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Doctors' Answers to "Frequently Asked Questions" - Prozac


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 08/15/2000]
Question: I am concerned about a friend who has been on prozac on and off for the past few years. He also drinks heavily and drives a delivery truck during the day. He says the prozac makes him tired and he pulls over for naps when he has to. How does the alcohol interact with the prozac and how does the prozac effect the time that the alcohol remains in his system? Is it safe for him to drive during the day after drinking at night and taking prozac?

Answer: Alcohol decreased the depth of sleep as does prozac. So, patients taking both are often tired. Hard to know which of the drugs is the culprit. Also, he may have sleep apnea-unrelated to the alcohol. But, alcohol would make it a lot worse. He needs to get his thyroid functions checked, decrease/stop the alcohol and be considered for a sleep study. The prozac is not a contraindication to professional driving. The sleep spells may be. So, he needs to find the cause and correct it.

[posted 07/9/2000]
Question: I have been diagnosed with mild depression. My doctor has started me taking Prozac at 20/mg. I have been on this drug for almost two weeks now. I have noticed that I am very tired, throughout the day, and night. I am sluggish and sleepy even after sleeping 12+ hours. I also have felt nausia, which this, the doctor warned me of. I also seem to have NO appitite, and my appitite was very poor BEFORE I started on the drug. The doctor said I might have more energy being on the drug, but the opposite has occured. Also, while I think it has helped my anxiety somewhat, it seems to have had only a mild effect on my depression. Is a new drug on order or should I wait this one out??

Answer: It usually takes about 3 weeks before you know how you'll feel. However, the fatigue generally lasts. This can often be blunted with ritalin 5mg for a couple of weeks concurrently with the prozac.

[posted 05/1/2000]
Question: I have taking Prozac for a couple years. Are there any other drugs that offer the same help but don't have the side effects?

Answer: Celexa, Serzone, Wellbutrin, Effexor in about that order.

[posted 04/17/2000]
Question: I am breastfeeding a 3 month old and am severely depressed. My doctor
started me on prozac last week. Is this the safest medicine for my
baby? Where can I find some documentation about breastfeeding and anti-depressants?

Answer: It would be recommended to stop breast feeding while on the Prozac. There is information in the PDR about Prozac, or information can be found from the company Lilly 800-545-5979.

[posted 04/25/2000]
Question: Just wondering if there is a problem taking Metabolite which includes Ma Huang with Prozac.

Answer: Not that I am aware of.

[posted 04/10/2000]
Question: I am taking both Prozac and Ritalin. Are either of these MAO inhibitors? I am considering taking Thermoslim and that is the only deterring factors - whether or not they are inhibitors.

Thank you
Karen Klein

Answer: Neither are MAO inhibitors. Prozac is a SSRI antidepressant and Ritalin is an amphetamine type drug.

[posted 04/6/2000]
Question: Is it possiible thatt the prozak dooesn''t work anymore becaus of the interaction of lorcet. I'm still very much depres?sed

Answer: Narcotics are an antidepressant, as is alcohol. The prozac is working but, being opposed by the narcotics.

[posted 03/26/2000]
Question: Prozac has been a great boon to my life. I'm currently taking 25 mg at bedtime, and 25 more in the morning. The week before my period starts, I take 50 mg in the morning, as I otherwise get VERY irritable. My husband and I have overcome the sexual side effects, so that is not my problem. I have always fought to keep my bodyfat percentage somewhere near normal. Since turning 40, it has gone way up. I have gained about 40 pounds, perhaps more than 40 pounds of fat! I am somewhat active, and have recently started working out on a stepper for 30 mins, 5 times a week. I think I have lost about 3 pounds in 3 weeks. I work at Wal-Mart, and walk all over a 200,000 square foot store 40 hours a week. I know that it is partly my age, but I can't believe my metabolism has quit on me this bad. I lost weight when I started on Prozac in '93, but needless to say, that has been regained, plus bonus pounds. I'm 5'6" and weigh 180 lbs. I have a muscular build, so I will never be skinny looking. If the Prozac is part of the problem, what could I take instead? I don't smoke, have never used alcohol, and only take vitamins and herbals such as garlic, fish oil, ginkgo, E, C, Calcium, multi-vitamins w/ iron and ginseng.
WellButrin made me irritable, as did St John's Wort. I have started taking ginseng every other day, and it makes me feel more energized. Will taking more of it help my metablism, as long as I don't take too much? I tried one pill of a product called Xenadrine, which is supposed to boost your metabolism, and was as irritable as my worst pre-Prozac PMS day. I appreciate any advice you feel is pertinent. If you can respond before April 20th, I can share your info with my doctor. Thanks so much.

Answer: This is a chronic problem with the whole class of drugs, although Prozac tends to be less severe than some. There doen't appear to be a great solution currently concerning ways to block this problem.

[posted 01/22/2000]
Question: I need to know if I have been harming myselft by taking 20mg Prozac and one or two Metabolife pills a day.
PLEASE, let me know ASAP. Thank you very much.

