, as it may
increase the potential for adverse reactions.
Other compounds that could
cause complications in combination with Prozac include lithium,
Coumadin,
Lanoxin
and Valium (or similar medications such as Dalmane, Halcion or
Klonopin).
Interactions between the herb St. John's wort and
Prozac are possible. Switching between antidepressants and
herbal treatment calls for medical guidance (physicians can find a suggested
protocol for gradual substitution of St. John's wort in Hyla Cass's book, St.
John's Wort: Nature's Blues Buster).
Check with your pharmacist and
physician before taking any other medicines or herbs.
Special Precautions
Some people may need very close monitoring if the doctor prescribes Prozac.
Because this drug may cause anxiety, nervousness and insomnia in a substantial number of people, those with a predisposition to such conditions need to alert their physicians if such symptoms are aggravated by Prozac.
Patients with kidney disease, diabetes, liver problems or a history of seizures also require careful monitoring while they are taking Prozac.
People with a history of suicide attempts must also be extremely vigilant. There have been reports that some people may develop a preoccupation with suicide or violence while taking Prozac.
It is still not certain whether this is caused by the underlying mental condition or is in some way related to the drug.
Family members must help monitor people on Prozac for suicidal thoughts or self-destructive behaviors. The doctor must be notified immediately in such cases.
Taking the Medicine
According to the manufacturer, you can take Prozac with or without food.
If it upsets
your stomach you may find that swallowing Prozac with meals may be helpful.
Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio.
© 2000