Adverse drug reactions with fluoxetine

A major challenge to the development of new drugs is the discovery of new therapeutic targets. For example, the phenomenal success of fluoxetine (Prozac ) has been due to the fact that it was the first selective serotonin re-uptake inhibitor approved for world market release, combined with its improved adverse drug reaction profile. However, no new classes of antidepressants have emerged in recent years. 

A Norwegian study by Olav Spigset utilizing that country s Adverse Drug Reactions Monitor Center reviewed 1,202 reports describing 1,861 adverse reactions to SSRIs. Again, the pattern of reports for the individual SSRIs (citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline) was very similar, with three exceptions. Fluvoxamine reports were comparatively elevated for gastrointestinal symptoms, fluoxetine... 

Fluoxetine is a potential drug of abuse.136 Overdose with sertraline causes suicidal tendencies, whereas citalopram causes fatal reactions such as cardiac dysfunction.137 The adverse effects could be treated with stomach wash, administration of activated charcoal, dialysis, and hemoperfusion. 

A study in 12 schizophrenic patients found that amitriptyline 50 to 100 mg daily had no effect on the serum levels of risperidone 3 mg twice daily. However, a 26-year-old man taking amitriptyline 25 mg daily developed extrapyramidal reactions alter his dosage of risperidone was increased from 2 to 4 mg daily On another occasion extrapyramidal adverse effects developed after risperidone 2 mg daily was added to treatment with amitriptyline 25 mg and fluoxetine 20 mg daily. Both pharmacokinetic and pharmacodynamic reasons for this reaction have been suggested. The cases illustrate that there is the potential for an adverse interaction between these drugs, which should be borne in mind when prescribing both drugs. 

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