Seromex is an antidepressant. The active ingredient ofSeromex is Fluoxetine hydrochloride.

Seromex is approved for the treatment of major depression (including child depression). Seromex is also used for relieve obsessive-compulsive disorder (in both adult and pediatric populations), bulimia nervosa, anorexia nervosa, panic disorder and pre-menstrual unpleasant feeling. Despite the availability of newer agents, Seromexremains extremely popular. fluoxetine Prozac Neuropharmacology A selective inhibitor of serotonin reuptake used for clinical depression and other psychiatric disorders Adverse effects Anxiety, nervousness, tremor, insomnia, diarrhea, nausea, anorexia, undesired weight loss, sexual dysfunction Contraindications MAOI therapy. See Serotonin-selective reuptake inhibitor.

          

excessive diarrhea weight loss/gain (measured by a change in bodyweight of 7 pounds) increased risk of bone fractures and injuries changes in sexual behaviour (see the next section) increased feelings of depression and anxiety (which may sometimes provoke panic attacks) mania and psychotic disorders tremors (and other symptoms of Parkinsonism in vulnerable elderly patients)[20] autonomic dysfunction including orthostatic hypotension, increased or reduced sweating akathisia renal impairment suicidal ideation (thoughts of suicide) photosensitivity Paresthesia dissociative disorders, cognitive disorders and loss of contact with reality Syndrome of inappropriate antidiuretic hormone hypersecretion
[21]

Fluoxetine (Prozac, Fontex, Seromex, Seronil, Sarafem, Fluctin) Fluoxetine was the first SSRI antidepressant approved for use in the US and was introduced by Eli Lilly in 1987. The patent expired in 2001 and fluoxetine is now available as a generic medication. Fluoxetine was derived from diphenhydramine (Benadryl), an antihistamine that was known to have antidepressant properties. The introduction of SSRI antidepressants dramatically changed the treatment of depression and SSRIs have become the most prescribed medications in the world. Adverse effects General side effects are mostly present during the first 1 4 weeks while the body adapts to the drug (with the exception of sexual side effects, which tend to occur later in treatment). In fact, it often takes 6 8 weeks for the drug to begin reaching its full potential (the slow onset is considered a downside to treatment with SSRIs). Almost all SSRIs are known to cause one or more of these symptoms:

   

Many side effects disappear after the adaptation phase, when the antidepressant effects begin to come to prominence. However, despite being called general, the side effects and their durations are highly individual and drug-specific. Usually the treatment is begun with a small dose to see how the patient's body reacts to the drug, after that either the dose can be adjusted (e.g. Prozac in the UK is begun at a 20 mg dose, and then adjusted as necessary to 40 mg or 60 mg). Should the drug prove ineffective, or the side effects intolerable to the patient, another common route is to switch treatment to either another SSRI, or an SNRI.[22] Mania or hypomania is a possible side effect. Users with some type of bipolar disorder are at a much higher risk, however SSRI-induced mania in patients previously diagnosed with unipolar depression can trigger a bipolar diagnosis. Depression 20-40 mg/day. Initial dose is 20 mg/day with weekly increases up to a maximum of 40 mg/day.

             

anhedonia apathy nausea/vomiting drowsiness or somnolence headache bruxism tinnitus extremely vivid or strange dreams dizziness fatigue mydriasis (pupil dilation) urinary retention changes in appetite insomnia and/or changes in sleep

The dose of fluoxetine may need to be decreased in elderly people and those with liver problems. An extended release form of fluoxetine is available from Eli Lilly. Prozac Weekly is available in 90 mg tablets and is taken once a week after therapeutic levels have been established with fluoxetine 20 mg/day. The first weekly tablet is taken 7 days after the last daily tablet. Prozac Weekly doesn't provide adequate antidepressant activity for everybody.

It takes several weeks for people to experience the full therapeutic effect of fluoxetine. The elimination half-life (amount of time it takes to metabolize half of the daily dose) is 4-6 days, and the elimination half-life of the metabolite norfluoxetine is 16 days or more. That means that it takes several weeks or months to completely eliminate fluoxetine from your system. How fluoxetine works Although the exact cause or causes of depression is unknown, it is increasingly clear that a biochemical imbalance is involved. Several neurotransmitters-dopamine, norepinephrine and serotonin-seem to play a part in anxiety and mood regulation, with serotonin being the most important. Fluoxetine and other SSRI antidepressants block the reabsorption of serotonin by nerve cells in the brain and throughout the body, allowing serotonin to accumulate and reestablishing biochemical balance. Fluoxetine was one of the earliest SSRI's and is not as "serotonin specific" as newer ones, so it has some effect on dopamine and norepinephrine, too. Fluoxetine is metabolized in the liver before it is excreted in the feces. When a substance is metabolized, it is broken down into other compounds. Some of these compounds are biologically inactive and are excreted; some are biologically active, and are called "active metabolites." Fluoxetine has one active metabolite, norfluoxetine, that has the same action as the parent compound. This extends the half-life (the amount of time the drug is active in your body) of fluoxetine significantly. There is considerable genetically determined variability in how rapidly people metabolize fluoxetine. That is why different people need different doses, and is also why Prozac Weekly is not effective for some people-they metabolize the medication too quickly. Side effects Most people who take SSRIs experience mild to moderate side effects initially; those side effects usually get better over time. The most common side effects experienced with fluoxetine are:

