- Sandoz Fluoxetine - Uses, Side Effects, Interactions -
- Fluoxetine Drug Interactions -
- Razadyne Monograph for Professionals -
- Razadyne Oral Capsule, Extended Release Drug Information,
Sandoz Fluoxetine - Uses, Side Effects, Interactions -
Continuous (Sarafem): 20 mg PO q Day initially; may gradually increase dose; not to exceed 80 mg/day, OR Intermittent (Sarafem): 20 mg PO q Day starting 14 days before menstruation and through first full day of menses (repeat each cycle) Upon therapy discontinuation, taper gradually over 4-6 months to minimize incidence of withdrawal symptoms and allow for detection of re-emerging symptoms; if withdrawal symptoms intolerable, following a dose reduction, resume previously prescribed dose and/or decrease dose at more gradual rate Renal impairment: Use caution; drug accumulation may occur with severe renal impairment Hepatic impairment (cirrhosis): Decreased clearance of parent drug and active metabolite (norfluoxetine); lower or less frequent dose recommended 7 years: 10 mg PO q Day, initially; may gradually increase dose after 2 weeks to 20 mg q Day; further increases may be considered after several weeks Adolescents and hher-weht children: Typical dosage range 20-60 mg q Day Lower-weht children: Typical dosage range 20-30 mg q Day 65 years In children and young adults, the risks must be wehed against the benefits of taking antidepressants Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during the initial 1-2 months of therapy and dosage adjustments The patient’s family should communicate any abrupt changes in behavior to the health-care provider Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy Not FDA approved for treatment of bipolar depression Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (aged 18-24 years) Risk of serotonin syndrome when used with other strong serotonergic drugs (see Contraindications and Drug Interactions) Risk of bleeding (GI and other) when used in combination with NSAIDs, aspirin, or drugs affecting coagulation; may impair platelet aggregation Activation of mania/hypomania (screen for bipolar disorder) Fluoxetine therapy has been associated with occurrence of rash and allergic reaction, including vasclitis; discontinue if they occur Bone fractures have been associated with antidepressant therapy; consider possibility of bone fracture when patient presents with bone pain May cause or exacerbate sexual dysfunction Use caution in patients with risk for QT prolongation, including congenital long QT syndrome, history of prolonged QT, or history of prolonged QT; QT prolongation and ventricular arrhythmia, iincluding torsade de pointes Hyponatremia reported with use; consider discontinuation if symptomatic hyponatremia occurs Use caution in patients with history of seizure disorders May prolong QT interval and cause ventricular arrhythmia, including torsade de pointes May cause nervousness, anxiety, insomnia, or anorexia Risk of mydriasis; may trger angle closure attack in patients with angle closure glaucoma with anatomiy narrow angles without a patent iridectomy Hypoglycemia reported; may alter glycemic control in patients with diabetes Pregnancy: Conflicting evidence regarding use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn, or PPHN (see Pregnancy) Risk of complications in neonates exposed to SNRIs/SSRIs late in third trimester (eg, feeding difficulties, irritability, and respiratory problems) Wait 1 week after discontinuation of Prozac before starting Prozac Weekly Gradually decrease dose when discontinuing Has long half-life, decrease in dose will not be fully reflected in plasma for several weeks Pregnancy category: C Treatment of pregnant women during the first trimester: There are no adequate and well-controlled clinical studies on the use of fluoxetine in pregnant women, but 1 prospective cohort study conducted by the European Network of Teratology Information Services reported an increased risk of cardiovascular malformations in infants born to women (N = 253) exposed to fluoxetine during the first trimester of pregnancy, compared with infants of women (N = 1359) who were not exposed to fluoxetine Use late in the third trimester associated with complications in newborns and may require prolonged hospitalization, respiratory support, and tube feeding A study of nearly 28,000 women taking SSRIs confirmed 2 previously reported birth defercts associated with fluoxetine - heart wall defects and craniosynostosis (BMJ 2015; 351:h3190) Several SSRIs (eg, fluoxetine, fluvoxamine, paroxetine, sertraline) are metabolized by CYP2D6 CYP2D6 is involved in the metabolism of approximately 20% of drugs in clinical use and displays large individual-to-individual variability in activity due to genetic polymorphisms More than 80 CYP2D6 variant alleles have been identified; however, 4 of the most prevalent alleles, CYP2D6*3, *4, *5, and *6, account for 93-97% of CYP2D6 poor metabolizers (PMs) CYP2D6*4, the most common variant (~25% frequency in whites), causes a splicing defect, CYP2D6*3 (2.7% frequency) causes a frameshift mutation, and CYP3D6*5 (2.6%) is an entire deletion of the CYP2D6 gene; individuals homozygous for these alleles have no CYP2D6 activity The impact of CYP2D6 activity is further complicated by some SSRIs (eg, fluoxetine, fluvoxamine, paroxetine, sertraline) that, in addition to being substrates for CYP2D6, are also known to moderately inhibit CYP2D6 activity The above information is provided for general informational and educational purposes only.
Fluoxetine Drug Interactions -
Initially 4mg twice daily; if well-tolerated, increase to maintenance dose 8mg twice daily (16mg/day) after minimum of 4 weeks; may attempt further increase to 12mg twice daily (24mg/day) after minimum of 4 weeks. Moderate hepatic or renal impairment (Cr Cl 9–59m L/min): usual max 16mg/day. Discontinue at the first sn of skin rash, unless not drug-related; consider alternative therapy if serious skin reactions occur.
Razadyne Monograph for Professionals -
Take with food Conversion from galantamine tablets and oral solution to galantamine ER should occur at same daily dosage with the last dose of galantamine tablets/oral solution taken in evening and starting galantamine ER once daily treatment next morning Moderate hepatic or renal impairment: max 8 mg q12hr (conventional) or 16 mg q Day (ER) Not recommended in severe hepatic or renal impairment Renamed Razadyne from Reminyl in the US to avoid confusion with Amaryl Serious skin reactions may occur; discontinue at first appearance of skin rash All patients should be considered at risk for adverse effects on cardiac conduction, including bradycardia and AV block, due to vagotonic effects on sinoatrial and atrioventricular nodes Active or occult gastrointestinal bleeding: monitor, especially those with an increased risk for developing ulcers Cholinomimetics may cause bladder outflow obstruction Monitor for respiratory adverse events in patients with a history of severe asthma or obstructive pulmonary disease The above information is provided for general informational and educational purposes only.
Razadyne Oral Capsule, Extended Release Drug Information,
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Razadyne fluoxetine interaction:
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