Fluoxetine + Alprazolam Pharmacology

Fluoxetine + Alprazolam

About Fluoxetine + Alprazolam
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Mechanism of Action of Fluoxetine + Alprazolam
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Pharmacokinets of Fluoxetine + Alprazolam
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Onset of Action for Fluoxetine + Alprazolam
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Duration of Action for Fluoxetine + Alprazolam
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Half Life of Fluoxetine + Alprazolam
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Side Effects of Fluoxetine + Alprazolam
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Contra-indications of Fluoxetine + Alprazolam
N/A
Special Precautions while taking Fluoxetine + Alprazolam
N/A
Pregnancy Related Information
Contraindicated
Old Age Related Information
N/A
Breast Feeding Related Information
Contraindicated
Children Related Information
N/A
Indications for Fluoxetine + Alprazolam
Depression, Panic disorder
Interactions for Fluoxetine + Alprazolam
N/A
Typical Dosage for Fluoxetine + Alprazolam
Varies with weight and severity of the disease.The dosage has to be decided by the treating specialist
Alprazolam: 0.25mg
Fluoxetine hydrochloride: 20mg
Schedule of Fluoxetine + Alprazolam
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Storage Requirements for Fluoxetine + Alprazolam
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Effects of Missed Dosage of Fluoxetine + Alprazolam
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Effects of Overdose of Fluoxetine + Alprazolam
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Fluoxetine

About Fluoxetine
Selective Serotonin Reuptake Inhibitor, Antidepressant.
Mechanism of Action of Fluoxetine
Fluoxetine preferentially inhibits the re-uptake of Serotonin (5 HT) in the CNS nerve terminals .This will result in an increased concentration of neurotransmitter Serotonin in the synaptic cleft and produces antidepressant effect. Fluoxetine has only less affinity towards Dopaminergic, Cholinergic and Adrenergic receptors.
Pharmacokinets of Fluoxetine
Absorption: It is well absorbed after oral administration. Distribution: It is very widely distributed in the body in protein bound form. Metabolism: Fluoxetine is extensively metabolised in the liver to Norfluoxetine. Excretion: Excreted mainly through urine.
Onset of Action for Fluoxetine
2- 4 weeks
Duration of Action for Fluoxetine
Up to 6 weeks
Half Life of Fluoxetine
2 - 9 days
Side Effects of Fluoxetine
1.Drowsiness
2.Headache
3.Nervousness
4.Insomnia
5.Anxiety
6.Dizziness
7.Tremor
8.Fatigue
9.Asthenia
10.Anorexia
11.Nausea
12.Diarrhoea
13.Dry mouth
14.Sweating
15.Pruritis
16.Rash.
Contra-indications of Fluoxetine
Hypersensitivity to Fluoxetine
Special Precautions while taking Fluoxetine
1.Hepatic disease
2.Renal disease
3.Cardiovascular disease
4.Epilepsy
5 Diabetes mellitus
6.Patient on MAOI therapy (Discontinue the MAO inhibitor at least 2 weeks before Fluoxetine is started)
7.Alcoholics
8.Patient at high risk of suicide
9.Slowly withdraw the drug with caution
10.Patient should be cautioned against driving vehicle, operating machine and activities requiring mental alertness or judgment
Pregnancy Related Information
Contraindicated.
Old Age Related Information
Use with caution.
Breast Feeding Related Information
Contraindicated.
Children Related Information
Contraindicated.
NEONATES: contraindicated
Indications for Fluoxetine
1.Depression
2.Panic disorder
3.Obsessive compulsive disorder
4.Obesity
5.Bulimia nervosa.
Interactions for Fluoxetine
MAOIs: Serious life threatening reactions. At least 14 days should elapse after MAOIs withdrawal and initiation of fluoxentine. At least 5 weeks should elapse after fluoxentine withdrawal and initiation of the therapy with MAOIs.
Diazepam: Half-life of diazepam prolonged.
Haloperidol: Chances of severe extrapyramidal reactions.
Lithium: Serum lithium levels increased leading to toxicity.
TCAs: Efiicacy and toxic effects of TCAs enhanced.
Warfarin, Digoxin: Since tightly bound to plasma proteins, concomitant use of other drugs bound to plama proteins may cause shift in plasma concentration resulting in adverse effects.
Typical Dosage for Fluoxetine
Adult:
Depression, Panic disorder: Initial dose: 20 mg in the morning for 1 month. Dose can be increased to 40 mg / day in two divided doses (20 mg at morning and 20 mg at noon) if sufficient response does not occur
Maximum dose: 80 mg / day
Obsessive compulsive disorder, Obesity: 20 - 60 mg / day
Bulimia nervosa: 60 - 80 mg / day
Schedule of Fluoxetine
H
Storage Requirements for Fluoxetine
Store at 15 - 25 degree C. Keep out of the reach of children.
Effects of Missed Dosage of Fluoxetine
Take the missed dose as soon as noticed and if it is the time to take the next dose then skip the missed dose.
Effects of Overdose of Fluoxetine
Give supportive measures and symptomatic treatment. Gastric lavage can be done to eliminate the drug from the body. Charcoal can be given to reduce the absorption of the drug.

