Prozac (Fluoxetine) - Uses, Dosages, Side effects, Brands

Prozac (fluoxetine) is a selective serotonin reuptake inhibitor.

It is used for the treatment of the following conditions:

  • Bipolar major depression

  • Bulimia nervosa

  • Major depressive disorder (unipolar)

  • Obsessive-compulsive disorder

  • Panic disorder

  • Premenstrual dysphoric disorder

  • Treatment-resistant depression

  • Off Label Use of Fluoxetine in Adults:

    • Binge eating disorder

    • Body dysmorphic disorder

    • Refractory fibromyalgia

    • Generalized anxiety disorder

    • Posttraumatic stress disorder

    • Premature ejaculation

    • Raynaud phenomenon

    • Selective mutism

    • Social anxiety disorder

Prozac (Fluoxetine) Dose in Adults

Prozac Dose in the treatment of Binge eating disorder as off-label use:

  • 10 to 20 mg orally once a day
  • The dose may be increased based on response and tolerability in increments of 10 to 20 mg at intervals ≥1 week up to 80 mg/day

Prozac Dose in the treatment of Bipolar major depression:

  • 20 mg orally once a day in the evening in combination with olanzapine or another second-generation antipsychotic.
  • The dose may be increased gradually in 10 to 20 mg increments
  • A Fixed-dose combination is also available.

Prozac Dose in the treatment of body dysmorphic disorder as off-label use:

  • 20 mg orally once a day initially
  • The dose may be increased gradually based on response and tolerability in increments of 20 mg every 2 to 3 weeks to a usual dose of 70 to 80 mg/day by week 6 to 10.
  • Max Dose is 120 mg/day.

Prozac Dose in the treatment of Bulimia nervosa:

  • 20 mg orally once daily initially
  • The dose may be increased gradually (eg, at intervals 1 week or more) based on response and tolerability in 20 mg increments up to a target dose of 60 mg/day.

Prozac Dose in the treatment of refractory fibromyalgia as an alternative agent:

Used as a 2nd line agent:

  • Start with 20 mg/day and increase by 10 mg every 2 weeks with a maximum dose of 80 mg/day.

Prozac Dose in the treatment of Generalized anxiety disorder as off-label use: 

  • start with 10 to 20 mg/day orally and may increase the dose by 10 mg to 20 mg every week with a maximum dose of 60 mg/day.

Prozac Dose in the treatment of major unipolar depressive disorder:

  • Start with 20 mg/day and increase by 10 mg every 2 weeks with a maximum dose of 80 mg/day.

Prozac Dose in the treatment of Obsessive-compulsive disorder:

  • start with 10 to 20 mg/day orally and may increase the dose by 10 mg to 20 mg every week with a usual dose of 40 - 80 mg/day.
  • some patients may require up to 120 mg/day for a response; however, adverse effects may increase.

Fluoxetine Dose in the treatment of Panic disorder:

  • start with 5 - 10 mg/day orally and may increase the dose by 5mg to 10 mg every 3 to 7 days with a maximum dose of 60 mg/day.

Fluoxetine Dose in the treatment of Posttraumatic stress disorder (PTSD) as off-label:

  • Start with 20 mg/day and increase by 10 mg every week with a maximum dose of 80 mg/day.

Fluoxetine Dose in the treatment of Premature ejaculation as off-label use: 

  • Start with 20mg/day and increase by 10mg every week with a maximum dose of 40mg/day.

Fluoxetine Dose in the treatment of Premenstrual dysphoric disorder (PMDD): 

  • Continuous daily dosing regimen:
    • Start with 10mg/day; increase to the usual effective dose of 20 mg once daily over the first month; max dose is 30mg/day.

Fluoxetine Dose in the treatment of Raynaud phenomena as an alternative agent:

  • 20 mg orally once a day in resistant patients who cannot tolerate vasodilators.

Fluoxetine Dose in the treatment of Social anxiety disorder (off-label):

  • Start with 20 mg/day and increase after 6 weeks by 10mg every week with a maximum dose of 60 mg/day.

  • Fluoxetine Dosing conversion:

    • Delayed release (once-weekly formulation):

      • Immediate-release fluoxetine 20 mg/day = delayed-release fluoxetine 90 mg/week.

  • Olanzapine/fluoxetine fixed-dose combination:

    • When using individual components of fluoxetine with olanzapine rather than fixed-dose combination product, corresponding approximate dosage equivalents are as follows:
      • Olanzapine 2.5 mg + fluoxetine 20 mg = combination strength 3/25
      • Olanzapine 5 mg + fluoxetine 20 mg = combination strength 6/25
      • Olanzapine 12.5 mg + fluoxetine 20 mg = combination strength 12/25
      • Olanzapine 5 mg + fluoxetine 50 mg = combination strength 6/50
      • Olanzapine 12.5 mg + fluoxetine 50 mg = combination strength 12/50

  • How to Discontinue Prozac (Fluoxetine)?

    • Fluoxetine should be gradually tapered off in patients who have been using it for more than three weeks.
    • The dose should be gradually reduced by 5 – 10 mg over a period of 2 – 4 weeks.
    • If the patient’s symptoms reappear, restart the previous dose on which the patient was stable and then start tapering more slowly.
    • Patients using fluoxetine for more than six months may benefit from tapering it over a period of three months.

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  • Switching antidepressants:

Although data regarding switching strategies from one antidepressant to another antidepressant is limited, some of the important points are listed here:

  • Cross-titration:

    • This method is usually followed especially when Prozac or the other antidepressant has been used for more than 2 – 4 weeks.
    • One drug is gradually tapered while the dose of the other drug is increased gradually at the same time.

