Presentation
This article presents the case of a 51-year-old woman receiving stable therapy with fluoxetine who developed takotsubo cardiomyopathy after an acute stress. [ncbi.nlm.nih.gov]
Entire Body System
- Weight Loss
INTRODUCTION: Pharmacotherapy for the management of obesity is primarily aimed at weight loss, weight loss maintenance and risk reduction (reduction in body fat, risk factors for cardiovascular disease and the incidence of diabetes mellitus). [ncbi.nlm.nih.gov]
loss, sexual dysfunction Contraindications MAOI therapy. [medical-dictionary.thefreedictionary.com]
loss—Fluoxetine may cause weight loss. [migraines.org]
Adverse Effects: General Activating on the sedation to excitation continuum Most activation or aggravation of all SSRI s Anxiety or nervousness Akathisia Insomnia Consider Trazodone ( Desyrel ) at bedtime Avoid in the elderly Weight loss may occur X. [fpnotebook.com]
Also, the same medications can cause weight gain in certain individuals and weight loss in others. There are also drugs that initially cause weight loss and then lead to weight gain with long-term use. [everydayhealth.com]
- Hyperthermia
The clinical features included coma, mydriasis, hyperthermia, tremor, hyperreflexia, rhabdomyolysis, renal failure and respiratory insufficiency. [ncbi.nlm.nih.gov]
Fenfluramine-induced hyperthermia and stimulation in the rabbit. Research Communications in Chemical Pathology and Pharmacology 13: 401–409, 1976 PubMed Google Scholar Reid LR, Threlkeld PG, Wong DT. [doi.org]
• MAO inhibitors: Potential for severe reaction when used with MAO inhibitors; autonomic instability, coma, death, delirium, diaphoresis, hyperthermia, mental status changes/agitation, muscular rigidity, myoclonus, neuroleptic malignant syndrome features [web.archive.org]
Gastrointestinal
- Nausea
[…] lead to a number of psychological (e.g., nervousness, anxiety, crying spells, psychomotor agitation, irritability, depersonalization, decreased mood, memory disturbances, confusion, decreased concentration, and/or slowed thinking) and somatic (e.g., nausea [ncbi.nlm.nih.gov]
Possible side effects include nausea, vomiting, diarrhoea, insomnia, anxiety, outbursts of violence, fever, skin rash and convulsions. This drug can interact dangerously, even fatally, with MAOI s. A brand name is Prozac. [medical-dictionary.thefreedictionary.com]
Nausea, drowsiness, dizziness, anxiety, trouble sleeping, loss of appetite, tiredness, sweating, or yawning may occur. If any of these effects persist or worsen, tell your doctor promptly. [webmd.com]
- Increased Appetite
The study included 64 overweight postmenopausal women, aged 54 - 65 years, with increased appetite. They were randomly assigned in 2 groups. [ncbi.nlm.nih.gov]
Increased levels of serotonin result in improvements in mood, sleep, appetite, and energy level and may help restore interest in daily living. [web.archive.org]
GI: nausea, diarrhea, dry mouth, anorexia, dyspepsia, constipation, abdominal pain, vomiting, flatulence, increased appetite. GU: sexual dysfunction. Metabolic: weight loss, hyponatremia. Musculoskeletal: muscle pain. [glowm.com]
Anorexia (poor appetite) has been reported in 4 percent to 17 percent of patients studied during clinical trials. Weight loss has also been reported at 2 percent and increased appetite, weight gain and taste perversion have also been reported. [everydayhealth.com]
- Polydipsia
Psychogenic polydipsia and fluoxetine-induced syndrome of inappropriate antidiuretic hormone secretion. Fluid restriction and discontinuation of fluoxetine. [ncbi.nlm.nih.gov]
Cardiovascular
- Hypertension
A case of branch retinal vein occlusion associated with fluoxetine-induced secondary hypertension is described. [ncbi.nlm.nih.gov]
An FDA alert was issued in July 2006 concerning infant persistent pulmonary hypertension. [web.archive.org]