Answer: Probably not.

[posted 11/11/1999]
Question: Your site is wonderful!
Jim had bypass 9 years ago and since has been on a variety of cholesterol medicines. The last was zocor until he asked to be changed to lipitor in sept. He was also on Paxil for mild depression until sept. when he changed to prozac.
Recently, he is experiencing greater fatique( drowziness )
and some nausea. We are trying to figure out which is the culprit? What would you think.
Secondly. we figure it makes sense to try stopping the prozac but wonder if we can do so cold turkey or should we back off slowly and how slowly? Thanks

Answer: The lipitor would be the easiest to stop for a short period to see if the nausea goes away. Stopping the prozac cold is probably ok. I do have patients who have some sort of withdrawal syndrome. But, this is only about 5% of patients, consequently, I'd probably cut it back in a gradual fashion-1/2 for a few days then 1/4 for a few days etc.

[posted 10/18/1999]
Question: I've been deeply depressed and had insomnia so my doctor put me on 20mg Prozac approx. 4 weeks ago and 0.5mg Klonopin at night and half a tablet in the morning. The Klonopin helped my insomnia and outbreaks of crying but after 3 weeks on these meds I seemed to become even more depressed. Last week my doctor upped the Prozac to mg and changed the Klonopin to 50mg Trazodone. Since taking the Trazodone my insomnia is back so she doubled the dosage and this still is not helping, plus my crying outbreaks seem to be starting again. I am very depressed and so tired but can not get more than 3-4 hours of sleep at night. I was on Prozac years ago and it worked great, but now after 4 weeks on the drug I don't see a change in my depression. Any suggestions would be greatly appreciated!

Answer: I'd increase the Prozac, mg isn't a very high dosage. If he/she is not comfortable with this, see a psychiatrist. Also, small doses of Ritalin are often very helpful in treating depression.

[posted 08/19/1999]
Question: I am taking St. Johns Wort and would like to start Prozac. Do I need to wait, or can I take them together?

Answer: Stop the St. John's for a week and then start the Prozac. In reality, there should be little interaction and the two can be taken together. However, they are different classes of anti-depressants chemically and doctors rarely do this to avoid the occasional severe reaction seen in occasional individuals. If there is no emergent reason, let one wash out.

Prozac [posted 1/7/99]
Question: I have a friend who is afraid of Prozac. I try to tell her that prozac, or any antidepressant, is like any other medication adjusting the chemical imbalances in people that effect the needed changes. Can you tell me in detail how prozac works? I assume it effects the serotonin, but how? Compare it to say, insulin or coumadin, or some other medication.

Answer: Well, we don't know. It appears to affect the reuptake of serotonin into nerve endings. That is, the nerve first releases serotonin and takes it back apparently to conserve the drug. The drug blocks reuptake, which seems to have the effect of increasing the levels. As to the exact mechanism, we don't know sufficiently at this time.

Prozac and Pregnancy [posted 1/6/99]
Question: I am currently taking 20 mg of Prozac and I am 9 months pregnant. I wanted to know of any dangers that would occur to my baby. Also if there is any affects on the baby when breastfeeding?

Answer: No studies done, but early risks look low. No studies have been done on children's neurological development, however. Risks are unpredictable currently.

Prozac and Pregnancy [posted 1/6/99]
Question: I want to know of any side effect of Prozac on pregnant women or their baby. Is there any information on breastfeeding and prozac?

Answer: Prozac is a Class C drug for use during pregnancy. Studies in pregnant women have not/and will not be done. Long term studies of children born to women on Prozac have not been done, but the drug does pass through the placenta. Prozac also passes into milk and is not recommended.

More Concerns About Prozac & Pregnancy [posted 12/10/98]
Question: I have been on Prozac for the last 4 years. Whenever I try to get off Prozac, I feel fine for a month or two but then the depressive symptoms again come back and I start on Prozac again. Are these the withdrawl symptoms or is it depression. I want to become pregnant, that's the reason I am trying to get off Prozac. Is it safe during pregnancy or are there any other safe alternatives.

Answer: Depression. It seems pretty safe with pregnancy as far as we can tell. Long term studies on children have not been done.

Male on Prozac & the Unborn Child  [posted 12/08/98]
Question: My wife and are anxious to start a family and considering the Prozac warnings for women, are there any risks associated with taking Prozac for 10 years by the male. I am particulary concerned with problems with conception and potential harm to the unborn child.

Answer: No

Prozac & Urinary Frequency   [posted 12/01/98]
Question:  I have been on Prozac for at least 6 months and I am finding myself with constant urinary frequency. (I go on an average of 14-20 times a day.) I have been tested for infections and other things, but everything is fine. Thinking back, I believe that this started when I started the Prozac. Is this a known side effect of Prozac? I am thinking of working with my doctor to get off Prozac, but I really like what it does for my bipolar and anxiety situation. (Plus, it is helping me lose the weight I gained with Effexor.) Is there anything close to Prozac out there that I can try? The only reason I am even considering getting off the Prozac is because the urinary frequency is interfering with work and school. Any help is most appreciated.

