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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.

This antidepressant medication 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 it 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.

iMedical Consensus Advisory

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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 this medication. 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 taking this medication 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 it with meals may be helpful.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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