New developments in the pathogenesis and treatment of neonatal pulmonary hypertension. Pediatr Pulmonol Suppl 1999 ;18: 201 - 204 8. Dakshinamurti S. Pathophysiologic mechanisms of persistent pulmonary hypertension of the newborn. [oadoi.org]
- Heart Disease
Prinivil (lisinopril) Common Uses: Used for hypertension, coronary heart disease, congestive heart failure, and kidney protection in people with diabetes. Status: Patent will expire in June 2002. [express-scripts.com]
Let your prescriber know beforehand if any of the following apply to you: Have kidney disease, epilepsy, liver problems or glaucoma Have a history of heart disease Have a history of mania Have a history of diabetes Currently receiving ECT Have a history [talkingsense.org]
If you have ever had a heart attack, a history of heart disease, diabetes, glaucoma, or liver disease, talk to your health care provider before you take Prozac. [goodtherapy.org]
Also, let your doctor know if you have or have ever had glaucoma, an enlarged prostate, difficulty urinating, seizures, diabetes, an overactive thyroid gland, or liver or heart disease. [fluoxetine.com]
Liver, Gall & Pancreas
- Jaundice
Kallen also examined the incidence of prematurity, LBW, and the incidence of respiratory distress, jaundice, hypoglycemia, and convulsions, diagnoses often included in the category of “poor neonatal adaptation.” [nature.com]
[…] weeks but 35 weeks or more. 72 - 77 For example, one study found that, relative to full-term infants, near-term infants had a statistically significantly higher risk for respiratory distress (4.2% vs 28.9%), temperature instability (0% vs 10%), and jaundice [doi.org]
Musculoskeletal
- Muscle Weakness
During the study, stroke patients left with paralysis or muscle weakness were given fluoxetine or a placebo for three months, starting 5-10 days after their stroke. Lisää A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Ä Ö 0-9 [fi.bab.la]
Tell your doctor right away if any of these unlikely but serious side effects occur: unusual or severe mental/mood changes (such as agitation, unusual high energy/excitement, thoughts of suicide ), easy bruising/bleeding, muscle weakness /spasm, shakiness [webmd.com]
Symptoms include: Difficulty focusing eyes, or bnormal pupil size Irregular gait Confusion or trouble with attention Unresponsiveness or stupor Tremors or muscle weakness Extreme sleepiness or falling unconscious Intense, abnormal excitement Rapid heartbeat [sunrisehouse.com]
weakness /spasm, shakiness (tremor), decreased interest in sex, changes in sexual ability, unusual weight loss, large pupils.Get medical help right away if any of these rare but serious side effects occur: bloody/black/tarry stools, vomit that looks [medicinenet.com]
Face, Head & Neck
- Epistaxis
We report a 66-year old woman who presented with severe hyponatremia and epistaxis associated with the use of fluoxetine. [ncbi.nlm.nih.gov]
Children: thirst, hyperkinesia, agitation, personality disorder, epistaxis, urinary frequency, menorrhagia. [empr.com]
[…] viral meningitis, 1 infection, 1 myocardial infarction, 1 mole removal 3 out of 56 (4 SAE in 3 participants) MY-1045/BRL-029060/1, (A), 2005 Paroxetine 2 depression (worsening), 2 emotional lability, 1 neoplasm, 1 insomnia, 1 nervousness, 1 carcinoma, 1 epistaxis [doi.org]
Possible increased risk of bleeding with SSRIs, including fluoxetine, and SNRIs; 1 events ranged from ecchymoses, hematomas, epistaxis, and petechiae to life-threatening hemorrhages. 1 329 452 453 454 455 456 458 Concomitant use of aspirin, NSAIAs, warfarin [web.archive.org]
Psychiatrical
- Suicidal Ideation
Bo Fluoxetine (Prozac) The Worst Year of My Life rlmgo Fluoxetine My Life as a Suicidal Child Anonymous Fluoxetine (Prozac) & Sertraline (Zoloft) Violence and Suicide Ideation Lighty Fluoxetine (Prozac) Train Wrecks & Trip Disasters [2] Waiting Painfully [erowid.org]
Hum Psychopharmacol 16: 495 – 505 Google Scholar | Crossref | Medline Hansen L, Wilkinson D ( 2001 ) Drug induced akathisia, suicidal ideation and its treatment in the elderly. [doi.org]
