Citalopram (as Citalopram hydrobromide) 20 mgCitalopram
20 mg tablets| 28 tabletP£ 15. 99 DT = £ 2. 34
Citalopram (as Citalopram hydrobromide) 40 mgCitalopram
40 mg tablets| 28 tabletP£ 27. 00 DT = £ 2. 37
▶Cipramil(Lundbeck Ltd)
Citalopram (as Citalopram hydrobromide) 20 mgCipramil 20 mg
tablets| 28 tabletP£ 8. 95 DT = £ 2. 34eiiiiF 236Fluoxetine 19-Jul-2017
lINDICATIONS AND DOSE
Major depression
▶BY MOUTH
▶Child 8–17 years:Initially 10 mg daily, increased if
necessary up to 20 mg daily, dose to be increased after
1 – 2 weeks of initial dose, daily dose may be
administered as a single or divided dose
PHARMACOKINETICS
▶Consider the long half-life offluoxetine when adjusting
dosage (or in overdosage).lINTERACTIONS→Appendix 1 : SSRIs
lSIDE-EFFECTS
▶Common or very commonChills.feeling abnormal.
haemorrhage.postmenopausal haemorrhage.uterine
disorder.vasodilation.vision blurred
▶UncommonCold sweat.dysphagia.dyspnoea.dysuria.
hypotension.mood altered.muscle twitching.self-
injurious behaviour.temperature sensation altered.
thinking abnormal
▶Rare or very rareLeucopenia.neutropenia.oral disorders
.pharyngitis.respiratory disorders.serum sickness.
speech disorder.vasculitis
▶Frequency not knownGrowth retardation
lBREAST FEEDINGPresent in milk—avoid.
lHEPATIC IMPAIRMENT
Dose adjustmentsReduce dose or increase dose interval.
lDIRECTIONS FOR ADMINISTRATIONDispersible tablets can
be dispersed in water for administration or swallowed
whole with plenty of water.
lPATIENT AND CARER ADVICEPatients and carers should be
counselled on the administration of dispersible tablets.
Medicines for Children leaflet: Fluoxetine for depression, obsessive
compulsive disorder and bulimia nervosawww.medicinesfor
children.org.uk/fluoxetine-depression-obsessive-compulsive-
disorder-and-bulimia-nervosa
Driving and skilled tasksPatients should be counselled
about the effects on driving and skilled tasks.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Tablet
▶Fluoxetine (Non-proprietary)
Fluoxetine (as Fluoxetine hydrochloride) 10 mgFluoxetine 10 mg
tablets| 30 tabletP£ 44. 00 DT = £ 44. 00
Dispersible tablet
CAUTIONARY AND ADVISORY LABELS 10
▶Olena(AMCo)
Fluoxetine (as Fluoxetine hydrochloride) 20 mgOlena 20 mg
dispersible tablets sugar-free| 28 tabletP£ 3. 44 DT = £ 3. 44
Oral solution
▶Fluoxetine (Non-proprietary)
Fluoxetine (as Fluoxetine hydrochloride) 4 mg per 1 mlFluoxetine
20 mg/ 5 ml oral solution| 70 mlP£ 12. 75 DT = £ 2. 78
Fluoxetine 20 mg/ 5 ml oral solution sugar free sugar-free|
70 mlP£ 12. 95 DT = £ 12. 95
▶Prozac(Eli Lilly and Company Ltd)
Fluoxetine (as Fluoxetine hydrochloride) 4 mg per 1 mlProzac
20 mg/ 5 ml liquid| 70 mlP£ 11. 12 DT = £ 2. 78
▶Prozep(Chemidex Pharma Ltd)
Fluoxetine (as Fluoxetine hydrochloride) 4 mg per 1 mlProzep
20 mg/ 5 ml oral solution sugar-free| 70 mlP£ 12. 95 DT = £ 12. 95
Capsule
▶Fluoxetine (Non-proprietary)
Fluoxetine (as Fluoxetine hydrochloride) 10 mgFluoxetine 10 mg
capsules| 30 capsuleP£ 55. 00 – £ 58. 50 DT = £ 58. 11
Fluoxetine (as Fluoxetine hydrochloride) 20 mgFluoxetine 20 mg
capsules| 30 capsuleP£ 20. 00 DT = £ 0. 58
Fluoxetine (as Fluoxetine hydrochloride) 30 mgFluoxetine 30 mg
capsules| 30 capsuleP£ 1. 80 DT = £ 1. 80
Fluoxetine (as Fluoxetine hydrochloride) 40 mgFluoxetine 40 mg
capsules| 30 capsuleP£ 1. 80 – £ 2. 16 DT = £ 2. 16
Fluoxetine (as Fluoxetine hydrochloride) 60 mgFluoxetine 60 mg
capsules| 30 capsuleP£ 54. 36 DT = £ 3. 72
▶Oxactin(Discovery Pharmaceuticals)
Fluoxetine (as Fluoxetine hydrochloride) 20 mgOxactin 20 mg
capsules| 30 capsuleP£ 0. 57 DT = £ 0. 58
▶Prozac(Eli Lilly and Company Ltd)
Fluoxetine (as Fluoxetine hydrochloride) 20 mgProzac 20 mg
capsules| 30 capsuleP£ 1. 50 DT = £ 0. 58eiiiiF 236Fluvoxamine maleate
lINDICATIONS AND DOSE
Obsessive-compulsive disorder
▶BY MOUTH
▶Child 8–17 years:Initially 25 mg daily, then increased in
steps of 25 mg every 4 – 7 days (max. per dose 100 mg
twice daily) if required, dose to be increased according
to response, doses above 50 mg should be given in
2 divided doses, if no improvement in obsessive-
compulsive disorder within 10 weeks, treatment should
be reconsideredlINTERACTIONS→Appendix 1 : SSRIs
lSIDE-EFFECTS
▶UncommonAllergic dermatitis.ataxia
▶Rare or very rareHepatic function abnormal (discontinue)
▶Frequency not knownBone fracture.glaucoma.
haemorrhage.hypomania.neuroleptic malignant-like
syndrome.urinary disorders
lBREAST FEEDINGPresent in milk—avoid.
lHEPATIC IMPAIRMENT
Dose adjustmentsStart with low dose.
lRENAL IMPAIRMENT
Dose adjustmentsStart with low dose.
lTREATMENT CESSATIONThe dose should preferably be
reduced gradually over about 4 weeks, or longer if
withdrawal symptoms emerge ( 6 months in patients who
have been on long-term maintenance treatment).
lPATIENT AND CARER ADVICE
Driving and skilled tasksPatients should be counselled
about the effects on driving and skilled tasks.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension
Tablet
▶Fluvoxamine maleate (Non-proprietary)
Fluvoxamine maleate 50 mgFluvoxamine 50 mg tablets|
60 tabletP£ 20. 98 DT = £ 18. 32
Fluvoxamine maleate 100 mgFluvoxamine 100 mg tablets|
30 tabletP£ 20. 98 DT = £ 18. 32
▶Faverin(Mylan)
Fluvoxamine maleate 50 mgFaverin 50 mg tablets|
60 tabletP£ 17. 10 DT = £ 18. 32
Fluvoxamine maleate 100 mgFaverin 100 mg tablets|
30 tabletP£ 17. 10 DT = £ 18. 32BNFC 2018 – 2019 Depression 237
Nervous system4