Fluoxetine is also known as Prozac, common antidepressant drug (1). It works as selective, competitive reversible antagonist of serotonin receptor that prevent reuptake of serotonin from synapse (2). Due to selectivity, little effect on other neurotransmitters, such as dopamine and noradrenaline. It increase the concentration of serotonin at the synapse and serotonergic neuronal transmission strength, and it triggers negative feedback loop of serotonin, which reduce the conversion of tryptophan to serotonin (3). Fluoxetine does not display species difference, but effect as antidepressant is depend on the dose thought out number of studies. Fluoxetine is administrated as tablets with usual starting dose of fluoxetine is 20mg per day, and it …show more content…
It is metabolised by different subtypes of CYP450 enzymes, and converted to active metabolites, n-demethylation metabolite (norfluoxetine). Both fluoxetine and norfluoxetine converted to p-trifluoromethylphenol by o-dealkylation, and to hippuric acid for excretion (3). The elimination half-life of fluoxetine for single dose is one to four days, for multiple doses is four to six days; half-life of norfluoxetine is seven to ten days (5). As well as the serotonin receptor, it also interact with channel ions (Na+, K+, and Ca2+), and monoamine oxidases A and B (6). Both fluoxetine and norfluoxetine show highest tissue concentration in lung, moderate in brain, heart, kidney, and liver, and low in embryonic/fetal tissue, amniotic fluid, and maternal plasma of rat (7, …show more content…
It is also known to cause drug interaction in dose dependence manner, single and multiple dose of 30mg did not affect the elimination or area under the curve (AUC) of diazepam 10mg, tolbutamide 1000mg or chlorothiazide 500mg, or of secobarbitone (secobarbital) 150mg, but 60mg prolonged the elimination of diazepam, but physiological responses to diazepam were unaffected (3). Also, fluoxetine might have enhanced the toxic effects of other drugs, such as, cocaine because of its weak pro-arrhythmogenic properties (10). Therefore, the concentration of fluoxetine and norfluoxetine is important.
The concentration could be altered due to level and activation of CYP450. Fluoxetine is substrate of CYP2D6 and CYP2C9, and potent inhibitor of CYP2D6, and moderate inhibitor of CYP2C9, 2C19, and 3A4 (11). One study shows genetic predisposition is mostly due to CYP2C9 (12). Another case report shows fluoxetine related death of a child with defect at CYP2D6 gene locus on chromosome 22 (poor metaboliser), due to high level of fluoxetine along with other drugs (methylphenidate, promethazine, and clonidine)
risperidone whereas in this one there was a fixed dose to limit breach in blinding and to facilitate comparison between similar groups, also having this fixed dosage helped prevent bias because when using a titrating schedule of dosing in a randomized trial, it tends to show bias toward a desired goal. Risperidone in this study was well tolerated and there weren’t significant differences in weight gain or sedation(13). One of the main things disliked about risperidone is its tendency to increase the incidence of dyskinesia and other extrapyramidal side effects. In this study only mild and transient dyskinesias were seen in only 3 children, however that could be due to the low fixed dosage(13) of the study.
This treatment is targeted for individuals who suffer from depression, bulimia, obsessive compulsive disorders and panic disorders. Prozac is sometimes used together with another medication called olanzapine (Zyprexa). to treat depression caused by bipolar disorder (manic depression). This combination is also used to treat depression after at least 2 other medications
There must be special attention toward the patient's addiction history before these agents are prescribed. An understanding of the toxicity and side effects of benzodiazepines, abuse patterns and alternative anxiolytic and hypnotic agents may help clinicians to be safe from issues of medico legal case.
While the codeine is what caused the CNS depression that threatened our patient, it should be noted that the ineffectiveness of his SSRI he spoke of in our review of systems may also be attributed to our patient’s possible status as an ultra-metabolizer. Fluoxetine, fluvoxamine, and paroxetine are influenced by a few genes of the CYP450 enzymes but none more than CYP2D6. The ultra-metabolizer phenotype of CYP2D6 causes the patient to have sub-therapeutic concentrations of SSRIs causing decreased response.
Chronic intake, the delayed onset of action, drug resistance and numerous side effects force the researchers to look for the new, safe antidepressant strategies (1, 2) with rapid onset and longer time of action.
