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Introduction to Prozac
Prozac is the trade name for fluoxetine, an SSRI (selective serotonin reuptake inhibitor) drug used to treat major depressive disorder (depression), bulimia nervosa (an eating disorder), obsessive-compulsive disorder, and panic disorder (including anxiety). It is one of the most well known drugs in the world and in many ways revolutionized the treatment of mental illness.
Fluoxetine is sometimes prescribed off-label to treat other conditions, including alcoholism, attention-deficit disorder (ADD), sleep disorders, headaches, posttraumatic stress disorder (PTSD), Tourette's syndrome, sexual problems, and obesity.
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How should Prozac be taken?
Prozac and generic fluoxetine are taken orally in capsule, tablet, or solution formulation. There are tablets made to be taken once per day, as well as a weekly pill, which is ideal for patients who have trouble remembering to take their medications daily. While usually Prozac is taken only once per day with the daily formulation, initial dosing may involve taking it twice per day until desired serotonin levels are achieved (see dosing below).
Prozac can be taken with or without food. Unless otherwise instructed by their physicians, patients should take Prozac in the morning. Patients who take Prozac twice per day usually take it first thing in the morning and again at noon. It should be taken exactly as directed, and patients should never take more than what has been prescribed. Unless instructed to stop taking Prozac by a physician or poison control center, patients should never stop taking Prozac suddenly (see precautions below). Patients who discontinue Prozac need to be tapered off the medication to mitigate adverse events associated with stopping.
Patients may need to take Prozac for several weeks before assessing its effectiveness. Patients who experience relief or remission from their symptoms while on Prozac need to keep taking it and should not stop their medication simply because they feel better, a common error with antidepressant drugs.
How does Prozac work?
Prozac works on neurotransmitters, the chemical messengers between nerve cells, such as serotonin. Low levels of serotonin can be responsible for issues like depression and anxiety. Basically, Prozac keeps excess serotonin from being absorbed by a reuptake pump mechanism in the nerve cells and instead sends it all to the destination nerves. Prozac only works on serotonin, not other neurotransmitters, hence its name as a “selective” serotonin reuptake inhibitor. Prozac also causes nerve cell axons to release more serotonin in the first place. This process can take up to several weeks, which is why users of Prozac may not see immediate results and need to stay on the medication for at least a few weeks to determine if it is working for them.
What are the common doses for Prozac?
Dosing for Prozac depends on the indication for which it is prescribed. For depression in adults, Prozac is usually initiated at 20 mg per day. Dosing can be increased in 20 mg increments, not to exceed a total dose of 80 mg per day.
Children and adolescents who receive Prozac for depression are often started at 10 mg per day. Dosing in this population usually does not exceed 20 mg per day.
Patients who are prescribed Prozac weekly, generally complete one week of daily dosing first before transitioning to weekly dosing, titrated to the desired effect.
Dosing for obsessive-compulsive disorder in adults is the same as for depression: starting at 20 mg per day and titrating up to a maximum of 80 mg per day for symptom relief.
Children who take Prozac for obsessive-compulsive disorder usually start at 10 mg per day and may be told to increase dosing up to 60 mg per day for full symptom control.
The ideal adult and teen dose of Prozac for bulimia nervosa is 60 mg per day in the morning. Patients may need to start at 20 mg per day and work up to the 60 mg dose.
When taken for panic disorder, Prozac is initiated at 10 mg per day for one week. After one week, dosing is increased to 20 mg per day. Occasionally, dosing up to 60 mg per day may be necessary for complete remission of symptoms.
What are other names for Prozac?
Prozac (fluoxetine) is marketed worldwide under dozens of different names. The most common names are Prozac Weekly, Rapiflux, Sarafem, Selfemra, and Symbax (a combination of fluoxetine and olanzapine used to treat depressive episodes in patients with bipolar disorder).