Fluoxetine

Fluoxetine, commonly known by the brand name Prozac^®, is a selective serotonin reuptake inhibitor (SSRI) primarily used to treat major depressive disorder and anxiety disorders. Another brand-name version of fluoxetine, Sarafem^®, is approved to treat premenstrual dysphoric disorder (PMDD). Fluoxetine works by increasing available serotonin levels in the brain, helping to regulate mood and emotional stability.

For depression and anxiety, the recommended dosage starts at 10 to 20 milligrams (mg) per day, although a healthcare provider may adjust this depending on your symptoms and needs.

Fluoxetine has a longer half-life compared to other SSRIs, which means withdrawal symptoms are less severe but can still occur if the medication is stopped abruptly. Some people may experience increased anxiety or restlessness when starting the medication, which typically resolves with continued use.

Prozac (fluoxetine hydrochloride) is a indicated for:

• Acute and maintenance treatment of major depressive disorder (MDD)

• Acute and maintenance treatment of obsessive compulsive disorder (OCD)

• Acute and maintenance treatment of bulimia nervosa

• Acute treatment of panic disorder, with or without agoraphobia

Prozac and olanzapine in combination for treatment of:

• Acute depressive episodes associated with bipolar I disorder

• Treatment resistant depression

Selective serotonin reuptake inhibitor (SSRI)

Most common adverse reactions (≥5% and at least twice that for placebo) associated with:

Major depressive disorder, obsessive compulsive disorder, bulimia, and panic disorder:

• Abnormal dreams

• Abnormal ejaculation

• Anorexia

• Anxiety

• Weakness

• Diarrhea

• Dry mouth

• Indigestion

• Flu syndrome

• Impotence

• Insomnia

• Libido decreased

• Nausea

• Nervousness

• Inflammation of the throat

• Rash

• Inflammation of the sinuses

• Sleepiness

• Sweating

• Tremor

• Vasodilatation

• Yawn

Prozac and olanzapine in combination:

• Also refer to the adverse reactions section of the package insert for Symbyax

The cost of fluoxetine varies depending on your insurance plan, which pharmacy you use, the dosage, and quantity. Without insurance, generic fluoxetine may cost about $26 for a month’s supply of 20 mg tablets, but coupons and discount cards are available to bring down the price as low as about $3. Prozac, the brand-name version of the medication, costs about $578 for the same amount. Insurance may cover all or some of the cost of this medication.

A prescription for fluoxetine through Hers starts at $49 per month and includes key benefits of using the Hers telehealth platform, such as free shipping and unlimited messaging with a provider.

You can get a prescription for fluoxetine after being evaluated by your primary care provider or a specialist who can determine if the medicine is right for you based on factors like your symptoms and medical history.

Hers offers access to fluoxetine. When you connect with a provider through the Hers platform, they’ll determine if this medication is right for you. If it’s deemed a good fit, your medication will be shipped directly to your door. Your prescription costs include shipping and ongoing asynchronous messaging with your provider and our customer service team.

• Serotonin syndrome and MAOIs

• Pimozide

• Thioridazine

• When using Prozac and olanzapine in combination, also refer to the contraindications section of the package insert for Symbyax

• Drug interactions: monoamine oxidase inhibitors (MAOIs), drugs metabolized by CYP2D6, tricyclic antidepressants (TCAs), CNS acting drugs, benzodiazepines, antipsychotics, anticonvulsants, serotonergic drugs, drugs that interfere with hemostasis (e.g., NSAIDs, aspirin, warfarin), drugs tightly bound to plasma proteins, olanzapine, drugs that prolong the QT interval

• Suicidal thoughts and behaviors in children, adolescents, and young adults

• Serotonin syndrome

• Allergic reactions and rash

• Activation of mania/hypomania

• Seizures

• Altered appetite and weight

• Increased risk of bleeding

• Angle-closure glaucoma

• Low blood sodium

• Anxiety and insomnia

• QT prolongation

• Potential for cognitive and motor impairment

• Long half-life

• Prozac and olanzapine in combination: When using Prozac and olanzapine in combination, also refer to the warnings and precautions section of the package insert for Symbyax

• Sexual dysfunction

• Pregnancy: SSRI use, particularly later in pregnancy, may increase risk for persistent pulmonary hypertension and symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulty, hypotonia, tremor, irritability) in the neonate

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants.

Monitor for worsening and emergence of suicidal thoughts and behaviors.

When using Prozac and olanzapine in combination, also refer to Boxed Warning section of the package insert for Symbyax.

Other medications are available to treat depression and anxiety disorders. Some of these other drugs may be better suited to you than others. If you’re interested in finding an alternative to fluoxetine, discuss your options with a healthcare provider.

Examples of medications that could be prescribed for depression or anxiety include the drugs listed below.

• Other SSRIs:

  • citalopram (Celexa^®)

  • escitalopram (Lexapro^®)

  • paroxetine (Paxil^®)

  • sertraline (Zoloft^®)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs):

  • desvenlafaxine (Pristiq^®)

  • duloxetine (Cymbalta^®)

  • venlafaxine (Effexor^®)

• Monoamine oxidase inhibitors (MAOIs):

  • isocarboxazid (Marplan^®)

  • phenelzine (Nardil^®)

  • selegiline (Emsam^®)

  • tranylcypromine (Parnate^®)

• Tricyclic antidepressants (TCAs):

  • clomipramine (Anafranil^®)

  • imipramine (Tofranil^®)

  • desipramine (Norpramin^®)

  • nortriptyline (Pamelor^®)

• Atypical antidepressants:

  • bupropion (Wellbutrin^®)

  • mirtazapine (Remeron^®)

  • vortioxetine (Trintellix^®)

*This information is from the label for brand name Prozac^®. See the Full Prescribing Information for more complete information. Fluoxetine, the active ingredient in Prozac, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient fluoxetine.