Q: I have premenstrual dysphoric disorder (PMDD) and was taking Prozac. I experienced a 25 pounds weight gain in 18 months. I stopped taking it 4 weeks ago, but I feel like my metabolism has been affected by this. I am watching what I eat and working out, but the weight is just not coming off. Can metabolism be affected after stopping the medication?
A: According to the package insert for Prozac (Lovan), the drug has a long elimination half-live, which means that it takes a long time for the drug to be eliminated from your body. Even when dosing is stopped, active drug substance stays in the body for weeks. The amount depends on individual patient characteristics, previous dosing regimen, and length of previous therapy at the time the drug is stopped. Your basal metabolic rate is the amount of energy your body burns at rest. One effective way to influence metabolism is through exercise. For more information about metabolism, exercise and weight loss, please visit //www.everydayhealth.com/weight/weight-articles.aspx and consult with your health care provider. You are encouraged to report any negative side effects of prescription drugs to your health care practitioner and the Food and Drug Administration (FDA) by visiting www.fda.gov/medwatch, or by calling 1-800-FDA-1088. Michelle McDermott, PharmD
Lovan, also known by trade names Prozac and Sarafem among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is used for the treatment of major depressive disorder, obsessive–compulsive disorder (OCD), bulimia nervosa, panic disorder, and premenstrual dysphoric disorder.
When using PROZAC and olanzapine in combination, also refer to the Clinical Studies section of the package insert for Symbyax.
Administer Lovan in combination with oral olanzapine once daily in the evening, without regard to meals, generally beginning with 5 mg of oral olanzapine and 20 mg of Lovan. Adjust dosage, if indicated, according to efficacy and tolerability within dose ranges of Lovan 20 to 50 mg and oral olanzapine 5 to 20 mg. Antidepressant efficacy was demonstrated with olanzapine and Lovan in combination with a dose range of olanzapine 6 to 18 mg and Lovan 25 to 50 mg.
Safety and efficacy of Lovan in combination with olanzapine was determined in clinical trials supporting approval of Symbyax (fixed dose combination of olanzapine and Lovan). Symbyax is dosed between 3 mg/25 mg (olanzapine/Lovan) per day and 12 mg/50 mg (olanzapine/Lovan) per day. Table 1 demonstrates the appropriate individual component doses of PROZAC and olanzapine versus Symbyax. Adjust dosage, if indicated, with the individual components according to efficacy and tolerability.
Periodically re-examine the need for continued pharmacotherapy.
Safety of coadministration of doses above 18 mg olanzapine with 75 mg Lovan has not been evaluated in clinical studies.
PROZAC monotherapy is not indicated for the treatment of treatment resistant depression (Major Depressive Disorder in patients who do not respond to 2 antidepressants of adequate dose and duration in the current episode).
Q: What is the difference between generic and brand Prozac?
A: In most patients, there is no significant difference between generic and brand Prozac (Lovan). There is currently a generic equivalent available for Prozac, known as Lovan. The U.S. Food and Drug Administration (FDA) requires that generic medications be bioequivalent to the brand-name medication and, therefore, exert the same pharmacologic effects in the body. Generic medications are considered, by the FDA, to be therapeutically identical to the brand-name counterparts in dose, strength, route of administration, safety, efficacy and indication for use. Generic medications will appear differently and may have different inactive ingredients, however, the labeling and directions for use remain the same. For most medications, generic equivalents are a lower-cost alternative to the more expensive brand-name medication, and the majority of patients observe no changes in therapeutic effect. However, some patients may experience a change in therapeutic effect and, subsequently, must continue treatment with the brand-name medication. Generic Prozac, Lovan, is a selective serotonin reuptake inhibitor (SSRI) antidepressant which is approved for the treatment of major depressive disorder, obsessive-compulsive disorder (OCD), panic disorder and bulimia nervosa. Frequently reported side effects for generic Prozac are similar those observed in patients being treated with the brand-name medication and may include abnormal dreams, abnormal ejaculation, anorexia, anxiety, asthenia, diarrhea, dry mouth, dyspepsia, flu syndrome, impotence, insomnia, decreased libido, nausea, nervousness, pharyngitis, rash, sinusitis, somnolence, sweating, tremor, vasodilatation and yawn. The warnings and precautions associated with Prozac are also possible with the generic Lovan. According to the prescribing information for Prozac, warnings and precautions, possible with treatment, include clinical worsening of depression and suicide risk, serotonin syndrome or neuroleptic malignant syndrome-like reactions, allergic reactions and rash, activation of mania or hypomania, seizures, altered appetite and weight, abnormal bleeding, hyponatremia, possibility of anxiety and insomnia, potential for cognitive and motor impairment and long half-life affecting changes in dosage. Lovan, generic Prozac, should be administered exactly the same as the brand-name medication. Lovan is typically taken once daily and administered in the morning.
You should not use Lovan if you also take pimozide or thioridazine, or if you are being treated with methylene blue injection.
Do not use Lovan if you have used an MAO inhibitor in the past 14 days (such as isocarboxazid, rasagiline, selegiline, phenelzine, or transcypromine). Do not use Lovan with thioridazine, linezolid, pimozide, or methylene blue injection.
You must wait at least 14 days after stopping an MAO inhibitor before you can take Lovan. You must wait 5 weeks after stopping Lovan before you can take thioridazine or an MAOI.
Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms.
Lovan could impair judgment, thinking, or motor skills. Use caution when operating machinery.
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
3. Who can and can't take Lovan
Lovan can be taken by adults for depression, obsessive compulsive disorder and bulimia.