  • Direct switch:

    • The direct switch is the abrupt discontinuation of one drug and initiating the other drug at an equivalent dose.
    • This method may be appropriate in cases where the drug has been used for less than 1 – 2 weeks or when the drug is discontinued because of the adverse effects.

Switching to or from an MAOI:

At least a 14 days drug-free interval should be allowed when switching from an MAOI to Prozac and vice versa. Cross titration is contraindicated when switching from an MAOI to an SSRI and vice versa.

Prozac (Fluoxetine) Dose in Children

Prozac Dose in the treatment of Anxiety with associated phobias and panic attacks:

  • Children 2 to 6 years:
    • 5 mg/dose or 0.25 mg/kg/dose orally once a day.

Prozac Dose in the treatment of Bulimia nervosa adjunct therapy with cognitive behavioral therapy: 

  • Children ≥12 years and Adolescents:
    • Initial: 20 mg orally once daily for 3 days, then 40 mg once daily for 3 days, then 60 mg once daily.

Prozac Dose in the treatment of Depression: 

  • Manufacturer's labeling:

    • Children ≥8 years and Adolescents:
      • Lower weight Children: Initial: 10 mg orally once a day(max dose: 20mg/day)
      • Higher weight Children and Adolescents: Initial: 10 to 20 mg orally once a day (max dose: 20mg/day)

  • Alternate dosing:

    • Children less than 11 years:
      • Start with 5 mg orally once a day; clinically, doses have been titrated up to 40 mg once a day.
    • Children older than 12 years and Adolescents:
      • Start with 10 mg orally once daily; clinically, doses have been titrated up to 40 mg once a day.

Prozac Dose in the treatment of depression associated with bipolar I disorder (in combination with olanzapine):

  • Children older than 10 years and Adolescents:
    • 20 mg orally in the evening

Fluoxetine dose in Obsessive-compulsive disorder:

  • Children less than 7 years:

    • 5 mg orally once a day

  • Children older than 7 years and Adolescents:

    • Lower weight Children:

      • 10 mg orally once a day (max 30mg/day)

    • Higher weight Children and Adolescents:

      • 10 mg orally once a day (max 60mg/day)

Fluoxetine Dose in the treatment of Repetitive behavior associated with autism spectrum disorders (ASD):

  • Children older than 5 years and Adolescents:
    • Start with 2.5 mg orally once a day for 7 days
    • Then the weight-based increase of 0.3 mg/kg/day during week 2
    • followed by 0.5 mg/kg/day during week 3 (max 0.8mg/kg/day)

Prozac Dose in the treatment of Selective mutism: 

  • Children older than 5 years and Adolescents:

    • 5 mg orally once a day for week 1, then increase to 10 mg in week 2, maximum daily dose: 60 mg/day.

Discontinuation of therapy:

  • Fluoxetine should be gradually tapered off in patients who have been using it for more than three weeks.
  • The dose should be gradually reduced by 5 – 10 mg over a period of 2 – 4 weeks.
  • If the patient’s symptoms reappear, restart the previous dose on which the patient was stable and then start tapering more slowly.
  • Patients using fluoxetine for more than six months may benefit from tapering it over a period of three to six months.

How to switch to other antidepressants: 

Although data regarding switching strategies from one antidepressant to another antidepressant is limited, some of the important points are listed here:

  • Cross-titration:

    • This method is usually followed especially when Fluoxetine or the other antidepressant has been used for more than 2 – 4 weeks. One drug is gradually tapered while the dose of the other drug is increased gradually at the same time.

  • Direct switch:

    • The direct switch is the abrupt discontinuation of one drug and initiating the other drug at an equivalent dose.
    • This method may be appropriate in cases where the drug has been used for less than 1 – 2 weeks or when the drug is discontinued because of the adverse effects.

Switching to or from an MAOI:

At least a 14 days drug-free interval should be allowed when switching from an MAOI to fluoxetine and vice versa. Cross titration is contraindicated when switching from an MAOI to an SSRI and vice versa.

Pregnancy Risk Factor C

  • Fluoxetine crosses over the placenta, and is then distributed in the amniotic liquid.
  • However, there are contradicting results for the teratogenic effects.

These effects are not teratogenic:​​​​​​​

  • Cyanosis
  • Apnea
  • Seizures
  • Neonatal Respiratory distress
  • Hypoglycemia and feeding difficulties
  • Hypotonia or hypertonia
  • Persistent crying, irritability and jitteriness
  • Tremors
  • Discontinuation syndrome
  • The newborn may have persistent pulmonary hypertension

Breastfeeding:

  • Breast milk contains fluoxetine and its activemetabolite (norfluoxetine), which is why it is not recommended for breastfeeding mothers.

Prozac dose in renal disease:

  • Use lower doses with severe renal impairment.
  • Not removed by hemodialysis

Prozac (Fluoxetine) Dose in Liver Disease:

Lower and less frequent dosing in hepatic impairment should be used.

  • Cirrhosis patient:

    • Administer a lower dose or less frequent dosing interval.

  • Compensated cirrhosis without ascites:

    • Administer 50% of normal dose.