Answer: Well, you would find out pretty fast if you stopped it. Prozac can affect bladder sphincter tone and give difficulty starting urine stream in some. But, if it goes away off the Prozac, clearly the cause.

Stopping Prozac  [posted 11/18/98]
Question:  What is the safest way to stop taking prozac? I go to a university hospital and
a doctor hasn't returned my calls. Prozac is causing me several terrible side effects.

Answer:
Well, most think you can stop it without a taper. But, some patients on large doses for long periods seem to have symptoms on stopping. For these, we recommend 1/2 for 1-2 weeks, possibly 1/4 then stop. Most can stop immediately without problems.

Prozac & Loss of Sex Drive [posted 11/11/98]
Question: I'm on Prozac (40 mg) for depression. My sex drive has suffered as a result. My doctor has prescribed 75 mg of Wellbutrin to counteract this effect. I haven't been able to find any info on this subject. Is this a common use of Wellbutrin?

Answer: No. Try Serzone instead of mixing them. Usually once the prozac has this effect (common by the way) it won't change with other medications.

Prozac Effectiveness [posted 11/05/98]
Question: When does prozac lose its effectiveness

Answer: Not usually at all.

Combining Alcohol & Prozac [posted 11/04/98]
Question: My mother has a terrible problem. She is on prozac and she has been drinking alcohol everday until she is totally enebriated I am very worried about her. She is 70 yrs old and I would like to know what the effects of prozac combined with alcohol will do to her if she continues this long term behavior.

Answer: Alcohol is a depressant so, doesn't make a lot of sense to treat depression with one drug and cause it with another. However, moderate intake has no contraindication.

Can Loss of Orgasm Be a Prozac Side Effect [posted 10/28/98]
Question:I am a bi-polar female who was put on Neurontin in June after being hospitalized for a major depression. I had discovered that my husband had had two affairs. We are in marriage counseling and our marriage is back on track. I had difficulty reaching an orgasm while in the hospital and can not reach one at all now. I am on prozac but have found my libido increased rather than decreased. I am frustrated since I can't have an orgasm. Has anyone else experience this? My doctor thinks I may have to "live with this" since this medication seems to control my mood swings. What do you think?

Answer: Prozac is notorious for decreasing or stopping female orgasm. I am not aware of Neurontin having this effect. Different antidepressants(Serzone, Wellbutrin, St. John's Wort) may need to be tried to find one that works without eliminating your orgasm.

Prozac & Tiredness [posted 10/22/98]
Question: I have been on prozac for about two weeks now and i am feeling very tired. I have been told that this is a side effect of the drug. Will that subside after I am on prozac for a while? Will I always be tired? Should I take the drug at night rather than in the morning? Thank you for your help.

Answer: Usually persists. But, I would take the drug at bedtime and see if that helps. Sometimes taking it wiht a sleeper helps. It tends to decrease depth and length of sleeping in some.

Prozac [posted 10/21/98]
Question: I am a 58 year old female. I have been taking 20mg of Prozac per day for approximately 3 years. Prior to that my doctor had tried me on serzone, effexor and all the available SRI's available. Prozac has been the only I could tolerate and help me with depression and make me feel well. Recently (about a month) I have been experiencing very tight muscles in my jaw, shoulders, and arms, and pain in my lower back. I tried taking Advil but it only helps temporarily. Could Prozac suddenly be causing these symptoms?

Answer: Probably not.

Prozac's Common Side Effects [posted 10/20/98]
Question: What are Prozac's known side effects and does it cause sun sensitivity?

Answer: Decreased sex drive, occasional sleep disturbance, occasional constipation. Rare/no sun sensitivity.

Prozac and Loss of Libido [posted 10/14/98]
Question: I have had migraines almost daily for 3 years. Prozac seems to reduce the number of headaches and associated symptoms but also, of course, reduces the libido. I have seen a number of other drugs suggested to combat this problem: Yohimbine, Urecholine, Pericatin, dopamine, adding Wellbutrin and amphetamine. Because the other non-SSRI types of anti-depressants have not been shown to be effective on migraine it is unlikely that I can switch. However, would Wellbutrin if added daily help the libido and if so, how much?

Answer: Usually doesn't help. Small doses of amphetamines seem to be the best-taken the day one desires to have sex. Have you tried other preventatives like beta blockers, calcium channel blockers, aspirin, etc?

