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]
Respiratoric
- Tachypnea
Symptoms included continuous crying, tachypnea, increased muscle tone, tremors, and hyperactive Moro reflex. The total drug concentration in cord blood was 80 ng/mL. [obfocus.com]
[…] compared with pretreatment levels. 21 Our findings may be consistent with some of the transient neonatal complications noted to occur in 20 to 30 percent of newborns with late prenatal exposure to SSRIs. 11,22-28 Mild respiratory distress, transient tachypnea [dx.doi.org]
Poor neonatal adaptation was defined as reported jitteriness, tachypnea, hypoglycemia, hypothermia, poor tone, respiratory distress, weak or absent cry, or desaturation on feeding. [nejm.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]
- Dyspepsia
Adverse Reactions: CNS stimulation (eg, anxiety, nervousness, insomnia, abnormal dreams), sexual dysfunction, anorexia, asthenia, diarrhea, dry mouth, dyspepsia, flu syndrome, respiratory symptoms, rash (may be serious), somnolence, sweating, tremor, [empr.com]
[…] anxiety and nervousness abnormal dreams sweating diarrhea asthenia, or lack of bodily strength skin rash tremor flu syndrome insomnia, drowsiness, and yawning sinusitis, an inflammation of the mucous membrane painful or difficult digestion, known as dyspepsia [medicalnewstoday.com]
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]
Flx 20 mg die vs pla: nervousness, tremor, dizziness, dyspepsia no more common than pla. [ncbi.nlm.nih.gov]
- Polydipsia
Psychogenic polydipsia and fluoxetine-induced syndrome of inappropriate antidiuretic hormone secretion. Fluid restriction and discontinuation of fluoxetine. [ncbi.nlm.nih.gov]
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]
Skin
- Blister
The drug will come with educational materials about PMDD and will be packaged in a box of four 7-day blister packs. It will be available by August, Lilly said. [web.archive.org]
After taking Fluoxetine AN Storage Keep your capsules in the blister pack until it is time to take them. If you take the capsules out of the box or the blister pack they will not keep well. [mydr.com.au]
How to store Fluoxetine generichealth Storage Keep your capsules in the blister pack until it is time to take them. If you take your capsules out of the blister pack they may not keep as well. [nps.org.au]
After taking PROZAC Storage Keep your capsules or tablets in the blister pack until it is time to take them. If you take your capsules or tablets out of the blister pack they may not keep as well. [news-medical.net]
Eyes
- Blurred Vision
[…] changes (such as seeing rainbows around lights at night, blurred vision ). [webmd.com]
Common problems include: Nausea Headaches Diarrhoea Insomnia Tiredness Sexual difficulties, such as delayed orgasm Many other side effects from blurred vision to hot flushes and sweating have been described. [web.archive.org]
Common side effects Common side effects of SSRIs can include: feeling agitated, shaky or anxious feeling or being sick indigestion diarrhoea or constipation loss of appetite and weight loss dizziness blurred vision dry mouth excessive sweating sleeping [nhs.uk]
Blurred vision If this happens, do not drive and do not use tools or machines until you feel better Flushing, sweating, difficulty sleeping, lack of appetite, loss of weight, aches and pains, reduced sexual drive or ability, yawning, a feeling that your [patient.info]
- Eye Pain
Get medical help right away if any of these rare but seriousbloody/black/tarry stools, vomit that looks like coffee grounds, fast/irregular heartbeat, fainting, seizures, signs of kidney problems (such as change in the amount of urine), eye pain /swelling [webmd.com]
Call your doctor at once if you have: blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights; signs of high levels of serotonin in the body--agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting [drugs.com]
Call your doctor at once if you have: blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights; high levels of serotonin in the body --agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, [uwhealth.org]
- Burning Eyes
Fluoxetine side effects Get emergency medical help if you have signs of an allergic reaction to fluoxetine (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple [drugs.com]
Psychiatrical
- Fear
A significant decrease in anxiety and fear was observed during feeding. [ncbi.nlm.nih.gov]