Common Side Effects of Fluoxetine Include:

  • Central Nervous System:

    • Insomnia
    • Headache
    • Drowsiness
    • Anxiety
    • Nervousness
    • Yawning

  • Endocrine & Metabolic:

    • Decreased Libido

  • Gastrointestinal:

    • Nausea
    • Diarrhea
    • Anorexia
    • Xerostomia

  • Neuromuscular & Skeletal:

    • Weakness
    • Tremor

  • Respiratory:

    • Pharyngitis

Less Common Side Effects of Fluoxetine:

  • Cardiovascular:

    • Vasodilation
    • Palpitations
    • Prolonged Q-T Interval On ECG
    • Chest Pain
    • Hypertension

  • Central Nervous System:

    • Dizziness
    • Abnormal Dreams
    • Agitation
    • Personality Disorder
    • Abnormality In Thinking
    • Chills
    • Emotional Lability
    • Amnesia
    • Confusion
    • Sleep Disorder

  • Dermatologic:

    • Diaphoresis
    • Skin Rash
    • Pruritus

  • Endocrine & Metabolic:

    • Hypermenorrhea
    • Increased Thirst
    • Weight Loss
    • Weight Gain

  • Gastrointestinal:

    • Dyspepsia
    • Constipation
    • Flatulence
    • Vomiting
    • Dysgeusia
    • Increased Appetite

  • Genitourinary:

    • Ejaculatory Disorder
    • Impotence
    • Urinary Frequency
    • Urination Disorder

  • Neuromuscular & Skeletal:

    • Hyperkinesia

  • Ophthalmic:

    • Visual Disturbance

  • Otic:

    • Otalgia
    • Tinnitus

  • Respiratory:

    • Flu-Like Symptoms
    • Sinusitis
    • Epistaxis

Contraindication to Fluoxetine Include:

The following patients are not recommended to take fluoxetine:

  • People who are allergic to fluoxetine.
  • Patients who use an MAOI.
  • Patients who receive linezolid or methyleneblue or Pimozide

Warnings and Precautions

  • Rash and Allergic Events

    • Fluoxetine has been linked to anaphylactic reactions and significant rash.

  • Suicidal Behaviors (US Boxed Warnings).

    • Use of Prozac in children, adolescents and young adults (aged 18-24) who have major depression has been linked to an increased risk for suicidal thoughts.
    • Patients should be closely monitored for any changes in behavior or clinical worsening. It is not recommended for children under 12 years old.

  • Prozac prevents platelet aggregation.

    • Patients with bleeding disorders, serious patients and those on anticoagulants and aspirin should not use it.

  • QT interval effect:

    • Dose-dependent QT prolongation has been linked to Prozac.
    • The drug should not be prescribed to patients with heart disease or those suffering from deranged electrolytes such as hypokalemia or hypomagnesemia.

  • Higher mental functions are affected:

    • It can cause impairment of higher mental functions.
    • Prozac should be avoided by drivers and operators of heavy machinery.

  • Bone fractures

    • This increases the risk of breaking bones.

  • Eye Effects

    • As a result, Prozac can cause narrow-angle glaucoma.

  • Serotonin syndrome

    • Serotonin syndrome, which is a potentially fatal condition that can be caused by SSRIs, is a serious condition. Patients who show the following symptoms should be concerned:
      • Mental status changes (hallucinations and agitations, delirium, or coma)
      • autonomic instability: sweating, resting bradycardia/ tachycardia and changes in blood pressure
      • Neurological features (rigidity and tremor, seizures and myoclonus).
      • Gastrointestinal symptoms such as nausea, diarrhea, and vomiting can include:

  • Sexual dysfunction

    • It can lead to or exacerbate sexual dysfunction.

  • Hyponatremia

    • Hyponatremia may lead to reversible SIADH. Seizures may result from sodium levels below 120 mEq/l

  • Bipolar disorder

    • Prozac is not approved to treat bipolar disorder. Patients with hypomania and mania should avoid Prozac.

  • Discontinuation syndrome

    • After abrupt withdrawal of escitalopram, patients who are on long-term escitalopram treatment may experience a discontinuation syndrome.
    • The symptoms of discontinuation syndrome include nausea, vomiting and diarrhea, headaches, anorexia and tremors.
    • Other symptoms include: imbalance, electric shock-like sensations; myalgias; arrhythmias; myalgias; irritability and aggressive behavior; mood instability; confusion; difficulty in concentration.

Fluoxetine: Drug Interaction

Risk Factor C (Monitor therapy)

Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.)

May enhance the antiplatelet effect of other Agents with Antiplatelet Properties.

Ajmaline

May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).

Ajmaline

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Ajmaline.

Amphetamines

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Amphetamines.

Anticoagulants

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants.

Antiemetics (5HT3 Antagonists)

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Antipsychotic Agents

Serotonin Modulators may enhance the adverse/toxic effect of Antipsychotic Agents. Specifically, serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Apixaban

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Apixaban. Specifically, the risk for bleeding may be increased. Management: Carefully consider risks and benefits of this combination and monitor closely.

Aspirin

Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of Aspirin.

Benzhydrocodone

CYP2D6 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of Benzhydrocodone.

Beta-Blockers

Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Beta-Blockers. Exceptions: Acebutolol; Atenolol; Betaxolol (Ophthalmic); Betaxolol (Systemic); Bisoprolol; Carteolol (Ophthalmic); Esmolol; Labetalol; Levobunolol; Metipranolol; Nadolol; Sotalol.

Blood Glucose Lowering Agents

Selective Serotonin Reuptake Inhibitors may enhance the hypoglycemic effect of Blood Glucose Lowering Agents.

Brexanolone

Selective Serotonin Reuptake Inhibitors may enhance the CNS depressant effect of Brexanolone.

Cannabidiol

CYP2C19 Inhibitors (Moderate) may increase the serum concentration of Cannabidiol.

CarBAMazepine

FLUoxetine may increase the serum concentration of CarBAMazepine.

Cephalothin

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased.

Cimetidine

May increase the serum concentration of FLUoxetine.