Prozac and Alcohol [posted 10/2/98]
Question: Prozac is frequently prescribed as an antidepressant, as it was for me several months ago, that is to be taken in the morning and NOT at night, because it interferes with sleep. I had been using Wellbutrin for two years, which was very helpful, but the constipation that it caused became intolerable. For three weeks I took the Prozac in the morning as prescribed and found myself unable to functioan due to fatigue and drowsiness, and then had difficulty sleeping once I went to bed at night.
I was virtually "out of it" all day, and uable to sleep when I really needed to. My psychiatrist suggested I continue with the drug, hoping this was a side effect that would wear off. No such luck, and a change of medications was imminent. Then, I decided to just TRY taking it before bed instead of in the morning. WOW, what a dramatic change!!! That first night, I slept like I had not slept in years....straight through. And, the next day, I felt better than I had felt in over a year: awake, alert, functional. I continue to take Prozac ONLY at night, and its benefits are a Godsend. After reading a number of entries under DEPRESSION, and noticing stories from patients who experienced fatigue and drowsiness from SRI's, I wanted to share my experience in the hope that a simple alteration in dosing time might help others find a solution with medication they believed did not work for them. With that in mind, although there is no question here, I hope you will print this.

Answer: Sure, glad to.

Prozac and Alcohol [posted 8/13/98]
Question: I am trying to find out some information about the known affects of drinking alcohol while taking Prozac. I have a family member who is doing this and I am trying to present them with some hard facts about why it is a bad idea.

Answer: It is listed as a contraindication, but there is little data. Alcohol is a depressant and this can have an interaction. I am not aware of direct drug interactions and in fact prozac is amazingly safe relative to side effects. I tell my patients not to over indulge and to limit themselves to one or two per day - due mainly to the depressant effects. However, I am not aware of direct interactions or contraindications.

Children and Prozac [posted 8/5/98]
Question: My six year old has been prescribed 10 mg of Prozac. I wonder what the effects will be and how long would you keep a child on such medicine? I would really appreciate any feedback on this subject.

Answer: There is no research done on children on any drugs due to ethical considerations. The side effects long term do not appear to differ from short term side effects.

Prozac Side Effects [posted 7/23/98]
Question: I have been on prozac and had side affects with this drug, including loss of memory and poor judgment calls in everyday actions. Are these normal and are there any other reports made about this?

Answer: This is not usual, but occasional patients have this type of reaction. It will clear with cessation of the drug.

Prozac [posted 7/21/98]
Question: How safe is Prozac?

Answer: So far incredibly safe, few drug interactions, no physical dependence. You will find patients that feel they do experience a withdrawal syndrome, but clearly not a usual dependence. Described as headache, disorientation, etc.

Prozac
Question: My daughter is on 20 mg a day of Prozac and all the other questions have been asking why this drug makes people tired and have no energy. My daughter’s doctor is giving her this drug to give her more energy I thought, as she was very depressed. She states that she now has so much energy. Should this be true?

Answer: This drug (and other SRI antidepressants) can be a lifesaver for the right patient. They feel just wonderful and see/feel things that have been blunted for years. This is a very heady experience. It is also wonderful as a physician to see this effect, which about 20% of patients experience.

Prozac and twitches
Question: My 54-year-old sister, who has had Alzheimer's symptoms (and "probable" diagnosis) for 5 years, has been on 20 mg. Prozac for probably 2-3 years. She has severe depression (cries constantly - she recognizes that she is losing her faculties). In the last several weeks she has developed sudden body, head, or hand and arm twitches or jerks - something like a startle reflex. Could the Prozac be causing this? Other drugs are indomethecin and Vitamin E. She tried Aricept for a while but got no benefit. Years ago she tried Cognex. She is at the stage of Alzheimer's where she needs help with everything, cannot understand or follow directions, but recognizes loved ones and the fact of her demise. (She was diagnosed here at the Univ. of Iowa but lives in a small town in southern Illinois, with her 54-year-old husband as her caregiver, and a long time family doctor, an internist, as her primary physician.

Answer: These would be uncommon in Alzheimer’s. I'd see her neurologist again.

Prozac
Question: I have been on Prozac several times. It has helped me very much with my depression and other problems related to Lupus E. I feel better. I have less muscular and joint pains, less anxiety, but there is a great problem for me. My sexual life is gone, and I think if I do not do something about it my relation with my husband will be ending soon. I have to decide if I want to go back to feeling physically and mentally bad or keeping my sexual drive and my husband. I have tried Yohimbe. I am also going through my pre-menopause, and I am under Premarin. My doctor prescribed male hormone, and also I had a hysterectomy 8 years ago but kept my ovaries. This has been for me the best antidepressant ever, but I think I will have to ask my doctor to change it and perhaps have the awful side/effects that I had with other previous antidepressants.

Answer: Two possibilities 1) Try serzone, wellbutrin or Effexor in that order. They tend to work nearly as well as the SRI antidepressants and serzone especially helps the sex drive. 2) There are reports of small amounts of amphetamines used on an occasional basis to give a patient an appropriate sex drive. These are taken 24 hours or so before you desire to have sex. It removes some of the spontaneity but restores your sexual drive while you are on the amphetamines. I have tried both and prefer the serzone if it works, but the amphetamines do help. Taking large doses long term is not good, but small doses used occasionally to save a marriage seem appropriate.

Prozac Side Effects
Question: Has cramping and pain of legs been associated with the use of prozac?

Answer: There is about 1-2% who report back pain, but not muscle spasms per se.