Lovan can be taken by children aged 8 years or older for depression.
Check with your doctor before starting to take Lovan if you:
- have had an allergic reaction to Lovan or any other medicines in the past
- have a heart problem, as Lovan can speed up or change your heartbeat
- have ever taken any other medicines for depression. Some rarely used antidepressants can interact with Lovan to cause very high blood pressure even when they have been stopped for a few weeks.
- are trying to become pregnant, are already pregnant or you are breastfeeding
- have an eye problem called glaucoma because Lovan can increase the pressure in your eye
- have epilepsy or are having electroconvulsive treatment - Lovan may increase the risk of having a seizure
If you have diabetes, Lovan can make it more difficult to keep your blood sugar stable. Monitor your blood sugar more often for the first few weeks of treatment with Lovan and adjust your diabetes treatment if necessary.
Q: Can Prozac cause hair loss?
A: Hair loss, also called alopecia, is a rare but possible side effect of Prozac (Lovan). It is always a good idea to check with oneâ€™s health care provider in matters like this. Here is a link to more Prozac information: //www.everydayhealth.com/drugs/prozac. Gregory Latham, RPh
Q: Does Prozac cause weight gain?
A: Drugs can cause weight gain in several different ways. Some can increase appetite or make you crave certain types of foods like those high in carbohydrates or fat. Other medications may slow down metabolism or cause fluid retention. However, the effect of prescription drugs on body weight is complex. Some drugs have no effect on weight, while others cause weight gain or weight loss. Also, the same medications can cause weight gain in certain individuals and weight loss in others. There are also drugs that initially cause weight loss and then lead to weight gain with long-term use. Most prescription medications associated with changes in body weight affect the central nervous system. These include antidepressants like monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs). Mood stabilizers (lithium, valproic acid), antipsychotics, and anticonvulsants have also been linked with weight gain. Prozac (Lovan) is an SSRI which may lead to weight gain or loss. Other drugs that have been reported to cause weight gain include diabetes medications (insulin, sulfonylureas, and thiazolidinediones), antihypertensive drugs, certain hormonal contraceptives, corticosteroids, antihistamines, some chemotherapy regimens, and antiretroviral protease inhibitors. If you think a drug you are taking is causing weight gain, tell your health care provider. Do not stop any medication or change the dose without first talking to your provider. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Laura Cable, PharmD., BCPS
Q: I have been taking Prozac and Wellbutrin together for 2 years. Do I have to take them forever?
A: Both Prozac (Lovan) and Wellbutrin (bupropion) are antidepressants that are typically used to treat depression, although they can be used for other purposes. Your healthcare provider will periodically re-evaluate your progress on these medications to determine if they are still needed. Your healthcare provider is best able to help guide your treatment decisions based on your specific circumstances. Do not stop or change the amount of medication you take without talking to your healthcare provider first. You may also find helpful information at //www.everydayhealth.com/drugs/prozac and //www.everydayhealth.com/drugs/wellbutrin
6. How to cope with s >
You can reduce the chance of having a side effect if you take Lovan in the evening so that you're asleep when the level of medicine in your body is highest.
What to do about:
- feeling sick (nausea) - try taking Lovan with or after food. It may also help to stick to simple meals and avoid rich or spicy food.
- headaches - make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking Lovan. Talk to your doctor if they last longer than a week or are severe.
- being unable to sleep - take Lovan first thing in the morning
- diarrhoea - drink plenty of water or other fluids to avoid dehydration. Signs of dehydration include peeing less than usual or having dark strong-smelling pee. Do not take any other medicines to treat diarrhoea or vomiting without speaking to a pharmacist or doctor.
- feeling tired or weak - if Lovan makes you feel tired or weak, stop what you're doing and sit or lie down until you feel better. Do not drive or use tools or machinery if you're feeling tired. Do not drink alcohol as it will make you feel worse. If these symptoms don't go away after a week or two, ask your doctor for advice.
Q: I have been taking 20mg of Prozac and now I am advised to take half that dosage of Zoloft. What mg of Zoloft is equal to 10 mg of Prozac?
A: Prozac (Lovan) is a selective serotonin reuptake inhibitor (SSRI) antidepressant. Prozac is FDA approved for use in major depressive disorder, bulimia nervosa, obsessive compulsive disorder, premenstrual dysphoric disorder, panic disorder and bipolar disorder. Zoloft (sertraline) is also a SSRI antidepressant. Zoloft is FDA approved for treatment of major depression, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, and social anxiety disorder. The lowest dose of Prozac that is available in capsules is 10mg. The lowest dose of Zoloft that is available in tablets is 25mg. 10mg of Prozac would be roughly equivalent to 25mg of Zoloft. Laura Cable, PharmD
What Is Prozac (Lovan)?
Prozac is the brand name of Lovan, a prescription drug used to treat depression.
This antidepressant is in a class of drugs known as selective serotonin reuptake inhibitors, or SSRIs. These medications work by increasing the amount of serotonin in the brain.
In addition to depression, Prozac is used to treat:
Lovan capsules and tablets sold under the brand name Sarafem are used to treat premenstrual dysphoric disorder (PMDD), a condition in which a woman has symptoms of depression, irritability, and tension before menstruation.
Prozac comes in several forms, including capsules, tablets, liquid, and delayed-release capsules.
Eli Lilly and Company makes Prozac, which was approved by the Food and Drug Administration (FDA) in 1987.
The delayed-release capsule Prozac Weekly is also made by Eli Lilly and Company.
Generic forms of Lovan, Lovan delayed-release capsules, and Sarafem are also available.