Clarithromycin

FLUoxetine may enhance the QTc-prolonging effect of Clarithromycin. Clarithromycin may increase the serum concentration of FLUoxetine.

CloBAZam

May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).

CloZAPine

CYP2D6 Inhibitors (Strong) may increase the serum concentration of CloZAPine.

CNS Depressants

May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.

Cobicistat

May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).

Collagenase (Systemic)

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and/or bleeding may be increased.

CYP2C19 Substrates (High risk with Inhibitors)

CYP2C19 Inhibitors (Moderate) may decrease the metabolism of CYP2C19 Substrates (High risk with Inhibitors).

CYP2C9 Inducers (Moderate)

May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers).

CYP2C9 Inhibitors (Moderate)

May decrease the metabolism of CYP2C9 Substrates (High risk with Inhibitors).

CYP2D6 Inhibitors (Moderate)

May decrease the metabolism of CYP2D6 Substrates (High risk with Inhibitors).

Cyproheptadine

May diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors.

Dabigatran Etexilate

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Dabigatran Etexilate. Agents with Antiplatelet Properties may increase the serum concentration of Dabigatran Etexilate. This mechanism applies specifically to clopidogrel. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling recommends avoiding prasugrel or ticagrelor.

Darunavir

May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).

Dasatinib

May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.

Deoxycholic Acid

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased.

Desmopressin

Selective Serotonin Reuptake Inhibitors may enhance the adverse/toxic effect of Desmopressin.

DULoxetine

CYP2D6 Inhibitors (Strong) may increase the serum concentration of DULoxetine.

Edoxaban

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased.

Fat Emulsion (Fish Oil Based)

May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.

Fesoterodine

CYP2D6 Inhibitors may increase serum concentrations of the active metabolite(s) of Fesoterodine.

Flibanserin

CYP2C19 Inhibitors (Moderate) may increase the serum concentration of Flibanserin.

Galantamine

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Galantamine.

Glucosamine

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Haloperidol

FLUoxetine may enhance the QTc-prolonging effect of Haloperidol. FLUoxetine may increase the serum concentration of Haloperidol.

HYDROcodone

CYP2D6 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of HYDROcodone. Specifically, concentrations of hydromorphone may be decreased.

Ibritumomab Tiuxetan

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Both agents may contribute to impaired platelet function and an increased risk of bleeding.

Ibrutinib

May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.

Imatinib

May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).

Indoramin

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Indoramin.

Inotersen

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Ioflupane I 123

Selective Serotonin Reuptake Inhibitors may diminish the diagnostic effect of Ioflupane I 123.

Limaprost

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Lofexidine

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Lofexidine.

Lumacaftor

May decrease the serum concentration of CYP2C9 Substrates (High Risk with Inhibitors or Inducers). Lumacaftor may increase the serum concentration of CYP2C9 Substrates (High Risk with Inhibitors or Inducers).

Lumefantrine

May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).

Metaxalone

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Methylphenidate

May enhance the adverse/toxic effect of Serotonin Modulators. Specifically, the risk of serotonin syndrome or serotonin toxicity may be increased.

MetyroSINE

May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors.

Multivitamins/Fluoride (with ADE)

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Multivitamins/Minerals (with ADEK, Folate, Iron)

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Multivitamins/Minerals (with AE, No Iron)

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Nebivolol

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Nebivolol.

Nicergoline

CYP2D6 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Nicergoline. Specifically, concentrations of the MMDL metabolite may be increased. CYP2D6 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of Nicergoline. Specifically, concentrations of the MDL metabolite may be decreased.

NIFEdipine

FLUoxetine may enhance the adverse/toxic effect of NIFEdipine.

NiMODipine

FLUoxetine may increase the serum concentration of NiMODipine.

Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective)

Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors.

Obinutuzumab

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased.

Omega-3 Fatty Acids

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Opioid Agonists

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Panobinostat

May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).

Peginterferon Alfa-2b

May decrease the serum concentration of FLUoxetine.

Pentosan Polysulfate Sodium

May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents.

Pentoxifylline

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Phenytoin

FLUoxetine may increase the serum concentration of Phenytoin.

Pitolisant

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Pitolisant.

Propafenone

May enhance the QTc-prolonging effect of FLUoxetine. FLUoxetine may increase the serum concentration of Propafenone.

Prostacyclin Analogues

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

QT-prolonging Agents (Highest Risk)

QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.

QuiNINE

May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).

Rifapentine

May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers).

Rivaroxaban

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Rivaroxaban. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling recommends avoiding prasugrel or ticagrelor.

Salicylates

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result.

Serotonin Modulators

May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Exceptions: Nicergoline; Tedizolid.

Tamsulosin

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Tamsulosin.

Tedizolid

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Thiazide and Thiazide-Like Diuretics

Selective Serotonin Reuptake Inhibitors may enhance the hyponatremic effect of Thiazide and Thiazide-Like Diuretics.

Thrombolytic Agents

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents.

Thyroid Products

Selective Serotonin Reuptake Inhibitors may diminish the therapeutic effect of Thyroid Products. Thyroid product dose requirements may be increased.

Timolol (Ophthalmic)

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Timolol (Ophthalmic).

TraMADol

CYP2D6 Inhibitors (Strong) may diminish the therapeutic effect of TraMADol. CYP2D6 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of TraMADol. CYP2D6 Inhibitors (Strong) may increase the serum concentration of TraMADol.

TraMADol

Serotonin Modulators may enhance the adverse/toxic effect of TraMADol. The risk of seizures may be increased. TraMADol may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Tropisetron

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Tropisetron.