Prozac for stress and anxiety
Question: I am presently under tremendous pressure and I am having severe anxiety attacks. My friend, who is a doctor, has recommended Prozac as a solution. I am a 50 year old male and am in need of relief. Your input would be appreciated.

Answer: All the SRI drugs have been used for the last several years to treat different types of anxiety and panic disorders. I'd try them. You might need to add drugs like valium, xanax, etc., but they often are very effective.

Prozac
Question: I have been on Prozac since 1993; starting at 10mg/day, then 30, and in the last 6 months to 30mg/day. It has been effective in treating my depression. Suddenly, I have become incapacitated: extreme dizziness, bad headaches, urinary hesitancy, no appetite. It's back into deep depression, but is it the Prozac shutting down? Or possibly a disconnected malady? A switch to Effexor is suggested. Any ideas?

Answer: I'm not sure this is all depression. The urinary hesitancy and headaches are common side effects of Prozac-- especially in larger doses. Vertigo would occasionally occur as a side effect. The lack of appetite could be depression. Do you feel like the "old depression"? Many of these sound like side effects to the drug. If this is so, a switch to a different class might be helpful, and Effexor or Wellbutrin is what most physicians would pick.

Prozac and Drowsiness
Question: I experience drowsiness and increased sleep desire from Prozac. This drug is very effective for me aside from this. Any suggestions?

Answer: Try Serzone-- usually less sleep disturbance.

Prozac and Striae
Question: Can prozac cause striae? My child has been on it for 4 months and is in a growth spurt and I have noted red stretch marks. Is this an indication to stop the drug?

Answer: I haven't used this drug in children, but I don't see this as reported in the PDR. On the other hand, there is no research done in children for ethical reasons. I'd have your physician query the company concerning this effect.

Prozac and Tylenol
Question: I have just started taking prozac and was wondering if it was still all right to take tylenol for headaches? If not, what should I be taking?

Answer: The answer to your question is yes, you can take tylenol as needed for headaches while being on prozac. However, if these headaches are occurring often, or are associated with other symptoms! they should be brought to the attention of your health care provider. In addition, both tylenol and prozac are metabolized by the body in the liver. This usually only becomes a significant issue if you start taking more than the daily recommended dosing of tylenol. If indeed you do need that much tylenol, then a visit to your health care provider is in order. In general, however, simple occasional headaches can be treated with tylenol as needed.

Cold medication and Prozac
Question: My friend is taking Prozac for depression. She has a cold that started with a headache and sore throat and low grade fever a week ago. Now she doesn’t have the headache or fever, but she still has an itchy throat and bad dry cough. No runny nose nor stuffy nose. She usually takes Alka-Seltzer Plus for her colds and it works very well for her. The alka -seltzer plus usually clears up her cold in one to two days. She read on the package of Alka Seltzer that it is not to be taken with MAOI medication for depression. What will happen if she takes Alka-seltzer plus for her cold? What kind of over the counter medication can she take?

Answer: Prozac is not a MAO inhibitor. Taking aspirin, etc... is not a problem.

Prozac and Infertility
Question: My wife has been taking Prozac for depression. We have also been trying to have a baby. Her doctor has been telling her that the drug does not cause any kind of infertility (or sexual dysfunction). Yet reports that we have both read about it indicate that it does. Currently she is taking Clomid with it. Which is true about Prozac?

Answer: Prozac causes an inability to reach orgasm and decreases the sexual drive. This is true for all the SRI drugs. It does not inhibit the fertility of a man or a woman, but their desire for intercourse and the satisfaction from intercourse is inhibited.

Prozac and dehydration
Question: I am currently taking 20 mg of prozac daily. I am curious if this drug has any effect on appearance of the skin. My reason worrying about this is because I'm on Prozac to treat intrusive obsessive/worrying thoughts. I try to drink the required amounts of water, but was just wondering if the drug causes dry mouth, constipation, or a dehydrated look to one's skin.

Answer: The dryness of the mouth has nothing to do with fluid balance, but with the subjective sensation of dryness. It will not affect your skin.

Prozac
Question: Are there any drugs which are harmful when combined with prozac?

Answer: It is not recommended to take other antidepressants (MAO inhibitors especially), alcohol. Trytophan, lithium, dilantin, and CNS active drugs should be watched closely.

Prozac and awareness
Question: My father is 86 and has recently been treated for Lymphoma. This was treated successfully with Chlorambucil. However, since the treatment he has felt very depressed. As a result of this he has gone on to Prozac, which have made him feel better, but in the last few days he has complained of feeling disconnected and not really in touch with reality. He has been on the Prozac now for some three months and I would say is generally much better because of it. He also takes Allopurinol for Gout, Quinine Sulfate for night cramps, Aspirin, and Enalapril for blood pressure regulation His doctor is mystified. Do you have any suggestions?

Answer: Common sense usually is the best advice. Try stopping the drug for 7-10 days and see what happens. St. John's Wort (hypericum) can be used occasionally to treat depression with usually less side effects than Prozac.