Suicide ideation acts and worsening in suicidal ideation. Binomial unconditional Mantel-Haenszel estimate. Mantel-Haenszel adjusted incidence difference. Pearson's chi-square test. [dx.doi.org]
- Mood Swings
Doctors prescribe fluoxetine to treat conditions involving mental symptoms including depression, obsessive-compulsive disorder, eating disorders, panic attacks and the mood swings and irritability caused by premenstrual dysphoric disorder. [livestrong.com]
Premenstrual dysphoric disorder characterized by mood swings, irritability, bloating, and breast tenderness in the premenstrual phase of the ovulatory cycle. How Fluoxetine is Taken Fluoxetine is taken by mouth, with or without food. [web.archive.org]
Premenstrual Syndrome (PMS): Track and Prevent Symptoms Premenstrual Syndrome (PMS) can cause from mood swings, munchies, and more. Learn about the symptoms, causes and treatments of... [medicinenet.com]
Increased serotonin levels in the brain may be beneficial in patients with obsessive-compulsive dirder, alcoholism, certain types of headaches, post-traumatic stress disorder (PTSD), pre-menstrual tension and mood swings, and panic disorder. [minddisorders.com]
- Euphoria
[…] straight away if you get: headaches, trouble focusing, memory problems, not thinking clearly, weakness, seizures, or losing your balance - these can be signs of low sodium levels thoughts about harming yourself or ending your life fits, feelings of euphoria [nhs.uk]
- Delusion
Narayan M, Meckler L, Nelson JC (1995) Fluoxetine-induced delusions in psychotic depression. J Clin Psychiatry 56: 329. View Article Google Scholar 36. [doi.org]
Neurologic
- Headache
[…] psychological (e.g., nervousness, anxiety, crying spells, psychomotor agitation, irritability, depersonalization, decreased mood, memory disturbances, confusion, decreased concentration, and/or slowed thinking) and somatic (e.g., nausea, dizziness, headache [ncbi.nlm.nih.gov]
Double-blind trial of fluoxetine: chronic daily headache and migraine. Headache. 1994 Oct;34(9):497-502. PubMed 17. Scahill L, Riddle MA, King RA, Hardin MT, Rasmusson A, Makuch RW, Leckman JF. [emedexpert.com]
Headaches should usually go away after the first week of taking fluoxetine. [nhs.uk]
Increased levels of the other stress hormone noradrenaline, also called norepinephrine, causes your blood vessels to constrict, which can cause your blood pressure to increase and can induce headaches. [livestrong.com]
- Agitation
Sudden discontinuation of serotonin reuptake inhibitors (SRI) can lead to a number of psychological (e.g., nervousness, anxiety, crying spells, psychomotor agitation, irritability, depersonalization, decreased mood, memory disturbances, confusion, decreased [ncbi.nlm.nih.gov]
It also causes you to feel jittery, anxious, nervous or agitated. [livestrong.com]
Tell your doctor right away if any of these unlikely but serious side effects occur: unusual or severe mental/mood changes (such as agitation, unusual high energy/excitement, thoughts of suicide ), easy bruising/bleeding, muscle weakness /spasm, shakiness [webmd.com]
Symptoms of serotonin syndrome can include: confusion agitation muscle twitching sweating shivering diarrhoea If you experience these symptoms, you should stop taking the medication and seek immediate advice from your GP or specialist. [nhs.uk]
- Hyperactivity
For the treatment of hyperactivity and inattention, psychostimulants demonstrate some benefit. [doi.org]
Abstract Hyperactivity of the hypothalamic pituitary adrenocortical (HPA) axis is one of the main clinical findings in depression. The HPA axis is interrelated with glucocorticoid signaling via glucocorticoid receptors (GCRs). [ncbi.nlm.nih.gov]
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more [drugs.com]
- Myoclonus
KEYWORDS: Anesthesia; Methylene blue; Myoclonus; Selective serotonin uptake inhibitor serotonin syndrome uptake inhibitor; Serotonin syndrome [ncbi.nlm.nih.gov]