Valbenazine

CYP2D6 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Valbenazine.

Vitamin E (Systemic)

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Vitamin K Antagonists (eg, warfarin)

Selective Serotonin Reuptake Inhibitors may enhance the anticoagulant effect of Vitamin K Antagonists.

Risk Factor D (Consider therapy modification)

Abiraterone Acetate

May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible. When concurrent use is not avoidable, monitor patients closely for signs/symptoms of toxicity.

Alcohol (Ethyl)

May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Management: Patients receiving selective serotonin reuptake inhibitors should be advised to avoid alcohol. Monitor for increased psychomotor impairment in patients who consume alcohol during treatment with selective serotonin reuptake inhibitors.

ARIPiprazole

FLUoxetine may enhance the adverse/toxic effect of ARIPiprazole. Specifically, the risk of neuroleptic malignant syndrome may be increased. ARIPiprazole may enhance the serotonergic effect of FLUoxetine. This could result in serotonin syndrome. FLUoxetine may increase the serum concentration of ARIPiprazole. Management: Aripiprazole dose should be reduced by at least half, except when used adjunctively for depression. Consult full interaction monograph or aripiprazole prescribing information for complete details.

ARIPiprazole Lauroxil

CYP2D6 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of ARIPiprazole Lauroxil. Management: Please refer to the full interaction monograph for details concerning the recommended dose adjustments.

Asunaprevir

May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).

AtoMOXetine

CYP2D6 Inhibitors (Strong) may increase the serum concentration of AtoMOXetine. Management: Initiate atomoxetine at a reduced dose (adult doses -- patients up to 70kg: 0.5mg/kg/day; patients 70kg or more: 40mg/day) in patients receiving a strong CYP2D6 inhibitor.

Brexpiprazole

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Brexpiprazole. Management: Reduce brexpiprazole dose to 50% of usual with a strong CYP2D6 inhibitor, reduce to 25% of usual if used with both a strong CYP2D6 inhibitor and a CYP3A4 inhibitor; these recommendations do not apply if treating major depressive disorder.

BusPIRone

May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Selective Serotonin Reuptake Inhibitors may decrease the metabolism of BusPIRone. Management: The combination of a selective serotonin reuptake inhibitor and buspirone should be undertaken with great caution. When combined treatment is clinically indicated, monitor closely for signs of serotonin toxicity/serotonin syndrome.

Cilostazol

CYP2C19 Inhibitors may increase the serum concentration of Cilostazol. Management: Consider reducing the cilostazol dose to 50 mg twice daily in patients who are also receiving inhibitors of CYP2C19.

Citalopram

CYP2C19 Inhibitors (Moderate) may increase the serum concentration of Citalopram. Management: Limit citalopram dose to a maximum of 20 mg/day if used with a moderate CYP2C19 inhibitor. Patients using this combination should be monitored closely for evidence of citalopram toxicity (e.g., serotonin syndrome, QT prolongation, etc.).

Clopidogrel

CYP2C19 Inhibitors (Moderate) may decrease serum concentrations of the active metabolite(s) of Clopidogrel. Management: Due to a risk for impaired clopidogrel effectiveness with such a combination, carefully consider the need for a moderate CYP2C19 inhibitor in patients receiving clopidogrel. Monitor patients closely for evidence of a diminished response to clopidogrel.

Codeine

CYP2D6 Inhibitors (Strong) may diminish the therapeutic effect of Codeine. These CYP2D6 inhibitors may prevent the metabolic conversion of codeine to its active metabolite morphine.

CYP2D6 Inhibitors (Strong)

May decrease the metabolism of CYP2D6 Substrates (High risk with Inhibitors).

CYP2D6 Substrates (High risk with Inhibitors)

CYP2D6 Inhibitors (Strong) may decrease the metabolism of CYP2D6 Substrates (High risk with Inhibitors). Exceptions: Ajmaline; Dapoxetine; Indoramin; Tamoxifen; Timolol (Ophthalmic); Tropisetron.

Dabrafenib

May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP2C9 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).

Dacomitinib

May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Avoid concurrent use of dacomitinib with CYP2D6 subtrates that have a narrow therapeutic index.

Deutetrabenazine

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Deutetrabenazine. Management: The total daily dose of deutetrabenazine should not exceed 36 mg, and the maximum single dose of deutetrabenazine should not exceed 18 mg with concurrent use of a strong CYP2D6 inhibitor.

Dextromethorphan

Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Dextromethorphan. Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Dextromethorphan. Management: Avoid the concurrent use of dextromethorphan and SSRIs, particularly fluoxetine and paroxetine, when possible. The risk for this interaction may persist for several weeks following discontinuation of fluoxetine or paroxetine.

DOXOrubicin (Conventional)

CYP2D6 Inhibitors (Strong) may increase the serum concentration of DOXOrubicin (Conventional). Management: Seek alternatives to strong CYP2D6 inhibitors in patients treated with doxorubicin whenever possible. One U.S. manufacturer (Pfizer Inc.) recommends that these combinations be avoided.

Eliglustat

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Eliglustat. Management: Reduce the eliglustat dose to 84 mg daily. Avoid use of eliglustat in combination with a strong CYP2D6 inhibitor and a strong or moderate CYP3A4 inhibitor.

Enzalutamide

May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP2C9 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP2C9 substrate should be performed with caution and close monitoring.

Fosphenytoin

May enhance the QTc-prolonging effect of FLUoxetine. FLUoxetine may increase the serum concentration of Fosphenytoin.

Gilteritinib

May diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Avoid use of this combination if possible. If the combination cannot be avoided, monitor closely for evidence of reduced response to the selective serotonin reuptake inhibitor.

Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)

May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Management: Avoid combination when possible. If used, monitor more closely for evidence of bleeding. Discontinue herbal products with anticoagulant or antiplatelet actions 2 weeks prior to surgical, dental, or invasive procedures.

Iloperidone

CYP2D6 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Iloperidone. Specifically, concentrations of the metabolite P88 may be increased. CYP2D6 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of Iloperidone. Specifically, concentrations of the metabolite P95 may be decreased. CYP2D6 Inhibitors (Strong) may increase the serum concentration of Iloperidone. Management: Reduce iloperidone dose by half when administered with a strong CYP2D6 inhibitor.

Linezolid

May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This could result in serotonin syndrome. Management: Consider alternatives to this combination whenever possible. If clinically acceptable, wait at least 2 weeks (5 weeks for fluoxetine) after SSRI discontinuation to initiate linezolid.

Linezolid

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Management: Due to a risk of serotonin syndrome/serotonin toxicity, discontinue serotonin modulators 2 weeks prior to the administration of linezolid. If urgent initiation of linezolid is needed, discontinue serotonin modulators immediately and monitor closely.

Lithium

May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This could increase the risk of serotonin toxicity/serotonin syndrome. Management: This combination should be undertaken with great caution. When combined treatment is clinically indicated, monitor closely for signs of serotonin toxicity/serotonin syndrome.

Metoclopramide

May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Management: Seek alternatives to this combination when possible. Monitor patients receiving metoclopramide with selective serotonin reuptake inhibitors for signs of extrapyramidal symptoms, neuroleptic malignant syndrome, and serotonin syndrome.

Metoclopramide

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Metoclopramide. Management: Reduce metoclopramide dose to 5 mg 4 times daily (30 minutes before each meal and at bedtime) and limit the maximum daily dose to 20 mg if combined with strong CYP2D6 inhibitors.

MiFEPRIStone

May increase the serum concentration of CYP2C9 Substrates (High risk with Inhibitors). Management: Use CYP2C9 substrates at the lowest recommended dose, and monitor closely for adverse effects, during and in the 2 weeks following mifepristone treatment.

Nonsteroidal Anti-Inflammatory Agents (Nonselective)

Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Consider using alternative analgesics, when appropriate, and/or addition of a gastroprotective agent. Monitor patients closely for signs/symptoms of bleeding, and for evidence of diminished SSRI effectiveness with concurrent use.

Perhexiline

CYP2D6 Inhibitors may increase the serum concentration of Perhexiline. Management: Consider alternatives to this combination if possible. If combined, monitor for increased perhexiline serum concentrations and toxicities (eg, hypoglycemia, neuropathy, liver dysfunction). Perhexiline dose reductions will likely be required.

Primaquine

CYP2D6 Inhibitors (Strong) may diminish the therapeutic effect of Primaquine. Management: Monitor for signs and symptoms of possible treatment failure with primaquine in patients who are taking strong CYP2D6 inhibitors. If efficacy of primaquine is compromised, may consider adjusting therapies.

Serotonin Reuptake Inhibitor/Antagonists

Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Serotonin Reuptake Inhibitor/Antagonists. This may cause serotonin syndrome. Management: Consider alternatives, and use conservative initial dosing. Monitor patients receiving these combinations for signs/symptoms of serotonin toxicity.

Tetrabenazine

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Tetrabenazine. Specifically, concentrations of the active alpha- and beta-dihydrotetrabenazine metabolites may be increased. Management: Tetrabenazine adult dose should be reduced by 50% when starting a strong CYP2D6 inhibitor. Maximum tetrabenazine adult dose is 50 mg/day when used with a strong CYP2D6 inhibitor.

Tricyclic Antidepressants

FLUoxetine may enhance the adverse/toxic effect of Tricyclic Antidepressants. FLUoxetine may increase the serum concentration of Tricyclic Antidepressants. Management: Consider alternatives to this combination when possible. Monitor for adverse effects of tricyclic antidepressants (TCAs), including serotonin syndrome and QT-interval prolongation, when a TCA is being used in combination with fluoxetine.

Vortioxetine

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Vortioxetine. Management: The vortioxetine dose should be reduced by 50% when used together with a strong CYP2D6 inhibitor. Following cessation of the strong CYP2D6 inhibitor, the vortioxetine dose should be returned to the normal level.

Risk Factor X (Avoid combination)

Bromopride

May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors.

BuPROPion

FLUoxetine may enhance the neuroexcitatory and/or seizure-potentiating effect of BuPROPion. BuPROPion may increase the serum concentration of FLUoxetine.

Dapoxetine

May enhance the adverse/toxic effect of Serotonin Modulators.

Dosulepin

Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Dosulepin.

Mequitazine

CYP2D6 Inhibitors (Strong) may increase the serum concentration of Mequitazine.

Methylene Blue

Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Methylene Blue. This could result in serotonin syndrome.

Methylene Blue

May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.

Monoamine Oxidase Inhibitors

May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. While methylene blue and linezolid are expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to monographs specific to those agents for details. Exceptions: Linezolid; Methylene Blue; Tedizolid.

Pimozide

FLUoxetine may enhance the QTc-prolonging effect of Pimozide. FLUoxetine may increase the serum concentration of Pimozide.

Tamoxifen

CYP2D6 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of Tamoxifen. Specifically, strong CYP2D6 inhibitors may decrease the metabolic formation of highly potent active metabolites.

Thioridazine

FLUoxetine may enhance the QTc-prolonging effect of Thioridazine. FLUoxetine may increase the serum concentration of Thioridazine.

Tryptophan

May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome.