Prozac
Question: I have been on Prozac 20 mg for about a year now. It was given to me for chronic pain in my lower back and left leg. I was given Oravail 200 mg at the same time. I really never noticed a significant change in the pain management. I have lost weight which I give Prozac credit for. That has helped. I've been taking melatonin at night to help me sleep, but is there any adverse side effects from taking this also? What are your comments?

Answer: Currently, we are not aware of any major problems with taking either Prozac or Mellatonin for long periods of time. However, if it is not helping, why take it?

Prozac vs. Zoloft
Question: Recently I was switched from Prozac to Zoloft. I was taking 10 mg per day Prozac, then a three day rest before starting 25 mg per day Zoloft for one week, then increased to 50 mg per day. My current symptoms are extreme tiredness as I can barely stay awake. Another problem I have been having since switching drugs is a "buzzing" when I bend my head down towards my chest. This is causing a mild tingling down my legs and arms. What is going on? Also, how long does it take your system to clear of either of these drugs?

Answer: These drugs take about a week to completely clear your system. You fail to mention why Prozac was stopped? If for side effects, the side effects of Prozac and Zoloft are very similar. If the problem you are experiencing is the drug, I'd discuss it with your physician and allow the drug to clear your system. Possibly a smaller dose might work. Also, Wellbutrin and Serzone are newer anti-depressants which have different side effects than Prozac and Zoloft.

Paxil/Prozac
Question: I have been on Paxil (20 mg) for a year now and seems like it has not been doing much good lately. I mentioned this to my doctor and he switched me to Prozac (20 mg). He said I could just stop the Paxil immediately and take the Prozac. He also said the Prozac would not start working well until about 4 weeks into my system. Whenever I have run out of Paxil or forgotten to take one, I seemed to become very unpleasant (mean and angry). This gets even worse in the period of getting the Prozac into my system. Does this sound right? Could I take a Paxil and a Prozac during this time to help my mood change for the better?

Answer: Both of these drugs are similar and I doubt that one would be markedly superior. However, you are really taking very small doses. Most patients need to be on 40 to 60 mg and even doses of 80 or 100 are not uncommon. Sometimes small doses of amphetamines will markedly improve the performance of this class of drugs.

Prozac and Hair Loss
Question: I am a 50 year old woman not doing HRT. I took Redux for six months, lost 20 pounds, and to my surprise, found it to eliminate all my menopause systems (terrible hot flashes and mini panic attacks). My Doctor suggested we stop Redux and try 10 mg of Prozac a day. It seems to work almost as good as Redux on the hot flashes and my temperament seems to be more even and stable. However, it seems to me that after three weeks of taking Prozac I seem to be noticing increased hair loss. Could this be a side effect of the Prozac?

Answer: Hair loss will usually take a minimum of three weeks. That is because the hair needs to grow out and have a "weak spot" at the base. If your hair loss is before 3 weeks I doubt if it is the Prozac, and possibly the weight loss since that lowers available protein and will create this weak area. I haven't had many complaints of hair loss with any of the SRI drugs.

Prozac
Question: I stopped taking Amitryptilene at the end of September (150-200 mg/day) and began taking Prozac (10 mg/day) at the beginning of October. I continued taking 10 mg/day until March when my dosage was increased to 20 mg/day. I am trying to learn whether or not there is any information on Prozac having an effect on a person's cholesterol level. The past many years, my cholesterol level is usually somewhere between 160 and 200 -- and my "ratio" is generally quite good. In the middle of last year I was not eating as healthy as I should have, but in October my cholesterol was still around 200. The last couple of months I ate "better" and even lost about five pounds (and I'm one who can easily gain 5 pounds during the holidays -- but didn't). At the end of December, I started working out more regularly again (and still eating pretty good). However, early in March my cholesterol was 245. My husband and I talked about this and could not think of anything any different aside from my beginning to take Prozac.

Answer: I'm not aware of any interaction. You might call the company and see if there have been any drug reports (Dista, a division of Eli Lilly: 800-645-5979). Another way is to stop it for 10 to 14 days and see if your cholesterol falls. If not, and I suspect there won't be a change, you need an evaluation for the cause. Several things can cause sudden rise, but this needs a complete physical. Common causes for a sudden rise are hypothyroidism, diabetes mellitus, hepatitis, etc.

Suicide and Prozac
Question: Is it true that Prozac patients have committed suicide while on medication?

Answer: Zoloft (sertaline hydrochloride) is an antidepressant usually included in the class of drugs called serotonin inhibitors. This class of drugs initially received a great deal of publicity concerning the increased risk of suicide. This publicity was mainly focused on Prozac (fluoxetine hydrochloride). Further evaluation has not demonstrated that there is any special risk for suicide. However, studies are still ongoing. Depression in general clearly increases the risk for suicide; consequently, would be expected to be higher in the group of patients taking this class of drug.

Weight Gain
Question: What are the consequences of stopping Prozac? I feel the drug is making me gain weight.

