Fluoxetine
Prozac
Selective Serotonin Reuptake InhibitorGeneric availableTDM data
Although the exact mechanism of fluoxetine is unknown, it is presumed to be linked to its inhibition of CNS neuronal uptake of serotonin.
Compare Fluoxetine →FDA-Approved Indications
- MDD — acute and maintenance (adults; pediatric 8+)
- OCD — acute and maintenance (adults; pediatric 7+)
- Bulimia nervosa — acute and maintenance (adults)
- Panic disorder — acute treatment (adults)
- Bipolar I depression — combination with olanzapine (Symbyax)
- Treatment-resistant depression — combination with olanzapine (Symbyax)
Common Off-Label Uses
- Body dysmorphic disorder
- Selective mutism
- Premature ejaculation
- Fibromyalgia
- Binge eating disorder
What Sets This Drug Apart
- Longest half-life of any SSRI: parent 1–3 days (acute), 4–6 days (chronic); active metabolite norfluoxetine 4–16 days
- Only SSRI with FDA-approved indication for Bulimia Nervosa (at 60 mg/day); also indicated for Bipolar I Depression (with olanzapine as Symbyax)
- Potent CYP2D6 inhibitor — can make normal metabolizers resemble poor metabolizers; effects persist 5+ weeks after discontinuation
- CYP3A4 inhibition not clinically significant
- Active metabolite norfluoxetine has SERT inhibition essentially equivalent to parent compound
- Activating side effect profile: insomnia 19%, anxiety 12%, nervousness 13% in combined trials
- Henssler 2024 severe-symptom discontinuation rate 0.018 (95% CI 0.006–0.050, k=3, I²=0%) — lowest among all ADs with subgroup data
- Cipriani 2018 acceptability OR 0.88 (95% CrI 0.80–0.96) — only SSRI with statistically significant better-than-placebo tolerability
- FDA-approved for pediatric MDD (≥8 years) and OCD (≥7 years)
- Labeled anorexia 10% vs 3% placebo, weight loss 2% vs 1% — no cross-SSRI weight NMA available
Boxed Warning
SUICIDAL THOUGHTS AND BEHAVIORS