Urokinase

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase.

Monitoring Parameters:

  • High-risk individuals have high levels of serum sodium
  • Blood glucose (for diabetics)
  • Baseline and clinically indicated liver and renal function
  • ECG monitoring and periodic assessment for patients at risk of QT prolongation or ventricular arrhythmia.
  • Depression and mental health
  • Suicidal ideation, especially at the beginning of therapy and when dosages are increased or reduced
  • Anxiety
  • Social functioning
  • Mania
  • Panic attacks
  • Signs & symptoms of serotonin Syndrome
  • Akathisia
  • Sleep status

How to administer Prozac (Fluoxetine)?

  • Administer fluoxetine in the morning or evening with or without food.

Mechanism of action of Prozac (Fluoxetine):

  • Fluoxetine inhibits selectively the reuptake serotonin. It does not affect the dopamine or Norepinephrine receptors.
  • It has a very limited effect on beta-adrenergic receptors, D 1-5 to 5, H 1-3, M 1-5 and 5HT 1-7. 
  • Fluoxetine doesn't bind to sodium, potassium, chloride, or calcium ion channel channels.

It is necessaryIt takes about one week for the effect to take place. You may see the maximum response in between 8 and 12 weeks.

It is easy to absorb;95% to albumin, alpha 1 glycoprotein It is metabolized in the liver.

Eliminating p after half-lifeThe half-life of the arent drug is between 1 and 3 days (acute), 4 – 6 days (chronic), 7.6 days for cirrhosis (cirrhosis), The half-life of norfluoxetine's metabolite is 9.3 days (in cirrhotic patients, it is 12.3 days).

ExcretionUrine

International Brands of Fluoxetine:

  • ACCEL-FLUoxetine
  • ACH-FLUoxetine
  • ACT FLUoxetine
  • APO-FLUoxetine
  • Auro-FLUoxetine
  • BCI FLUoxetine
  • BIO-FLUoxetine
  • DOM-FLUoxetine
  • JAMP-FLUoxetine
  • Mar-FLUoxetine
  • MINT-FLUoxetine
  • MYLAN-FLUoxetine
  • Odan-FLUoxetine
  • PHL-FLUoxetine
  • PMS-FLUoxetine
  • PRIVA-FLUoxetine
  • PRO-FLUoxetine
  • PROzac
  • Q-FLUoxetine
  • RAN-FLUoxetine
  • RIVA-FLUoxetine
  • SANDOZ FLUoxetine
  • TEVA-FLUoxetine
  • VAN-FLUoxetine
  • Actan
  • Actisac
  • Adef-XL
  • Adep
  • Adepssir
  • Adofen
  • Alzac
  • Anextin
  • Ansi
  • Ansilan
  • Antiprestin
  • Bellzac
  • Biozac
  • Boniflox
  • Captaton
  • Daforin
  • Dagrilan
  • Dawnex
  • Deprexin
  • Deprizac
  • Deproxin
  • Dominium
  • Drafzin
  • Elevamood
  • Elizac
  • Flocept
  • Floxet
  • Flozak
  • Fluctin
  • Fluctine
  • Fludac
  • Fludec
  • Fluneurin
  • Flunil
  • Fluovex
  • Fluox
  • Fluox-Puren
  • Fluoxeren
  • Fluronin
  • Flush
  • Flutin
  • Flutine
  • Fluval
  • Fluxen
  • Fluxet
  • Fluxetin
  • Fluxil
  • Fluzac
  • Fluzyn-20
  • Fontex
  • Fropine
  • Fuloren
  • Gerozac
  • Huma-Fluoxetin
  • Lanclic
  • Linz
  • Lorien
  • Lovan
  • Margrilan
  • Modipran
  • Moltoben
  • Motivest
  • Neupax
  • Nopres
  • Nuzak
  • Nycoflox
  • Octozac
  • Olena
  • Oxactin
  • Oxedep
  • Oxetin
  • Oxetine
  • Plazeron
  • Portal
  • Praxin
  • Prazac
  • Prizma
  • Prodep
  • Prolert
  • Prozac
  • Prozac 20
  • Prozac
  • Dispersible
  • Prozac Weekly
  • Prozit
  • Qualisac
  • Reneuron
  • Salipax
  • Seronil
  • Sinzac
  • Symbyax
  • U-Zet
  • Youke
  • ZAC
  • Zactin

Prozac (Fluoxetine) brands in Pakistan:

Fluoxetine (Hcl) [Syrup 20 Mg/5ml]
Flintrocin Life Pharmaceutical Company

Fluoxetine (Hcl) [Liquid 20 Mg/5ml]
Advance Scotmann Pharmaceuticals
Azene Raazee Theraputics (Pvt) Ltd.
Depcure Medicraft Pharmaceuticals (Pvt) Ltd.
Depricap Nabiqasim Industries (Pvt) Ltd.
Prome Hamaz Pharmaceutical (Pvt) Ltd.
Rize Werrick Pharmaceuticals
Xeal Mac & Rans Pharmaceuticals (Pvt) Ltd

Fluoxetine (Hcl) [Tabs 10 Mg]
Futine Wilshire Laboratories (Pvt) Ltd.