Interactions Fluoxetine interacts with many medications, especially those that are metabolized in the liver and those that have an effect on serotonin. Some of the medications that interact with fluoxetine are:

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Tricyclic antidepressants Antipsychotic medications-thioridazine (Mellaril) should not be taken concurrently with fluoxetine because there is a risk of developing life-threatening heart dysrhythmias. Antiarrhythmic medications Anticonvulsive medications Benzodiazepines (a type of antianxiety medication) Aspirin, non-steroidal anti-inflammatory medications Warfarin Serotonergic medications (medications that affect serotonin)-these can cause serotonin syndrome o MAOI (monamine oxidase inhibitor), other SSRI and SNRI (serotonin-norepinephrine reuptake inhibitor) antidepressants o Triptans (medications for migraine headache) o Lithium o St. John's Wort, valerian, kava kava o Tramadol (a pain medication) o Cocaine, Ecstasy and other recreational drugs

Withdrawal Abrupt discontinuation of SSRIs can cause unpleasant withdrawal symptoms. Because fluoxetine lasts so long in the body, withdrawal symptoms may not be as severe as with other SSRI's, but they can still occur and the dose should be gradually tapered before stopping the medication. Symptoms of fluoxetine withdrawal include:

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Mood instability Irritability, agitation, anxiety Dizziness Sensations of electrical shock Headache, lethargy or insomnia

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Restlessness and anxiety Headache Flu-like syndrome Digestive problems-dry mouth, loss of appetite, nausea, flatulence, heartburn, diarrhea or constipation Sleep problems-somnolence or insomnia Rash or hives Dizziness Sweating Tremor or seizures Sexual side effects

Warnings, precautions and contraindications Increased risk of suicide: Recent studies suggest that there is an increased risk of suicide in the early weeks of therapy. Although this phenomenon was initially observed in children and an FDA warning was mandated related to the use of antidepressants in children, further observations have caused the warning to be extended to adolescents and young adults. All people who start taking fluoxetine, regardless of age, should be monitored closely for the first several weeks. This includes:

For more information about serious side effects, see the section on Warnings and Precautions.

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At least weekly face-to-face appointments with a physician or therapist At least daily monitoring by family or friends Eliciting (asking about) information about thoughts of suicide or self-harm

Observation by self and others for agitation, mood changes, restlessness, unusual thoughts and other symptoms.

hyperplasia, co-administration of MAO inhibitors, convulsions of various origins, epilepsy, pregnancy, lactation, hypersensitivity to fluoxetine. Using during pregnancy and breastfeeding Seromex is contraindicated during pregnancy and lactation. Special instructions Seromex should be used with caution in patients with impaired liver and kidney, with a history of epileptic seizures, cardio-vascular diseases. Patients with diabetes may change in blood glucose levels that require correction dosing regimen of hypoglycemic drugs. When applied in debilitated patients with fluoxetine increases the risk of epileptic seizures. With the simultaneous application of Seromex and electroconvulsive therapy may develop prolonged seizures. Fluoxetine can be applied not earlier than 14 days after discontinuation of MAO inhibitors. The period after the abolition of fluoxetine before therapy MAO inhibitors should not be less than 5 weeks. Elderly patients need correction of dosing regimen. Safety of fluoxetine in children has not been established. During the period of treatment it needed to avoid use alcohol. During the period of treatment should refrain from potentially hazardous activities requiring increased attention and rapid psychomotor reactions.