Even though some of these drugs are widely used and accepted by society, they can still have an impact on your health and can cause severe side effects. Clomipramine is included in this. Clomipramine classifies as an anti-depressant, this means that they affect certain brain circuits and the chemicals (called neurotransmitters) that pass along signals from one nerve cell to another in the brain. These chemicals include serotonin, dopamine, and norepinephrine. In various ways, different antidepressants seem to affect how these neurotransmitters behave. Clomipramine is used widely throughout Australia, mainly for treating obsessive-compulsive disorder (OCD), but it is also used for major
Chronic intake, delayed onset of action, drug resistance and numerous side effects of current antidepressants have forced researchers to look for new and safer drugs (1, 2) with rapid onset and longer acting times.
It is used for the treatment of major depressive disorders, autism, and obsessive-compulsive disorder etc. The common side effects may include loss of appetite, rash, and trouble sleeping. Serious side effects include mania, seizures and increased risk of suicidal behavior in people under 25. If the intake of fluoxetine is stopped suddenly, several withdrawal symptoms may be experienced such as dizziness, anxiety, and changes in sensation. It is believed to increase the serotonin activity in the
Serotonin (5-hydroxytryptamine, 5-HT) is a neurotransmitter in the brain that has an enormous influence over many brain functions. It is synthesized, from the amino acid L-tryptophan, in brain neurons and stored in vesicles. Serotonin is found in three main areas of the body: the intestinal wall; large constricted blood vessels; and the central nervous system. The most widely studied effects have been those on the central nervous system. The functions of serotonin are numerous and appear to involve control of appetite, sleep, memory and learning, temperature regulation, mood, behavior (including sexual and hallucinogenic behavior), cardiovascular function, muscle contraction, endocrine regulation, and
A non-stimulant treatment, atomoxetine, interacts with norepinephrine transporters, increasing the synaptic concentration of norepinephrine. In a study conducted again to
The efficacy and safety of the drug in patients under the age of 18 years is not established. With renal / hepatic insufficiency and long-term treatment, control over the picture of peripheral blood and liver enzymes is necessary. Patients who did not take previously psychoactive drugs respond to the drug at lower doses compared to patients taking antidepressants, anxiolytics or alcohol. With endogenous depression, alprazolam can be used in combination with antidepressants. With the use of alprazolam, patients with depression have seen cases of hypomanic and manic development. Like other benzodiazepines, alprazolam has the ability to induce drug dependence in long-term admission in large doses (more than 4 mg / day). With a sudden discontinuation of alprazolam, there may be comeback syndromes, such as depression, irritability, insomnia, increased sweating, especially with prolonged admission (more than 8-12 weeks). When patients develop such unusual reactions as increased aggressiveness, acute excitations, feelings of fear, thoughts of suicide, hallucinations, increased muscle cramps, difficult sleep, superficial sleep, treatment should be discontinued. During pregnancy Xanax is very dangerous due to its toxic effect on the fetus and increases the risk of congenital malformations when applied in the first trimester of pregnancy. Admission of therapeutic doses in later periods
Many individuals may assume that it has a better safety profile due to the agent not being a controlled substance, and efficacy still remains questioned (Mohammadi & Akhondzadeh, 2007). In the present paper, the similarities and differences between methylphenidate and atomoxetine will be investigated in regards to efficacy and safety. The following literature that is examined supports methylphenidate’s efficacy over the use of atomoxetine. Furthermore, it also supports there are non-significant differences in terms of the safety profiles when the medications are compared.
Historically, the use of drugs as fixers of the world's private ills has run into serious, if unanticipated, snags. At the turn of the century, the medical community thought that Cocaine was a completely appropriate, nonaddictive drug, and widely prescribed it. In the 1950s and '60s, first barbiturates and then amphetimines were recommended for various psychological ailments. It
Selective Serotonin Reuptake Inhibitors (SSRIs) are currently one of the most controversial groups of medicines, with fluoxetine, more commonly known by its brand name Prozac, at the head of the controversy. Opponents of the use of SSRI medications as a successful and safe method for treating depression and related disorders assert that the actions of the drug are an unnatural and a dangerous form of tampering with our neurochemistry. Not only are these medications incredibly safe in almost all cases, they are actually an unnatural method of modifying an already disordered, natural sequence of chemicals in the brain, and therefore are not a form of tampering, but are a method for fixing
In this study, one of the most common prescribed SSRIs, FLX will be utilized. SSRIs block the reuptake of 5-HT thereby increasing the extracellular concentration of 5-HT in the synaptic cleft available thereby altering normal synaptic and neural function. Due to the fact that monoamines and monoamine metabolism is essential and obligatory for normal neural development this proposal will focus on how FLX affect neural development using the following approaches.