Fluoxetine (Hcl) [Tabs 20 Mg]
Bfit Qintar Pharmacuticals
Depset Z-Jans Pharmaceutical (Pvt) Ltd.
Diprex Silver Oak Corporation.
Faxetine Delta Pharma (Pvt) Ltd.
Flit Tagma Pharma (Pvt) Ltd.
Flovitin Valor Pharmaceuticals
Floxac The Schazoo Laboratories Ltd.
Fluser Genome Pharmaceuticals (Pvt) Ltd
Futine Wilshire Laboratories (Pvt) Ltd.
G-Flax Olive Laboratories

Fluoxetine (Hcl) [Tabs 40 Mg]
Futine Wilshire Laboratories (Pvt) Ltd.
Maritin Miracle Pharmaceuticals(Pvt) Ltd

Fluoxetine (Hcl) [Caps 20 Mg]
Advance Scotmann Pharmaceuticals
Alert Rakaposhi Pharmaceutical (Pvt) Ltd.
Azene Raazee Theraputics (Pvt) Ltd.
Besquil Rotex Medica Pakistan (Pvt) Ltd
Brite Libra Pharmaceuticals (Pvt) Ltd
Croftine Crown Pharmaceuticals
Cyconil Global Pharmaceuticals
Deeprex Healers Laboratories
Dep Nil Z-Jans Pharmaceutical (Pvt) Ltd.
Dep-F Vega Pharmaceuticals Ltd.
Depagor Unimark Pharmaceuticals
Depcure Medicraft Pharmaceuticals (Pvt) Ltd.
Depex Merck Private Ltd.
Deplow Alina Combine Pharmaceuticals (Pvt) Ltd.
Deporex Medera Pharmaceuticals (Pvt) Ltd.
Depranil Bloom Pharmaceuticals (Pvt) Ltd.
Deprefed Fedro Pharmaceutical
Depret Shazals Pharmaceuticals
Depretine Hygeia Pharmaceuticals
Depricap Nabiqasim Industries (Pvt) Ltd.
Depricap Nabiqasim Industries (Pvt) Ltd.
Deprifex Hansel Pharmacueutical Pvt (Ltd)
Deprox Epla Laboratories (Pvt) Ltd.
Deptin Alson Pharmaceuticals
Deptin Alson Pharmaceuticals
Eluxit Everest Pharmaceuticals
Envoytrin Envoy Pharma
Erozac English Pharmaceuticals Industries
Extine Umersons
Ezilex Ambrosia Pharmaceuticals
F-Tin Miracle Pharmaceuticals(Pvt) Ltd
Fair Pearl Pharmaceuticals
Felix Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Fexatin Rasco Pharma
Fextim Geofman Pharmaceuticals
Flectin Bryon Pharmaceuticals (Pvt) Ltd.
Flit Tagma Pharma (Pvt) Ltd.
Flonital A.J. & Company.
Flotin Nenza Pharmaceuticals (Pvt) Limited
Floxetin Wilsons Pharmaceuticals
Floxitol Usawa Pharmaceuticals
Fluctine Gray`S Pharmaceuticals
Fludecate Caraway Pharmaceuticals
Flufa Farm Aid Group Pak Ltd.
Flufend Friends Pharma (Pvt) Ltd
Fluoxesaf Saaaf Pharmaceuticals
Flute Mass Pharma (Private) Limited
Flutix Aries Pharmaceuticals (Pvt) Ltd
Flux Hilton Pharma (Pvt) Limited
Fluxine Don Valley Pharmaceuticals (Pvt) Ltd.
Fluxit Jafson Pharmaceuticals (Pvt) Ltd.
Fluxyan Roryan Pharmaceutical Industries (Pvt) Ltd
Fuzon Spl Pharmaceuticals (Pvt) Ltd
Fxitine Fynk Pharmaceuticals
Galaxy Glitz Pharma
Galaxy Glitz Pharma
Hapilux Novartis Pharma (Pak) Ltd
Helen Paramount Pharmaceuticals
Lexetine Leads Pharma (Pvt) Ltd
Loxovit Rex Pharmaceuticals Pakistan
Luox Goodman Laboratories
Lutine Lowitt Pharmaceuticals (Pvt) Ltd
Minest Wise Pharmaceuticals (Pvt) Ltd
Modipran Bex Pharma (Pvt) Ltd.
Nozac Danas Pharmaceuticals (Pvt) Ltd
Nuxac Fassgen Pharmaceuticals
Optimist Dr. Raza Pharma (Private) Limited
Oxecam Valor Pharmaceuticals
Oxetin Pharmatec Pakistan (Pvt) Ltd.
Prolyd Zesion Pharmaceutical (Pvt) Ltd
Prome Hamaz Pharmaceutical (Pvt) Ltd.
Prozac Eli Lilly Pakistan (Pvt) Ltd.
Prozyn Platinum Pharmaceuticals (Pvt.) Ltd.
Recap Biorex Pharmaceuticals
Reset Medera Pharmaceuticals (Pvt) Ltd.
Rize Werrick Pharmaceuticals
Rozax Medisure Laboratories Pakistan (Pvt.) Ltd.
Sawan Polyfine Chempharma (Pvt) Ltd.
Sepretine Shawan Pharmaceuticals
Seronil Searle Pakistan (Pvt.) Ltd.
Serotin Rock Pharmaceuticals
Skymet Zinta Pharmaceuticals Industries
Teozin Pulse Pharmaceuticals
Ufrex Cirin Pharmaceuticals (Pvt) Ltd.
Vonder Standpharm Pakistan (Pvt) Ltd.
Welflux Welmark Pharmaceuticals
Xetin Epoch Pharmaceutical
Xutin Genome Pharmaceuticals (Pvt) Ltd
Zactin Fozan Pharmaceuticals Industriers (Pvt) Ltd
Zauxit Zafa Pharmaceutical Laboratories (Pvt) Ltd.

Fluoxetine (Hcl) [Caplet 20 Mg]
Fluxac Helicon Pharmaceutek Pakistan (Pvt) Ltd.
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