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
Duration
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).
Contra-indications, adverse effects, precautions
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, tricyclicantidepressants, 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 treatmentis 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 ofagitation, tremors, hypotony, respiratory difficulties, sleeping disorders, etc.) if the mother was under treatmentin the 3rd trimester. If treatment starts during pregnancy, preferably use sertraline.
Breast-feeding: avoid; consider switchin gto sertraline or if not available, paroxetine.
Remarks
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.