Answer: Prozac is not especially noted for weight gain. One of the potential risks of the drug is actual weight loss. Weight loss may be a symptom of depression; consequently, treatment of your depression may cause weight gain. I would discuss this with your physician and absolutely do not decrease or stop the drug without seeing your doctor.

Urinary Hesitancy
Question: I have a patient who is taking Prozac and is experiencing severe urinary hesitancy. Is this a side effect of this drug?

Answer: Prozac, like many other antidepressants, has some anti-cholinergic activity. The parasympathetic nervous system is consequently affected and can cause urinary symptoms as well as constipation and a dry mouth. These will clear with discontinuation of the drug.

Sleeping/Tension
Question: I have been using Prozac for about 3 months - the suggested trial time - and am having some side effects that I need information on. My sleep pattern has shortened. If I don't take Klonopin before I sleep, I wake up clutching myself or the pillow. I feel that my muscles are continually tight. Sometimes, the back of my head feels very tight which often can be relieved by relaxing my jaw - which always seems to be tight. I am taking 20mg a day. I would GREATLY appreciate any suggestions. And where do I look to find what ever your answers are? Please e-mail me back.

Answer: One of the most common complaints of patients on prozac and other drugs has to do with the lack of diminution of sleep. Other than other sedatives-like klonopin-there doesn't appear to be much to be done other than stop the drug. There are newer more selective drugs in this class which are advertized by the drug companies as having less effect on sleep and sexual libido-the other major complaint. I have used these drugs and find some improvement. Serzone is the first of these drugs-others are on the way.

Prozac and Wellbutrin
Question: I have been taking Prozac for 7 years. During the last year, I became more and more depressed until it became intolerable. The psychiatrist I am seeing put me on Wellbutrin in ADDITION to the Prozac. I am taking 20mg of Prozac in the morning and 75mg of Wellbutrin in the morning and 75mg more at noon. Is this a normal procedure to use both drugs together? I called my old doctor and he said it was unusual but not unheard of. I have had an aching pain under my rib cage on the right for the past few weeks and I am concerned about liver function being affected. My doctor does not seem to want to answer all my questions. I am very nervous about this and I don't know where to turn so I searched the Internet for information. Please help. I am feeling much much better after taking the Wellbutrin for 2 weeks now. It's like a new beginning. But is it the combination or just the Wellbutrin? THANK YOU!

Answer: Prozac(fluoxetine hydrochloride) is an anti-depressant from the family of drugs called serotonin uptake inhibitors and is used in treating depression, obsessive-compulsive disorders, and panic disorders. Wellbutrin(bubropion hydrochloride) is an antidepressant almost in a class by itself. Currently, the mode of action is not clear. It can be used with other antidepressants except the class called Monoamine Oxidase Inhibititors(MAO). This is a fairly common combination when one drug does not appear to be treating the depression effectively. You will need to be checked occasionally for liver function, but these drugs are usually fairly non-toxic in conventional doses.

Prozac and Alcohol
Question: I would like to know the effects combining alcohol and Prozac are. I understand that it can cause greater sedative effect, but I would like to know how it affects the central nervous system and anything else. Does drinking reduce the effect Prozac has, or impair its function in the brain? Also, I have heard that one drink while on an anti-depressant has the effect of two. Is this true?

Answer: Prozac(fluoxetine hydrochloride)belongs to a group of anti-depressant drugs called Serotonin Reuptake Inhibitors(SRI). Any drug which works primarily in the central nervous system can impair ones judgement or cognitive skills. Ethanol works also as a depressant and an inhibitor of motor skills, judgement and cognitive ability. The interaction of these two drugs has not been well studied; however, common sense dictates extreme care in mixing drugs-yet, alone two that work in the same part of the body.

Unable to have Orgasm
Question: I am a 45 year old male. I take 40 mg of prozac daily for clinical depression. I am able to achieve an erection and have intercourse but I am unable to reach an orgasm or to ejaculate. This has only occured since I have taken this medicine. I previously tried zoloft and serzone but they caused gastrointestinal discomfort. Could a doctor familiar with this condition and medication please recommend any other medications etc. That would allow orgasm and still help with the depression?

Answer: The biggest side effect and complaint of my patients using SRI class of drugs is a lack of sex drive and erections. Women will complain about lack of drive also. Serzone can get around this problem. Sometimes Effexor will work or a complete different class of anti-depressant.

Stopping Dosage
Question: My pharmacology class would like to know about prozac. What happens if you stop taking it abruptly? Do you have any statistical or research information?

Answer:There does not appear to be any specific problems with discontinuing Prozac(or any drug of this class, the SRI antidepressants) abruptly. There is no addiction or dependence. I do have patients who feel psychologically dependent because they benefit so markedly. However, stopping it abruptly is without problem.

Prozac vs. Effexor
Question: My doctor recently changed my prescription from 40 mg. Prozac per day to 37.5 mg. Effexor twice a day. What is the difference in the two medicines? I have also had trouble sleeping since the change. Could this be related to the Effexor?