Alprazolam

About Alprazolam
Benzodiazepine derivative, Anti anxiety.
Mechanism of Action of Alprazolam
Alprazolam mainly acts on Limbic system and ascending reticular formation in the CNS and binds to the BZD receptor. The binding will facilitates GABA mediated chloride channel opening and produce hyperpolarisation. This will produce an increase in the concentration of the inhibitory neurotransmitter GABA and increase in chloride ions and decreases firing rate of neuron. This in turn alters normal functions of the body.
Pharmacokinets of Alprazolam
Absorption: It is well absorbed after oral administration. Distribution: It is distributed widely in the body in protein bound form. Metabolism: It is metabolised to active and inactive metabolite in the liver. Excretion: Drug is excreted in urine.
Onset of Action for Alprazolam
15 - 30 minutes
Duration of Action for Alprazolam
12 - 16 hours
Half Life of Alprazolam
12 -15 hours
Side Effects of Alprazolam
1.Ataxia
2.Drowsiness
3.Light headedness
4. Slurred speech
5.Nausea
6.Constipation or diarrhoea
7.Tremor
8.Dependence
9.Anorexia
0.Confusion
11.Light headedness
12.Mood changes
13.Muscle rigidity
14.Amnesia
Contra-indications of Alprazolam
1.Hypersensitivity to Benzodiazepines
2.Acute angle closure glaucoma
Special Precautions while taking Alprazolam
1.Renal impairment
2.Hepatic impairment
3.Pulmonary insufficiency
4.Drug abuse
5.Bipolar disorder
6.Driving vehicles and operating machines and people involving any other dangerous activities
Pregnancy Related Information
Contraindicated
Old Age Related Information
Use with caution
Breast Feeding Related Information
Contraindicated
Children Related Information
Contraindicated
NEONATES- contraindicated
Indications for Alprazolam
1.For the short-term management of anxiety,
2.Treatment of Panic disorder.
Interactions for Alprazolam
Alcohol & other CNS depressants: Enhanced CNS effects.
Aminophylline: Antagonizes the sedative effect.
Cimetidine, Oral contraceptives, Disulfiram, Fluoxetine, Isoniazid, Ketoconazole, Metoprolol, Propoxyphene, Propranolol,
Valproic Acid: Elimination of alprazolam decreased due to inhibition of hepatic metabolism leading to enhanced activity.
Digoxin: Increase in serum concentration of Digoxin.
Imipramine & Desipramine: Enhanced activity of these drugs.
Levodopa: Decrease in antiparkinsonism efficacy.
Rifampicine: Decreases efficacy.
Typical Dosage for Alprazolam
Adult:
Anxiety: 0.25 - 0.5 mg every 8 hours in a day. Depending on the severity of the disease the dose can be gradually increased every 3 or 4 days.
Maximum dose: 4 mg / day in divided dose.
Anxiety with depression: 0.5 mg every 8 hours in a day
Maintenance dose: 1.5 - 4.5 mg/ day in divided dose
Panic disorder: starting dose: 1.5 mg /day in 3 divided dose. Depending on the severity of the disease the dose can be gradually increased every 3 or 4 days.

Children: Not recommended
Schedule of Alprazolam
H
Storage Requirements for Alprazolam
The drug should be kept at 15 - 30 degree C in a tightly closed container. Keep out of the reach of children
Effects of Missed Dosage of Alprazolam
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose.
Effects of Overdose of Alprazolam
Give supportive measures and symptomatic treatment. Flumazenil can be given as antagonist. Hypotension can be treated with vasopressors.If the patient is conscious induce emesis followed by charcoal administration

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