There is some concern that a small percentage of individuals are at risk for paranoia and violence rather than suicide. Any alterations in thought processes, mood or anxiety must be reported to the physician immediately. Serotonin Syndrome: Serotonin syndrome is a toxicity syndrome that occurs in SSRI overdose or when more than one serotonergic medication is taken. Because many, many medications affect serotonin, it is important to make sure your doctor and pharmacist know about all medications, over the counter medications, natural remedies, recreational drugs, herbal teas, nutritional supplements and vitamins you take. The symptoms of serotonin syndrome begin abruptly and dramatically minutes or hours after the offending medication is taken. The early symptoms are shivering, anxiety, rapid heart rate, tremors and twitches and anxiety. Symptoms may progress to fever, high blood pressure, sweating, muscle contractions and agitation. In severe serotonin syndrome, there may be cardiovascular collapse and shock, fever over 104F, muscle rigidity, seizures, hallucinations, coma, multiple organ failure and death. Allergies: Allergic reactions to fluoxetine are rare but do occur. Rashes, hives and anaphylaxis have been observed. Vasculitis: On rare occasions people have developed a lupus-like vasculitis. This syndrome usually begins with a rash and progresses to involve the lungs, kidneys and liver. It can result in organ failure and death. Post SSRI Sexual Dysfunction: Transient sexual dysfunction is common in both men and women after starting fluoxetine. Usually it resolves after taking the medication for a few weeks; occasionally it may be necessary to discontinue fluoxetine, and symptoms resolve within a few weeks of discontinuation. Occasionally, however, sexual dysfunction may persist for months or years or may never resolve. The sexual side effects most often seen are decreased libido, female anorgasmia and ejaculatory dysfunction. Pregnancy: SSRIs, including fluoxetine, are contraindicated in women who are pregnant or who wish to become pregnant. They are associated with cardiac birth defects and pulmonary hypertension of the newborn. Uses of fluoxetine Fluoxetine is approved for the treatment of depression and obsessive compulsive disorder in adults and children. It is the only antidepressant approved in the US for use in children. It is also approved to treat bulimia, panic disorder, premenstrual dysphoric disorder (PMDD), hypochondriasis, and body dysmorphic disorder. It is used off label to treat a wide range of other problems such as alcoholism, attention deficit disorder (ADD), borderline personality disorder, obesity, sexual problems and phobias Seromex contraindications Glaucoma, bladder atony, severe renal dysfunction, benign prostatic

(Fluctan, Prozac, Fontex, Serafem, Seronil, Fluoxetine)

Seromex (Prozac) is an antidepressant in a group of drugs called Selective Serotonin Reuptake Inhibitors (SSRIs). Serotonin influences the cardiovascular, renal, immune and gastrointestinal systems, and is essential to regulate body temperature, heart rate, blood pressure and the sympathetic nervous system. The most common side effects of SEROMEX are nausea, insomnia, anorexia, drowsiness, anxiety, nervousness, tremors and weakness, but a serious rash developed in 7% of patients in the clinical trials. Akathasia, or inner restlessness is also a common side effect ofSEROMEX.

SEROMEX has a longer half-life than most antidepressants meaning it stays in the body longer. Therefore the symptoms may take up to 25 days to appear. According to Dr. Joseph Glenmullen, 14% of SEROMEX users will experience withdrawal symptoms. But

he also believes many cases are missed due to the long half-life of the drug and therefore the numbers are much higher.

SSRIs mechanism of action is on Serotonin, a hormone also called 5hydroxytrptamine, found in the pineal gland, blood platelets, digestive tract and the brain. Serotonin acts as both a chemical messenger that transmits nerve signals between nerve cells and causes the blood vessels to narrow. Serotonin makes blood clots form and is a muscle as well as a vasoconstrictor, but it also plays an important role in sleep, appetite, memory, aggression, sexual behavior, cardiovascular activity, respiratory activity, motor output, neuroendocrine and sensory function, and perception. According to Dr. Ann Blake Tracy, an increase in Serotonin produces rushes of insulin that drops blood sugar levels and can create a chemically induces hypoglycemia (low blood sugar). Additionally, too much Serotonin damages blood vessels, particularly in the lungs and may adversely affect heart valves. This is because Serotonin is a powerful vasoconstrictor (narrows the blood vessels).

seizures or epilepsy; bipolar disorder (manic depression); or a history of drug abuse or suicidal thoughts Do not crush, chew, break, or open an extended-release fluoxetine capsule. Swallow it whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

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Before taking fluoxetine Do not use fluoxetine if you are using any of the following drugs:

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pimozide (Orap); thioridazine (Mellaril); or an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate).

Serious and sometimes fatal reactions can occur when these medicines are taken with fluoxetine. You must wait at least 14 days after stopping an MAO inhibitor before you can take fluoxetine. You must wait 5 weeks after stopping fluoxetine before you can take thioridazine (Mellaril) or an MAOI. To make sure you can safely take fluoxetine, tell your doctor if you have any of these other conditions:

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cirrhosis of the liver; kidney disease; diabetes; glaucoma;