Fluoxetine

INTRODUCTION

Indications

Major depressive disorder. Obsessive compulsive disorder (OCD). Bulimia nervosa. Panic disorder. Depressive episodes associated with bipolar I disorder (when used with olanzapine). Treatment-resistant depression (when used with olanzapine). Sarafem: Premenstrual dysphoric disorder (PMDD). Unlabeled Use: Anorexia nervosa, attention-deficit hyperactivity disorder (ADHD), Diabetic neuropathy, Fibromyalgia, Obesity, Raynaud's phenomenon, Social anxiety disorder (social phobia), Posttraumatic stress disorder (PTSD).

Action

Selectively inhibits the reuptake of serotonin in the CNS. Therapeutic Effects: Antidepressant action. Decreased behaviors associated with panic disorder, bulimia. Decreased mood alterations associated with PMDD.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, anxiety, drowsiness, headache, insomnia, nervousness, abnormal dreams, dizziness, fatigue, hypomania, mania, weakness. EENT: stuffy nose, visual disturbances. Resp: cough. CV: chest pain, palpitations. GI: diarrhea, abdominal pain, abnormal taste, anorexia, constipation, dry mouth, dyspepsia, nausea, vomiting, weight loss. GU: sexual dysfunction, urinary frequency. Derm: ↑ sweating, pruritus, erythema nodosum, flushing, rashes. Endo: dysmenorrhea. F and E: hyponatremia. MS: arthralgia, back pain, myalgia. Neuro: tremor. Misc: SEROTONIN SYNDROME, allergic reactions, fever, flu-like syndrome, hot flashes, sensitivity reaction.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Watch for signs of neuroleptic malignant syndrome, including hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in blood pressure (BP), and incontinence. Symptoms typically occur within 4–14 days after initiation of drug therapy, but can occur at any time during drug use. Report these signs to the physician immediately.

• Monitor and report signs of serotonin syndrome, including hyperthermia, rigidity, myoclonus, and autonomic instability with fluctuating vital signs and extreme agitation that may proceed to delirium and coma. Patients should not take fluoxetine with other drugs that increase serotonin levels (e.g., MAO inhibitors).

• Be alert for increased depression and suicidal thoughts, especially in the initial period of drug therapy and in children and teenagers. Likewise, inform physician or other mental health care professional if patient demonstrates other mood changes such as increased anxiety, nervousness, or abnormal arousal (mania).

• Monitor signs of allergic reactions, including pulmonary symptoms (laryngeal edema, wheezing, dyspnea, cough) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Assess pain levels periodically to help document drug efficacy when used to treat fibromyalgia, diabetic neuropathy, Raynaud's phenomenon, or other chronic pain syndromes.

• Assess any muscle, joint, or back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess dizziness ...