Fluoxetine has been used with success in obsessive-compulsive disorder and intention myoclonus, however, its use in these disorders remains investigational. [pubmed.ncbi.nlm.nih.gov]
Available by prescription only Capsules: 10 mg, 20 mg (Prozac and Sarafem), 40 mg (Prozac) Capsules (delayed-release): 90 mg Oral solution: 20 mg/5 ml Tablets: 10 mg Indications and dosages Depression, bipolar disorder ◇, alcohol dependence ◇, cataplexy ◇, myoclonus [glowm.com]
and seizures may occur. • Serotonin syndrome: Symptoms of agitation, confusion, hallucinations, hyper-reflexia, myoclonus, shivering, and tachycardia may occur with concomitant proserotonergic drugs (ie, SSRIs/SNRIs or triptans) or agents which reduce [web.archive.org]
- Hyperreflexia
The clinical features included coma, mydriasis, hyperthermia, tremor, hyperreflexia, rhabdomyolysis, renal failure and respiratory insufficiency. [ncbi.nlm.nih.gov]
[…] after delivery for direct toxic effects of this drug, drug discontinuation syndrome, and serotonin syndrome (e.g.,. respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypo/hypertonia, hyperreflexia [drugs.com]
Treatment
He failed to respond to standard treatment with high dose intravenous immunoglobulin, but showed stabilization and improvement following treatment with fluoxetine. [ncbi.nlm.nih.gov]
Heterogeneity of the treatment effect was tested by including a random treatment × time interaction. Time was the number of days from treatment initiation. [doi.org]
Prognosis
CONCLUSIONS: In patients with ischemic stroke, early administration of fluoxetine may improve the neurological functional prognosis. [ncbi.nlm.nih.gov]
Etiology
The significance of life events as etiologic factors in the diseases of children: II. A study of a normal population. Journal of Psychosomatic Research, 16, 205–213. Google Scholar Compas, B. E. (1987). [doi.org]
As proinflammatory cytokines are involved in the etiology of depression, one may expect that antidepressants have negative immunomodulating effects. [ncbi.nlm.nih.gov]
Upon the appearance of rash or of other possibly allergic phenomena for which an alternative etiology cannot be identified, fluoxetine should be discontinued. A major depressive episode may be the initial presentation of Bipolar Disorder. [fluoxetine60.com]
Epidemiology
Some epidemiological studies suggest an increased risk of cardiovascular malformations; however, the mechanism is unknown. [drugs.com]
J Clin Psychiatry 57: 449 – 454 Google Scholar | Crossref | Medline Sachdev P ( 1995 ) The epidemiology of drug-induced akathisia: Part I. Acute akathisia. [doi.org]
Pathophysiology
Evidence suggests that neurotrophic factors, inflammatory markers, and circadian rhythm dysfunctions could be involved in pathophysiology of major depressive disorder. [ncbi.nlm.nih.gov]
Several lines of evidence suggest that sigma-1 receptors play roles in the pathophysiology of psychiatric diseases, as well as in the active mechanisms of some selective serotonin reuptake inhibitors (SSRIs). [oadoi.org]
Our results suggest a potential clinical application for fluoxetine in amblyopia as well as new mechanisms for the therapeutic effects of antidepressants and for the pathophysiology of mood disorders. View Full Text [science.sciencemag.org]
Prevention
Fluoxetine plasma levels cannot be used to guide relapse-prevention treatment. [ncbi.nlm.nih.gov]
Recognition and prevention of fluoxetine-associated drug interactions can improve patient safety and reduce preventable medication errors. References Latner AW. The Top 200 Drugs of 1999. The More Things Change, the More They Stay the Same. [crediblemeds.org]
MHRA advice on valproate: In April 2018, we added warnings that valproate must not be used in pregnancy, and only used in girls and women when there is no alternative and a pregnancy prevention plan is in place. [guidance.nice.org.uk]