Fluoxetine cardiovascular

SSRIs are widely used for treatment of depression, as well as, for example, panic disorders and obsessive—compulsive disorder. These dmgs are well recognized as clinically effective antidepressants having an improved side-effect profile as compared to the TCAs and irreversible MAO inhibitors. Indeed, these dmgs lack the anticholinergic, cardiovascular, and sedative effects characteristic of TCAs. Their main adverse effects include nervousness /anxiety, nausea, diarrhea or constipation, insomnia, tremor, dizziness, headache, and sexual dysfunction. The most commonly prescribed SSRIs for depression are fluoxetine (31), fluvoxamine (32), sertraline (52), citalopram (53), and paroxetine (54). SSRIs together represent about one-fifth of total worldwide antidepressant unit sales. 

Tricyclic drugs have, as the name implies, a three-ring structure, and interfere with reuptake of norepinephrine and/or serotonin into axon terminals. Tricyclic drugs include imipramine (Tofranil), amitriptyline (Elavil), clomipramine (Anafranil), and nortriptyline (Pamelor, Aventil). Tricyclics have the occasional but unfortunate cardiovascular side effects of arrhythmia and postural hypotension. Newer, nontricyclic antidepressants have been developed that are collectively referred to as SSRIs. These have a potent and selective action on serotonin, and lack the cardiovascular side effects of the tricyclics. These include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and fluvoxamine (Luvox). A fifth SSRI, citalopram (Celexa) has been used in Europe and has recently been approved in the United States. Venlafaxine (Effexor) blocks reuptake of norepinephrine and serotonin, while bupropion (Wellbutrin) acts on both dopamine and norepinephrine. 

Fluoxetine (Prozac] Moderate, selective inhibition of serotonin reuptake No sedative, anticholinergic, or cardiovascular side effects helpful in obsessive-compulsive disorder May cause anxiety, nausea, insomnia long half-life can lead to accumulation... 

Fluoxetine selectively blocks the uptake of serotonin. It is devoid of anticholinergic properties and hence has little or no effect on the cardiovascular system, including orthostatic hypotension or arrhythmias. 

Fluoxetine appears not to have the cardiovascular effects associated with tricyclic compounds, but 10 patients did discontinue treatment because of tachycardia, palpitation, and dyspnea (3). Two older women each had a myocardial infarction and subsequently died, although these events may not have been drug-related. 

Roose SP, Glassman AH, Attia E, Woodring S, Giardina EG, Bigger JT Jr. Cardiovascular effects of fluoxetine in depressed patients with heart disease. Am J Psychiatry 1998 155(5) 660-5. 

Newer, safer drugs that are selective inhibitors of sero-tonin reuptake [e.g., fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil)] have no or minimal antimuscarinic, antihistaminic, or adverse cardiovascular effects. They are now the drugs of choice for treatment of depressive disorders. 

The SSRIs include fluoxetine, citalopram, sertraline, paroxetine, es-citalopram, and fluvoxamine. The SSRIs have a low affinity for his-taminic, a i-adrenergic, and muscarinic receptors, and therefore produce fewer anticholinergic and cardiovascular adverse effects than the TCAs, and are not associated with weight gain. The most... 

Indalpine is a non-tricyclic antidepressant with a serotonin selective profile. It is 6-7 times more potent than fluoxetine and clomipramine in inhibiting serotonin reuptake m vitro in rat brain synaptosomes. Statistically significant clinical effects within one week of onset of treatment have been reported. An anxiolytic effect may accompany the antidepressant effect. Indalpine appears devoid of anticholinergic and cardiovascular side effects and does not promote weight gain or affect appetite. 

B. Cardiovascular effects are usually minimal, although trazodone can cause hypotension and orthostatic hypotension, bupropion can cause sinus tachycardia, and fluoxetine may cause minor ST-T wave changes. 

A study in 11 healthy subjects found that paroxetine 20 mg daily for 16 days had no effect on the response to a 6-mg dose of subcutaneous sumatriptan, as measured by prolactin levels. The sumatriptan levels remained unaltered, its cardiovascular effects were unchanged and no clinically significant adverse effects occurred. Other studies report that the concurrent use of sumatriptan and SSRIs (fluoxetine 20 to 60 mg daily, fluvoxamine 200 mg daily, paroxetine 20 to 50 mg daily, sertraline 50 to 100 mg daily) was successful and uneventful. No adverse effects have been noted in 148 other patients. However, a case report describes a 65-year-old woman who had been taking paroxetine 20 mg [daily] for a number of years, who developed confusion, strange behaviour, sinus tachycardia, hypertension and hyperthermia shortly after starting sumatriptan. The serotonin syndrome was diagnosed, and she recovered completely on withdrawal of the two drugs. ... 

Cardiovascular Carotidynia, a focal cervical pain that involves the anatomical territory of the affected carotid artery and often radiates to the ipsilateral side of the face or ear, has been attributed to fluoxetine and citalopram [4 ]. 

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