Panic attacks, characterized by sudden, unexpected attacks of extreme fear and worry about having these attacks. [web.archive.org]
Although sometimes dismissed as shyness, social anxiety disorder can cause crippling fear that interferes with school attendance, work performance, and relationships. [health.harvard.edu]
The Observer says the revelations raise new fears over how many prescriptions for the drug are given out by doctors. [news.bbc.co.uk]
- 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]
- Aggressive Behavior
If so, pharmacological enhancement of serotonin activity should be expected to reduce impulsive aggressive behavior in subjects in whom this behavior is prominent. [doi.org]
The evidence shows that diminished serotonergic function can be linked to aggressive behavior and that treatments that increase serotonergic function reduce aggression. [nature.com]
Since central serotonergic (5-HT) system dysfunction is related to impulsive aggressive behavior, pharmacologic enhancement of 5-HT activity should reduce impulsive aggressive behavior in individuals with IED. [ncbi.nlm.nih.gov]
Urogenital
- Hot Flushes
Common problems include: Nausea Headaches Diarrhoea Insomnia Tiredness Sexual difficulties, such as delayed orgasm Many other side effects from blurred vision to hot flushes and sweating have been described. [web.archive.org]
Can I take Fluoxetine for hot flushes? Fluoxetine is not used for the treatment of hot flushes. It is used for the treatment of depression and belongs to a group of medicines called selective serotonin re−uptake inhibitors (SSRI) antidepressants. Q. [1mg.com]
Hot flushes not nearly as bad, low mood gone. The other symptoms of menopause are still there but a lot easier to cope with now. [drugs.com]
Completed Treatment Obsessive Compulsive Disorder (OCD) 1 Not Available Completed Treatment Premenstrual Syndrome 1 Not Available Enrolling by Invitation Not Available Bipolar Disorder (BD) 1 Not Available Enrolling by Invitation Treatment Menopausal Hot [drugbank.ca]
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]
- Insomnia
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]
Subsequently, he developed headache, hyperhydrosis (diaphoresis), flushing, shaking, nausea, and vomiting, slurred speech (scanning speech), anxiety, restlessness, agitation, confusion, hallucination, and insomnia. [ncbi.nlm.nih.gov]
Q: Is Prozac for insomnia? A: Prozac (fluoxetine) is not indicated for insomnia treatment by the U.S. Food and Drug Administration (FDA). [everydayhealth.com]
- Dizziness
Contact your doctor if you experience difficulty breathing, dizziness, drowsiness, anxiety, restless feeling, nervousness, confusion, or diarrhea. [drugs.com]
[…] 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, dizziness [ncbi.nlm.nih.gov]
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]
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Dizziness or severe drowsiness can cause falls, fractures, or other injuries. [everydayhealth.com]
- 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]
Workup
Serum
- Hypoglycemia
[…] neonates should be monitored 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 [drugs.com]
[…] ventricular arrhythmia, including torsade de pointes May cause nervousness, anxiety, insomnia, or anorexia Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy Hypoglycemia [reference.medscape.com]
Symptoms include jitteriness, problems with feeding and breathing, and hypoglycemia, or low blood sugar. Breastfeeding is not advised, as fluoxetine can pass into the milk. [medicalnewstoday.com]
- Hyponatremia
Hyponatremia is one of the most common electrolyte abnormalities and can be life threatening. Fluoxetine is a serotonin reuptake inhibitor and may rarely cause hyponatremia. Furthermore, fluoxetine may rarely increase the risk of bleeding events. [ncbi.nlm.nih.gov]
Hiroyuki MATSUMOTO, Hyponatremia Associated with Selective Serotonin Reuptake Inhibitors, Internal Medicine, 44, 3, (173), (2005). James A. Bourgeois, Reversible Hyponatremia and Venlafaxine, Psychosomatics, 46, 5, (495), (2005). [dx.doi.org]
If you suspect that you or someone in your care has mild hyponatremia, call your GP for advice and stop taking SSRIs for the time being. If you suspect severe hyponatremia, call 999 to request an ambulance. [nhs.uk]
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). [doi.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]