氟西汀

用途

• Adjunctive treatment of aggression
• To help control urine marking or separation anxiety
• To control pruritus when other therapies have failed
• Generalized anxiety disorder
• Urine spraying, psychogenic alopecia, and aggression
• Treatment of canine separation anxiety in conjunction with a behavior modification plan
• Separation anxiety and noise aversions
• Adjunctive pharmacological intervention for conflict-related aggression
• Compulsive disorders
• Adjunctive treatment of behavior disorders
• Adjunctive treatment of behavior disorders
• Separation anxiety, compulsive disorders, and aggression

給藥方式

可能的副作用

• Anorexia or decreased appetite (common, often transient)
• Lethargy or depression
• Gastrointestinal upset (vomiting, diarrhea)
• Anxiety, irritability, or restlessness
• Insomnia or hyperactivity
• Panting (dogs)
• Changes in elimination patterns (cats)
• Paradoxical aggressive behavior (in previously unaggressive animals)
• Seizures (rare but possible)
• Lethargy
• Decreased appetite
• Vomiting
• Weight loss
• Trembling
• Restlessness
• Gastrointestinal disturbances
• Paradoxical increase in anxiety
• Increased aggression

注意事項與禁忌

• Known hypersensitivity to fluoxetine
• Concurrent use of Monoamine Oxidase Inhibitors (MAOIs), including selegiline and amitraz (found in some tick collars)
• Patients with epilepsy or a history of seizures
• Concurrent use with drugs that lower the seizure threshold (e.g., acepromazine, chlorpromazine)
• Known sensitivity to fluoxetine or other SSRIs
• History of seizures or epilepsy
• - **Seizure Disorders:** Use is contraindicated in patients with a history of seizures. - **Diabetes Mellitus:** Use with caution as fluoxetine may alter blood glucose levels, necessitating insulin adjustments. - **Hepatic Impairment:** Dosages may need to be reduced in patients with severe liver disease due to decreased clearance. - **Tapering:** Because of the long half-life of the active metabolite (norfluoxetine), tapering off the drug is generally only necessary when a patient has been on the drug long-term (>8 weeks). - **Pregnancy/Nursing:** Safety is not fully established (FDA Category C in humans). Excreted in milk at 20-30% of plasma levels; use caution in nursing animals.

藥物相互作用

• BUSPIRONE: Increased risk for serotonin syndrome
• CYPROHEPTADINE: May decrease or reverse the effects of SSRIs (acts as a serotonin antagonist)
• DIAZEPAM, ALPRAZOLAM: Fluoxetine may increase diazepam and alprazolam plasma levels
• DIURETICS: Increased risk for hyponatremia
• INSULIN: May alter insulin requirements (can alter blood glucose)
• ISONIAZID: Increased risk for serotonin syndrome
• MAO INHIBITORS (e.g., amitraz, selegiline): High risk for serotonin syndrome; use contraindicated. A 5-week washout is required after stopping fluoxetine before starting an MAOI, and a 2-week washout if switching from an MAOI to fluoxetine.
• PENTAZOCINE: Serotonin syndrome-like adverse effects possible
• PHENYTOIN: Increased plasma levels of phenytoin possible
• PROPRANOLOL, METOPROLOL: Fluoxetine may increase these beta-blocker's plasma levels; atenolol may be safer to use
• TRAMADOL: SSRIs can inhibit the metabolism of tramadol to active metabolites, decreasing efficacy and increasing toxicity risk (serotonin syndrome, seizures)
• TRICYCLIC ANTIDEPRESSANTS (e.g., clomipramine, amitriptyline): Fluoxetine may increase TCA blood levels and increase the risk for serotonin syndrome
• TRAZODONE: Increased plasma levels of trazodone possible
• WARFARIN: Fluoxetine may increase the risk for bleeding
• Monoamine Oxidase Inhibitors (MAOIs) (e.g., selegiline): Risk of fatal serotonin syndrome. Fluoxetine should not be used within 2 weeks of MAOI treatment, and MAOIs should not be used within 6 weeks of fluoxetine treatment.
• Anticonvulsants: Fluoxetine antagonizes the effects of anticonvulsants and lowers the seizure threshold.
• Phenothiazines: Lowers seizure threshold, increasing the risk of seizures.
• Aspirin and other anticoagulants: Increased risk of bleeding in the case of tissue trauma.
• Serotonergic agents (e.g., Trazodone): Increased risk of serotonin syndrome. Use alongside trazodone may be considered in exceptional cases only with careful monitoring.
• Other serotonergic agents: Increased risk of serotonin syndrome.

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