Answer:Prozac is a drug that belongs to a class of drugs called Serotonin Reuptake Inhibitors. These drugs work (we think) at the nerve to nerve interface by blocking the reuptake of serotonin back into the sending nerve after a nerve transmission. Effexox is belongs to a different class of drugs which effects dopamine as well as serotonin reuptake. Therefore, they act in a different manner on similar chemicals in the brain. Some patients are much better on one drug or the other-presumably because of their different action. Both drugs can affect sleep; but, it sounds like Effexor is having more of an affect.

Time Frame in System
Question: How long does it take for prozac to completely exit your system?

Answer: Chemically out in about 24-36 hours. Cellular effects seem to last 4-5 days in some patients.

Pregnancy
Question:Is it harmful for pregnant women to take Prozac? What kind of effects does it have on the fetus?

Answer:Currently there is no indication of any harm to the fetus by Prozac. Studies done in mice and bacteria show no potential for genetic mutations or changes. There also appears to be little or no effect on fertility.

Prozac & Cough Suppresant
Question:I am currently taking Prozac and have a slight cough and sore throat. Is there something I can take that will not have a harmful effect? Is there a regular cough suppressant without all the other symptom.

Answer: Dextromethorphan is usually a good agent for cough relief and only has minor constipation. It is available over the counter and shouldn't cause problems with prozac.

Switch From Prozac
Question:How do you switch over from prozac to an alternative medication such as, St. John's Wort? Do you recommend it for mild cases of depression?

Answer: There hasn't been enough research done yet to tell the doses and effects in spite of what 20-20 would have you believe. If you decide to try it, let the Prozac wash out of your system for a week or so. Doses are currently somewhat of a guess.

Prozac & The Military
Question:My son was on prozac for a few months while in residential treatment for an identity disorder a few years ago. Now he is applying for military service. When he told the army recruiter he had been on prozac the recruiter called him back several weeks later and told him he could not apply to the army until he had been off prozac for 5 years. What is the big scare with prozac? I have read there is hardly any half life. The prozac had no effect on my son and that is the reason we took him off of it. Can you give me some feedback on the military and prozac? Can you refer me to any place where I could read up more on this decision of enlistment for anyone who has taken prozac? Is it possible to have the word "prozac" removed from his medical records as it was a med he did not really need, or stay on long?

Answer: It doesn't have anything to do with the drug; but, with the situation requiring him to take it. The military is very conservative and also a risk avoider. They will avoid situations where they have difficulty predicting behavior. A report from his physician might help. Also, try a different service and "forget" about the prozac.

Prozac & The Elderly
Question:What are the side effects of prozac for the elderly?

Answer: No major difference than for other patients. The major difference is that the elderly tend to have less response. They will experience constipation, dry mouth and occasional problems with urination. This can occasionally be a problem with elderly men with large prostates.

Life Long Use
Question: My mother (51 yrs/in otherwise good health) was told by her doctor that he thought that she should just plan to use prozac for the rest of her life. What are the long term and short term side effects of the drug?

Answer: Long term really isn't known, but doesn't appear to differ from short term side effects. Short term side effects include dry mouth, constipation, sleep disorders, occasional headache

Lethargic Behavoir
Question: Thanks for the information I found through your web page. I am currently taking 20 mg Prozac daily and found that I have to take it around 7:00pm, otherwise I am in a drugged state most of the day. The pill actually made me feel tired and depressed if I took it in the morning. My depression and what I called sad thoughts are gone, but I thought that this was an “upper” so to speak, but actually find that I am tired most of the time, gaining weight because I have no desire to do anything more than watch TV. Fortunately I am still active and interested in my work, but my home life has suffered. What do you recommend for my lethargic being?

Answer: The situation you are describing is not an uncommon one found in patients on anti-depressant medication. Ultimately the question is, are the fatigue and lethargy related to the medication, or are they due to the depression, with insufficient medication control of the depressive symptoms? Perhaps there is, or are, issues in your life that have not been addressed or resolved, or have occurred recently, and are contributing to some depressio I mptoms. A visit to your health care provider or prescribing physician would be of benefit. He or she has seen your energy level before, and knows what your depressive symptom presentation was prior to starting the Prozac. They would have the best chance of determining whether your lethargy is medication related, is the result of the your depression recurring, or is the result of another problem altogether. He or she can then determine the best course of action to take.

Dosage Safety
Question: I am on PROZAC 250 mg. I am taking 3 doses per day. Is it dangerous?

Answer: I hope you mean 25 mg and not 250 mg. 250 three times a day would be a very large dosage indeed. Assuming you are taking 25 mg three times a day this is an average to small dosage and shouldn't cause any particular problems other than the usual dry mouth, constipation and occasional headache.

Duration
Question: How long can you stay on Prozac? I have been on it for two years, and it really seems to help.

Answer: Doesn't seem to be any current limit. Many patients have been on this drug for over 7 years. No current known long term side effects.



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