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Prozac
side effects, nutrient depletions, herbal interactions and health notes:

Data provided by Applied Health

Alcohol should be avoided when taking Prozac.1

Monitor sugar levels in diabetics on Prozac, due to blood sugar fluctuations.2

Folate (Folic Acid) , vitamin B12, and homocysteine status in 213 outpatients with major depressive disorder taking 20 mg per day of fluoxetine for 8 weeks. They found that subjects with low folate levels were more likely to have melancholic depression and were significantly less likely to respond to fluoxetine. They also found that homocysteine and B12 levels were not associated with depressive subtype or treatment response. Individuals suffering from depression who do not respond adequately to pharmaceutical antidepressants, specifically fluoxetine, might benefit from supplementation with folate levels. Individuals taking fluoxetine should consult with their prescribing physician and/or a nutritionally trained healthcare professional before initiating supplementation with folate. Folic aid supplementation at levels of 400-800 mcg per day may serve to enhance the action of fluoxetine with no attendant risk. Folic acid is also plays a key role in the production of S-adenosyl methionine (SAM) which can also influence emotional state.3

Reports have suggested that when taken in the form of a supplement, L-tryptophan can interact adversely with fluoxetine. Typical symptoms include nausea and vomiting, agitation, anxiety and restlessness, headache, dizziness and increased perspiration. Individuals taking fluoxetine should avoid the use of L-tryptophan supplements without consulting the prescribing physician and/or a nutritionally trained healthcare professional. Apparently this response has never been elicited when fluoxetine has been combined with a protein-rich diet containing significant levels of L-tryptophan.4

Avoid foods and supplements containing tryptophan or 5-HTP.5

While fluoxetine works to increase the functional level of serotonin by inhibiting its reuptake, 5-HTP is converted into serotonin in the brain. Simultaneously taking fluoxetine and 5-HTP could result in excessive levels of serotonin. Such a combination could produce an adverse reaction in the form of serotonin syndrome; it could also alter the levels of other related hormones. Meltzer et al have found that fluoxetine potentiates the 5-hydroxytryptophan-mediated increase in plasma cortisol and prolactin secretion in subjects with major depression or with obsessive compulsive disorder. Even though a potentially valuable synergy might conceivably develop from the careful combining of fluoxetine and 5-hydroxytryptophan, such experimentation would be premature until more thorough research has been conducted. Individuals taking fluoxetine should avoid using 5-HTP as a supplement if they are taking fluoxetine or any other SSRI drug.6

Alcohol : Dizziness and drowsiness are side effects commonly associated with fluoxetine, and other SSRI drugs. Naranjo and Bremner, along with fellow researchers, have published several studies which found that fluoxetine could decrease the desire to consume alcohol and assist in the reduction of alcohol intake in alcoholics . Given the tendency of both fluoxetine and alcohol to cause disorientation and diminished motor control the combined use of these two substances represents serious risk to the user and those around them. Individuals taking fluoxetine should avoid consumption of alcohol during the course of treatment.7

The adverse reactions include the "serotonin syndrome", cardiovascular complications, extrapyramidal side effects such as akathisia, dyskinesias, and parkinsonian-like syndromes and an apparently increased risk of suicidality. Fluoxetine-induced mania and hypomania, seizures and sexual disorders are evaluated along with minor symptoms of allergic reactions, stuttering, hematological changes, psoriasis, and inappropriate secretion of the antidiuretic hormone. The major fluoxetine-drug interactions involve the amino acids L-dopa and L-tryptophan, anorexiants, anticonvulsants, antidepressants, anxiolytics, calcium channel blockers, cyproheptadine, lithium salts, and drugs of abuse. The underlying mechanism and the paradoxical effects of fluoxetine are addressed.8

St. Johnís Wort may dangerously intensify the effects of Prozac. These two substances should not be used together.9

Melatonin may help improve sleep used together with these agents in depressed individuals.10

