Fluoxetine
Original SSRI (1987). | Compound
Aliases (2)
▸ Overview TL;DR
Original SSRI (1987). Longest half-life of class (~4-6 days parent, 7-15 days metabolite) → minimal discontinuation syndrome but slow steady-state. FDA-approved MDD, OCD, bulimia, PMDD, panic. Not relevant to Dylan; same SSRI side-effect profile as sertraline.
▸ Mechanism of action
Selective SERT inhibition. Norfluoxetine (active metabolite) extends pharmacology weeks beyond last dose. Mild 5-HT2C antagonism contributes to slight activating profile and is hypothesized to underlie weight neutrality vs other SSRIs (though long-term weight effects remain). Mild CYP2D6/2C19 inhibition (potent vs sertraline).
▸ Pharmacokinetics Approximate
Approximate decay curve drawn from the half-life mention(s) in the source notes. Real PK data not yet ingested per compound.
▸ What to expect Generic
- 1Week 1Tolerability and dose-response.
- 2Week 2-4Early effect window.
- 3Week 4-8Peak benefit assessment.
- 4Week 8+Cycle decision point.
▸ Side effects + safety
- Common (>10%): Nausea, headache, insomnia, sexual dysfunction (40-70%), anxiety/jitteriness early.
- Less common (1-10%): Weight loss early, weight gain long-term, tremor, sweating, anorgasmia.
- Rare-serious (<1%): Serotonin syndrome, hyponatremia, suicidal ideation <25 yo (FDA black box), QT prolongation at high doses.
- Specific watch periods: First 4 weeks for activation/suicidal ideation; long half-life means drug interactions persist 5+ weeks after stopping.
▸References5 sources
PMID 29477251
2018Cipriani 2018 network MA.
PMID 18316756
SSRI sexual dysfunction.
PMID 19996044
Fluoxetine + tamoxifen breast cancer outcomes.
PMID 15327508
Pediatric MDD efficacy (TADS trial).
PMID 1540999
Bulimia 60mg pivotal trial.