Therapeutic Action
Antidepressant, selective serotonin re-uptake inhibitor (SSRI)
PDF page 147
Loading InternPractice…
Drug reference
Antidepressant, selective serotonin re-uptake inhibitor (SSRI)
PDF page 147
Major depression Generalised anxiety Severe post-traumatic stress disorder
PDF page 147
Administer with caution and monitor use in patients with epilepsy, diabetes, hepatic impairment (reduce dose or frequency of administration) or severe renal impairment; history of gastrointestinal bleeding, bipolar disorders, suicidal ideation (in young adults) or closed-angle glaucoma. May cause: gastrointestinal disturbances, drowsiness (caution when driving or operating machinery); fatigue, headache, dizziness, seizures, sexual dysfunction, blurred vision, hyponatraemia especially in older patients; mental disorders: anxiety, insomnia, agitation, aggressive behaviour, suicidal ideation in young adults; withdrawal symptoms very frequent if discontinued abruptly: dizziness, paraesthesia, nightmares, anxiety, tremors and headaches. Avoid combination with: aspirin, NSAIDs and warfarin (risk of bleeding); serotonergic drugs: other SSRI, tricyclic antidepressants, ondansetron, tramadol, etc. (risk of serotonin syndrome). Monitor combination with: carbamazepine, phenytoin, risperidone (increased plasma concentrations), drugs which lower the seizure threshold (antipsychotics, mefloquine, etc.). Avoid alcohol during treatment (increased risk of adverse effects). Pregnancy: re-evaluate whether the treatment is still necessary; if it is continued, maintain fluoxetine at effective dose or consider switching to another SSRI if the woman plans to breast- feed. Observe the neonate (risk of agitation, tremors, hypotony, respiratory difficulties, sleeping rd disorders, etc.) if the mother was under treatment in the 3 trimester. If treatment starts during pregnancy, preferably use sertraline. Breast-feeding: avoid; consider switching to sertraline or if not available, paroxetine.
PDF pages 147, 148
20 mg capsule
PDF page 147
Major depression Adult: 20 mg on alternate days for one week, then 20 mg once daily. In case of insufficient response after 3 weeks, increase up to 40 mg daily max. Generalised anxiety, severe post-traumatic stress disorder Adult: 20 mg once daily
PDF page 147
Major depression: at least 9 months. Discontinue treatment gradually (e.g. half dose once daily for 2 weeks then on alternate days for 2 weeks). If signs of relapse or withdrawal occur, increase the dose then decrease it more gradually. Generalised anxiety, severe post-traumatic stress disorder: 2 to 3 months after symptoms resolve. Discontinue treatment gradually (over at least 2 weeks).
PDF page 147
Do not open the capsules. It is necessary to wait at least 2 to 3 weeks before assessing the antidepressant effect. This must be explained to the patient.
PDF page 148
– – Below 25 °C
PDF page 148
20 mg on alternate days for one week, then 20 mg once daily. In case of insufficient response after 3 weeks, increase up to 40 mg daily max.
PDF page 147
20 mg once daily
PDF page 147