Ginkgo biloba (Ginkgo) Sexual dysfunction, decreased sex drive, delayed ejaculation and difficulty achieving orgasm are common side effects associated with taking fluoxetine and other SSRI drugs. In small studies involving both men and women using SSRI drugs, Dr. Alan Cohen, University of California at San Francisco, has found that an extract of Ginkgo biloba (240 mg per day) could effectively reverse many of these adverse side effects. Ellison and DeLuca have also reported success in using Ginkgo to counter adverse effects of fluoxetine upon genital sensation. Meanwhile, in related research, Sohn and Sikora have explored the efficacy of Ginkgo in the treatment of impotence. Cohen recommends an initial dose of 60 mg Ginkgo, twice daily, gradually increasing up to 240 mg, twice daily. He noted that some patients have safely taken more than 500 mg in combination with their antidepressant treatments. Individuals taking fluoxetine should avoid the use of Ginkgo without consulting the prescribing physician and/or a healthcare professional trained in botanical medicine.11

Hypericum perforatum (St. Johnís Wort) Since the emergence of Hypericum as a popular herbal supplement in recent years many have been concerned about the risk of serotonin syndrome due to excessive dosing and the combination of the herb with SSRI drugs. Demott has reported one case where a patient taking another SSRI drug, trazadone, may have experienced a serotonin syndrome reaction upon taking Hypericum with their drug. In that instance, the patient reported symptoms consistent with a serotonin syndrome such as confusion, flushing, perspiration, muscle twitching, and ataxia. Gordon reported on another case where a patient took one dose of paroxetine (Paxil) after using Hypericum: Even though a potentially valuable synergy might conceivably develop from the careful combining of fluoxetine and Hypericum, such experimentation would be premature until more thorough research has been conducted. Individuals taking fluoxetine should avoid using Hypericum unless they have consulted with and are being monitored by their prescribing physician and/or a healthcare provided trained in medical herbalism.12



References

1 Naranjo CA, Pouos CX, Bremner KE, Lanctot KL. Fluoxetine attenuates alcohol intake and desire to drink. Int Clin Psychopharmacol 1994;9:163-72.

1 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 2000

1 Pronsky, Z Food Medication Interactions, 11th edition, 1999

1 Naranjo CA, Pouos CX, Bremner KE, Lanctot KL. Fluoxetine attenuates alcohol intake and desire to drink. Int Clin Psychopharmacol 1994 Sep;9(3):163-172.

1 Naranjo CA, Bremner KE. Serotonin-altering medications and desire, consumption and effects of alcohol-treatment implications. EXS. 1994;71:209-219

1 Naranjo CA, Bremner KE. Clinical pharmacology of serotonin-altering medications for decreasing alcohol consumption. Alcohol Alcohol Suppl. 1993;2:221-229

1 Naranjo CA, Kadlec KE, Sanhueza P, Woodley-Remus D, Sellers EM. Fluoxetine differentially alters alcohol intake and other consummatory behaviors in problem drinkers. Clin Pharmacol Ther. 1990 Apr;47(4):490-498.

2 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 2000

2 Pronsky, Z Food Medication Interactions, 11th edition, 1999

3 Fava M, et al. Am J Psychiatry 1997 Mar;154(3):426-428

4 Barr LC, et al. Biol Psychiatry. 1997 May 1;41(9):949-954; Threlkeld DS, ed. Apr 1997.

4 Barr LC, Heninger GR, Goodman W, Charney DS, Price LH. Effects of fluoxetine administration on mood response to tryptophan depletion in healthy subjects. Biol Psychiatry. 1997 May 1;41(9):949-954

4 Department of Child and Adolescent Psychiatry, J.W.Goethe University, Frankfurt/Main, Germany. [email protected]

4 Psychopathology. 2002 Jul-Aug;35(4):234-40

4 Departments of Psychology and Psychiatry, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands. [email protected]

4 PMID: 11400999 [PubMed - indexed for MEDLINE] J Affect Disord. 2001 May;64(2-3):107-19.

4 Spillmann MK, Van der Does AJ, Rankin MA, Vuolo RD, Alpert JE, Nierenberg AA, Rosenbaum JF, Hayden D, Schoenfeld D, Fava M. Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.

4 Smith KA, Fairburn CG, Cowen PJ. Symptomatic relapse in bulimia nervosa following acute tryptophan depletion. Arch Gen Psychiatry 1999 Feb;56(2):171-176.

