Fludac (Fluoxetine HCl)
Also sold as: Fludac, Prodep, Flunil, Prozac
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Capsule 10/20/40/60mg +1
Indications
- MDD (including pediatric)
- OCD (incl. pediatric)
- Bulimia nervosa
- Premenstrual dysphoric disorder
- Panic disorder
Adult Dosing
Most
Start 10-20 mg OD; max 80 mg/day
Pediatric Dosing
FDA-approved for pediatric depression. Monitor suicidality.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| No adjustment needed | No CrCl-based adjustment |
Hepatic Adjustment
Reduce dose / increase interval
Pregnancy & Lactation
Pregnancy: Category C
Most data among SSRIs; small risks (PPHN, withdrawal)
Lactation: Caution
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| MAOIs | CONTRAINDICATED — washout 5 weeks (long half-life) | Major |
| Tramadol, triptans, linezolid | Serotonin syndrome | Major |
| Pimozide, thioridazine | CONTRAINDICATED — QT | Major |
| NSAIDs, anticoagulants | Bleeding | Major |
| CYP2D6 substrates (metoprolol, codeine, tamoxifen) | Altered metabolism | Moderate |
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Side Effects
Common
- Nausea
- Insomnia (more activating than other SSRIs)
- Sexual dysfunction
- Headache
- Anxiety initially
Serious / Discontinue If
- Suicidality (early, <25y)
- Serotonin syndrome
- Hyponatremia
- Bleeding
- Long withdrawal due to long half-life (sometimes used to taper other SSRIs)
Contraindications
- MAOI within 2 weeks (5 weeks if from fluoxetine)
- Pimozide, thioridazine
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Fludac 20 | Cadila | 10 cap ₹35 |
| Prodep 20 | Sun Pharma | 10 cap ₹38 |
Monitoring Required
- Mood, suicidality, Na+
- Wash out 5 weeks before MAOI
Patient Counseling Points
- Take in morning (activating)
- Effect at 4-6 weeks
- Long half-life — less withdrawal but slower exit
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References
- BNF
- Lexicomp
- Indian National Formulary
- Specialty society guidelines