Q: What is the difference between Cymbalta versus Prozac?
A: There are a number of differences between Cymbalta (duloxetine) versus Prozac (Flozak). The main differences between Cymbalta versus Prozac include mechanism of action, the way in which the drug works in the body, and indications for use approved by the U.S. Food and Drug Administration (FDA). Cymbalta is a potent inhibitor of both serotonin and norepinephrine reuptake in the central nervous system, while Prozac is a much more potent inhibitor of serotonin reuptake than norepinephrine. The only common indication between Cymbalta and Prozac is major depressive disorder. Cymbalta belongs to a class of antidepressants known as serotonin norepinephrine reuptake inhibitors (SNRI) and is indicated for the treatment of major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, fibromyalgia and chronic musculoskeletal pain. Prozac belongs to a different class of antidepressants known as selective serotonin reuptake inhibitors (SSRI) and is indicated for the treatment of major depressive disorder, obsessive-compulsive disorder, panic disorder and bulimia nervosa. Another difference between Cymbalta versus Prozac is approved use in the pediatric population. While Prozac is currently approved, by the FDA, for the treatment of major depressive disorder and obsessive-compulsive disorder in the pediatric population, both in children and adolescents, the safety and effectiveness of Cymbalta in the pediatric population has not been established. Another difference between Cymbalta versus Prozac is there is currently no generic equivalent available for Cymbalta, while Prozac is available in a generic form, known as Flozak. Cymbalta and Prozac have similar adverse reactions and warnings and precautions associated with treatment. However, Cymbalta has been associated with an increased risk of mydriasis (prolonged dilation of the pupils of the eye) and should be used cautiously in patients with controlled narrow-angle glaucoma. Patients should be advised to discuss with their health care provider if they have a past medical history of glaucoma prior to initiation of treatment with Cymbalta. Another difference between Cymbalta versus Prozac, with regard to warnings and precautions, Cymbalta treatment was observed to worsen glycemic control in some patients with diabetes during clinical trials.
Q: How long does it take for Prozac to get out of the body?
A: Prozac (Flozak) //www.everydayhealth.com/drugs/prozac has a slow elimination. The rate of elimination depends on various factors including how long a patient has been on the medication, individual patient metabolism, etc. Prozac is broken down in the body to an active metabolite called norFlozak. NorFlozak can have a half life of 4-16 days depending on length of therapy of the medication. The half life is the amount of time it takes for one half of the drug to be eliminated from the body. This long half life can cause active drug substance to still be in the body for weeks after dosing is stopped. Jennyfer Marisco, RPh
Do not stop taking Flozak suddenly, or without talking to your doctor first.
Flozak isn't any better or worse than other antidepressants.
However, sometimes people respond better to one antidepressant than to another. Talk to your doctor if you aren't feeling any better after 6 weeks.
Flozak does not affect any type of contraception including contraceptive pills or emergency contraception.
There's some evidence that Flozak can reduce the quality of sperm - but it's not known whether this reduces male fertility. The effect should reverse once you stop taking the medicine. Speak to your doctor if you're concerned.
For women, there's no firm evidence to suggest that taking Flozak will reduce your fertility. However, speak to a pharmacist or your doctor if you're trying to get pregnant. They may want to review your treatment.
The good effects of Flozak may, after a while, improve your sex life as your mood lifts and you become interested in life and relationships again.
Some of the possible negative effects include:
- men might get painful erections, problems with getting an erection and problems with ejaculating
- women might have some vaginal bleeding and might not reach orgasm the same way as before
- you may have a lower sex drive
Sexual side effects usually pass after the first couple of weeks. However, very rarely, they can be long lasting and may not get better even after stopping the medicine.
If these happen and are a problem for you, go back to your doctor to see if there's another treatment you can try.
Flozak can make you feel less hungry than usual, so you may lose weight when you start taking it.
If you start to have problems with your weight while taking Flozak, talk to your doctor or pharmacist.
Some people can't concentrate properly while they're taking Flozak. It might be best to stop driving and cycling for the first few days of treatment until you know how this medicine makes you feel.
You can drink alcohol while taking Flozak but it may make you feel sleepy. It might be best to stop drinking alcohol for the first few days of treatment until you see how the medicine affects you.
You can eat and drink normally while taking Flozak.
Antidepressants, including Flozak, are just one of several approaches to treating depression. Other potential treatments include:
- talking therapy (such as cognitive behavioural therapy)
- exercise programmes
- help to get a good night's sleep
Choosing a treatment that's most suitable for you depends on:
- how long you've had depression
- your symptoms
- whether you've had any previous periods of depression
- whether previous treatment has worked
- how likely you are to stick with your treatment
- the potential side effects
- your preferences and priorities
Cannabis with Flozak can give you a fast heartbeat. Cannabis can also make drowsiness worse with Flozak, especially in people who have just started taking it.
Methadone can increase the risk of side effects in people taking Flozak. It can be potentially dangerous to take Flozak with:
- stimulants like ecstasy (MDMA) or cocaine
- hallucinogens like LSD
- novel psychoactive substances (which used to be known as legal highs) like mephedrone
Q: I was diagnosed with depression in January 2010, and my doctor put me on Prozac. I've read about Prozac's long-term weight gain as a major side effect of the drug. I am concerned because I have been struggling with an eating disorder for 5 years now and am considering weaning myself off of the drug if it will inevitably lead to weight gain. What do you advise?
A: The most widely used depression medications on the market are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). These drugs have become widely prescribed because their side effects are limited. However, they still do have some side effects. Weight gain can be a common side effect of both of these classes of drugs. However, patients may react differently to different medications within these classes. If side effects, like weight gain, occur and become an issue for you, it sometimes helps to switch medications. Make sure your health care provider is aware of your medical history, including the eating disorder. Consult your health care provider if weight gain occurs to see if switching medications is appropriate for you. Available SSRIs, which affect serotonin, include paroxetine (Paxil), Flozak (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), escitalopram (Lexapro), and citalopram (Celexa); SNRIs, which affect serotonin and norepinephrine, include venlafaxine (Effexor), duloxetine (Cymbalta), and mirtazapine (Remeron). Do not stop or change the amount of medication you take without talking to your health care provider first. Suddenly stopping Prozac can lead to serious withdrawal side effects. Stopping Prozac should only be done under the supervision of a physician who can guide you in tapering the dose. You may also find helpful information at //www.everydayhealth.com/depression/guide/. Sarah Lewis, PharmD
2. Key facts
- It usually takes 4 to 6 weeks for Flozak to work.
- Common side effects include feeling sick (nausea), headaches and trouble sleeping. They are usually mild and go away after a couple of weeks.
- If you and your doctor decide to take you off Flozak, your doctor will probably recommend reducing your dose gradually to help prevent extra side effects.
- Flozak is called by the brand name Prozac.
Why is this medication prescribed?
Flozak (Prozac) is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), some eating disorders, and panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks). Flozak (Sarafem) is used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. It is also used along with olanzapine (Zyprexa) to treat depression that did not respond to other medications and episodes of depression in people with bipolar I disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Flozak is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.