4 Meltzer H, Bastani B, Jayathilake K, Maes M. Fluoxetine, but not tricyclic antidepressants, potentiates the 5-hydroxytryptophan-mediated increase in plasma cortisol and prolactin secretion in subjects with major depression or with obsessive compulsive disorder. Neuropsychopharmacology. 1997 Jul;17(1):1-11.

5 Mindell, E, Hopkins V: Prescription Alternatives. New Canaan, CT: Keats Publishing, Inc, 1998; p. 379.

5 Pronsky, Z Food Medication Interactions, 11th edition, 1999

6 Meltzer H, et al. Neuropsychopharmacology. 1997 Jul;17(1):1-11.)

7 Naranjo CA, et al. Int Clin Psychopharmacol 1994 Sep;9(3):163-172; Naranjo CA, Bremner KE. EXS. 1994;71:209-219; Naranjo CA, Bremner KE. Alcohol Alcohol Suppl. 1993;2:221-229; Naranjo CA, et al. Clin Pharmacol Ther. 1990 Apr;47(4):490-498; Cornelius JR, et al Arch Gen Psychiatry 1997 Aug;54(8):700-705; Lejoyeux M. Alcohol Alcohol Suppl. 1996 Mar;1:69-75.

8 Messiha FS. Fluoxetine: adverse effects and drug-drug interactions. J Toxicol Clin Toxicol 1993;31(4):603-630.

8 Threlkeld DS, ed. Central Nervous System Drugs, Antidepressants, Selective Serotonin Reuptake Inhibitors. In: Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparison, Apr 1997.

9 Demott K. St. Johnís wort tied to serotonin syndrome. Clinical Psychiatry News 1998;26:28.

9 Gordon JB. SSRIs and St. Johnís wort: possible toxicity? Am Fam Physician 1998;57:950.

9 Pronsky, Z Food Medication Interactions, 11th edition, 1999

9 Demott K. St. Johnís wort tied to serotonin syndrome. Clinical Psychiatry News 1998;26:28.

9 Gordon JB. SSRIs and St. Johnís wort: possible toxicity? Am Fam Physician 1998;57:950.

10 Dolberg OT, Hirschmann S, Grunhaus L. "Melatonin for the treatment of sleep disturbances in major depressive disorder." Am J Psychiatry, Aug. 1998; 155(8):1119-121.

11 Cohen AJ. Psychiatry On-Line; Sohn M, Sikora R. J Sex Educ Ther 1991;17:53-61; Ellison JM, DeLuca P. J Clin Psychiatry. 1998 Apr;59(4):199-200

11 Cornelius JR, Salloum IM, Ehler JG, Jarrett PJ, Cornelius MD, Perel JM, Thase ME, Black A. Fluoxetine in depressed alcoholics. A double-blind, placebo-controlled trial. Arch Gen Psychiatry 1997 Aug;54(8):700-705

11 Ellison JM, DeLuca P. Fluoxetine-induced genital anesthesia relieved by Ginkgo biloba extract. J Clin Psychiatry. 1998 Apr;59(4):199-200. (Letter)

11 Sohn M, Sikora R. Ginkgo biloba extract in the therapy of erectile dysfunction. J Sex Educ Ther 1991;17:53-61.

11 Cohen AJ. Long term safety and efficacy of Ginkgo biloba extract in the treatment of anti-depressant-induced sexual dysfunction. Psychiatry On-Line

12 .) Demott K. Clinical Psychiatry News 1998;26:28; Gordon JB. Am Fam Physician 1998;57:950.



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Disclaimers

The information in Drug Watch is provided as a courtesy to NewsTarget readers by Applied Health Solutions in cooperation with Healthway Solutions. Although the information is presented with scientific references, we do not wish to imply that this represents a comprehensive list of considerations about any specific drug, herb or nutrient. Nor should this information be considered a substitute for the advice of your doctor, pharmacist, or other healthcare practitioner. Please read the disclaimer about the intentions and limitations of the information provided on these pages. It is important to tell your doctor and pharmacist about all other drugs and nutritional supplements that you are taking if they are recommending a new medication. Copyright © 2007 by Applied Health Solutions, Inc. All rights reserved.

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