Selective serotonin reuptake inhibitors include-

Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Citalopram, Escitalopram

Refer- Fluoxetine

 Interacting drugs - summary

 Fluvoxamine +  Tricyclic antidepresants

Plasma TCA levels may be increased

Fluvoxamine + Benzodiapines                                                                               Clearance of benzodiazepines may be decreased

Fluvoxamine + Beta blockers                                                                                       Propranol plasma levels have increased fivefold,

Fluvoxamine + Carbamazepine                                                                                    Serum carbamazepine levels may be increased

Fluvoxamine + Clozapine                                                                                           Elevated serum levels have occurred

Fluvoxamine + Dilitiazem                                                                                              Bradycardia has occurred with concurrent use

Fluvoxamine +  L-tryptophan                                                                                  Concurrent use with fluoxetine produce toxicity

Fluvoxamine + Methadone                                                                                             Significantly increased methadone, plasma dose level

Fluvoxamine + smoking                                                                                             Smokers had a 25% increase in metabolism of fluvoxamine

Fluvoxamine + Theophylline                                                                                      Clearance of theophylline may be decreased

Fluvoxamine +  Warfarin                                                                                   Pharmacodynamic interaction (increased bleeding)

Headache, asthena, flu syndrome, chills, palpitations, nausea, diarrhoea, constipation, dyspepsia, anorexia, vomiting, flatulance, tooth disorder, somnolence.

Reports not available

Approved by FDA on December5,1994

Indications:

Depression

Dosage:

Initial : Recommended starting dose is 50mg as a single bedtime dose. In trials, patients are titrated with a range of 100 to 300mg/day. Increase dose in 50mg increments every 4 to 7 days,as tolerated,until maximum therapeutic benefits is acheived

. Recommende not to exceed 300mg/day.

Advisable to give total daily dose of less than 100mg in two divided doses

. If doses are unequal,give larger dose at bed time.

EVIDENCE BASED MEDICINE (MIMS- April 2003)

Premenstrual sydrome

Comparative effectiveness of various intreventions

Beneficial

Overall Premenstrual Syndrome

Symptoms

1. Prostagalndin inhibitors (e.g. Indomethicin)

2. Selective serotonin Reuptake Inhibitors (e.g. Fluoxetine, Seratinine, Fluvoxamine) Breast symptoms only

1. Leuteal phase control

2. Bromocriptine Bloatedness and Swelling

1. Spironolactone/ diuretics

Likely to be beneficial

1. Tobolone

2. Oestrogen

3. Vitamin B-6

4. Evening primrose B-6

Trade-off between Benefits and Harms

1. Danazol

2. Gonodotropin-releasing hormone (GnRH analogues)

3. Non-SSRI antidepressants/ anxiolytics

4. Hysterectomy with/without oophorectomy

Unknown effectiveness

1. Progesterone

2. Progestogens

3. Oral contraceotives

4. Cognitive behaviour treatment

5. Dietary supplements

6. Relaxation treatment

7. Endometrial ablation

8. Laproscipic bilateral oophorectomy

KEY POINTS

1. Trials have found that SSRIs and prostagalndin inhibitors relieve premenstrual symptoms. Antidepressants and ovulation suppression with danazol and GnRH analoges are also effective but have significant adverse effects, including the masculanising effects of danazol and the menopausal effects of GnHR analogues

. 2. There is a limited evidence suggesting that oestrogen, viatmin-B6 , evening Primrose Oil and excercise may also be beneficoial

3. Trials have found that bromocriptine is effective for breast symptoms and diuretics are effective for bloatedness and swelling. Both can have adverse efects.

4. There is no good evidence to support the use of progesterone or oral contraceptives

5. Few treatments have been adequately validated in trials.

1. May cause dizziness. Observe caution while driving or performing tasks requiring alertness, coordination or physical dexterity.

2.Avoid alcohol or other CNS depressants medicines.

3. Concomitant medication- Consult physician or pharmacist before taking concomittant OTC products or prescription drugs

4. Pregnancy or lactation- Notify physician of pregnancy, ofintent to become pregnant or if breast feeding

5. Rash- Notify physician if rash hives develop.

6.Completing course of therapy- While patients may notice improvement in therapy in 1 to 4 eweeks, advise patients to continue theraoy as directed.

Refer Fluoxetine

Not known.

Refer Fluoxetine.