Fluoxetine gastrointestinal

Fluoxetine and other serotonin reuptake inhibitors Gastrointestinal symptoms, decreased libido, sexual dysfunction, anxiety (acutely), insomnia, tremor... 

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... 

Gastrointestinal adverse effects are one of the major disadvantages of SSRIs. The most common is nausea, and the incidence is said to be 20% or more for paroxetine (45,46), sertraline (47), fluvoxamine (5), fluoxetine (48), and citalopram (10,49). Although nausea can lead to drug withdrawal, it usually disappears after a few weeks. Other gastrointestinal symptoms that occur commonly with fluoxetine and sertraline are loose stools and diarrhea (47,48,50), while constipation has been more often reported with fluvoxamine (5) and paroxetine (45,46). 

Gastrointestinal adverse effects are one of the major disadvantages of SSRIs (see General section). Two women developed stomatitis while taking fluoxetine in one it recurred on rechallenge (25). 

In addition to their demonstrated effectiveness, SSRls also have a low propensity to cause anticholinergic effects, orthostatic hypotension, and sedation, and can usually be dosed once daily. These medications are not risk free, however. Gastrointestinal adverse effects, confusion, agitation, dizziness, and insomnia have been reported in patients with AD taking fluoxetine, especially at higher doses (>20 mg of fluoxetine daily). Paroxetine reportedly causes more anticholinergic effects than other SSRls. For a more complete discussion of treatment of depression refer to Chap. 67 on depressive disorders. 

Clomipramine, fluvoxamine, sertraline, and fluoxetine are approved by the FDA for treatment of OCD in children and adolescents. Childhood and adult OCD appear to respond similarly to drug therapy. The SSRIs appear to be effective and well tolerated in treatment of OCD in children and are generally considered first-line agents. Treatment with an SSRI produces a favorable response in 75% of children and adolescents with OCD. A combination of SSRIs and CBT is preferred in most cases. In children, the most commonly described side effects of SSRI therapy include nausea, headache, tremor, gastrointestinal complaints, drowsiness, akathisia, insomnia, disinhibition, and agitation. Clomipramine was significantly better than placebo in the treatment of OCD in children and adolescents, with 75% of patients having a moderate to marked improvement. Clomipramine was also more effective than desipramine in children and adolescents. ... 

Many of the selective serotonin reuptake inhibitors are well tolerated by breast-fed infants. Fluoxetine has resulted in some reports of gastrointestinal problems, irritability, and insomnia. ... 

Litoxetine is a new selective and potent inhibitor of serotonin receptors that has antiemetic effects against cisplatin-induced emesis. The clinical use of the majority of sero-toninergic antidepressants such as fluoxetin and fluvoxamine is associated with gastrointestinal discomfort which appears to be due to stimulation of 5-HT3 receptors. Litoxetine, by antagonizing 5-HT3 receptors, may limit nausea and vomiting associated with fluoxetin or fluvoxamine (see also Figure 73). 

Since their introduction in the 1980s, selective serotonin reuptake inhibitors (SSRls) such as paroxetine, fluoxetine, and citalopram have enjoyed tremendous clinical and commercial success due to their improved safety profile when compared with first-generation tricyclic antidepressants like imipramine. Nevertheless, they still display several side effects including gastrointestinal distress, anxiety, insomnia, weight gain, and sexual dysfunction. Like other current antidepressants. 

Conversely, in a ease-control study in patients stabilised on warfarin, the increase in risk of hospitalisation for an upper gastrointestinal bleed after starting either fluvoxamine or fluoxetine was higher than for other SSRIs (relative risk 1.2) but this did not reach statistical significance (95% eonfidenee interval 0.9 to 1.6). Note that these drugs were eonsidered separately, and the number taking each individual SSRI was not stated. 

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