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# Mylot%25252525252525252525252525252525252525252525252525252525252525252525252525252525252520at
## Overview
Mylot%25252525252525252525252525252525252525252525252525252525252525252525252525252525252520at (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) used to treat various psychiatric conditions.
## Primary Indications
* Major depressive disorder (MDD)
* Obsessive-compulsive disorder (OCD)
* Bulimia nervosa (for the binge-eating and purging behaviors)
* Panic disorder
* Premenstrual dysphoric disorder (PMDD)
## Adult Dosing
* **MDD:** Start with 10-20 mg once daily. Usual dose range: 20-60 mg once daily. Maximum dose: 80 mg once daily.
* **OCD:** Start with 10-20 mg once daily. Usual dose range: 20-60 mg once daily. Maximum dose: 80 mg once daily.
* **Bulimia Nervosa:** 60 mg once daily.
* **Panic Disorder:** Start with 10 mg once daily. May increase to 20 mg once daily after at least 1 week. Usual dose range: 20-60 mg once daily. Maximum dose: 60 mg once daily.
* **PMDD:** 20 mg once daily. Can be taken continuously or intermittently during the luteal phase.
## Pediatric Dosing
* **MDD:** For patients aged 8 years and older, start with 10 mg once daily. May increase to 20 mg once daily after 1-2 weeks. Usual dose range: 20-60 mg once daily.
* **OCD:** For patients aged 7 years and older, start with 10 mg once daily. May increase to 20 mg once daily after 1-2 weeks. Usual dose range: 20-60 mg once daily.
## Dose Adjustments
No dose adjustment is typically needed for renal impairment, but caution is advised.
No dose adjustment is typically needed for hepatic impairment, but caution and potentially lower doses are advised due to its long half-life.
## Contraindications
* Concomitant use with MAOIs or within 14 days of discontinuing an MAOI.
* Concomitant use with thioridazine or pimozide.
* Known hypersensitivity to fluoxetine.
## Adverse Effects
* **Common:** Insomnia, nausea, diarrhea, headache, somnolence, dry mouth, decreased appetite, asthenia, sexual dysfunction (decreased libido, ejaculatory/orgasm difficulties).
* **Serious:** Suicidal ideation and behavior (especially in pediatric patients and young adults), serotonin syndrome, increased bleeding risk, hyponatremia, activation of mania/hypomania, QT prolongation (rare).
## Key Drug Interactions
* **MAOIs (including linezolid and methylene blue):** Risk of serotonin syndrome. Avoid coadministration.
* **Thioridazine and Pimozide:** Increased plasma concentrations and risk of serious cardiac events. Avoid coadministration.
* **CYP2D6 inhibitors:** May increase fluoxetine concentrations.
* **Drugs that prolong QT interval:** Increased risk of arrhythmias.
* **NSAIDs and anticoagulants:** Increased risk of bleeding.
* **Tricyclic Antidepressants (TCAs):** Fluoxetine can inhibit TCA metabolism, increasing TCA levels.
## Monitoring
* Monitor for suicidal ideation, especially at the initiation of therapy and with dose changes, in pediatric patients and young adults.
* Monitor for signs and symptoms of serotonin syndrome.
* Monitor for clinical effectiveness and adverse effects, including sexual dysfunction and hyponatremia.
* Monitor electrolytes if clinically indicated.
## Clinical Pearls
* Fluoxetine has a long half-life (approximately 4-6 days for fluoxetine and 9-10 days for its active metabolite, norfluoxetine), meaning it takes time to reach steady-state and to be cleared from the body. This can be beneficial for once-daily dosing but also increases the risk of drug accumulation and prolonged side effects or withdrawal symptoms if discontinued abruptly.
* Due to its long half-life, dose changes may take several weeks to be fully apparent.
* May be activating; consider taking in the morning to reduce insomnia.
* Can be taken with or without food.
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*This information is intended for healthcare professionals. Always verify current prescribing information with the official product monograph or reliable drug information resources before making clinical decisions.*
