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Fluoxetine Substitution & Pregnancy

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#1 Lala



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Posted 09 September 2016 - 02:26 AM

I have been taking Cybalta 20mg daily for 2 years. I stopped cold turkey 3 days ago as I am trying to fall pregnant. (It causes birth defects in pregnancy.)


My psychiatrist has prescribed Fluoxetine (Lorien tablet 20mg) as a SUBSTITUTE  FOR TAPERING Cymbalta. Instead of tapering the Cymbalta I am tapering the Fluoxetine. My psychiatrist has found that by doing so I will not have brain zaps and other negative Cymbalta withdrawals. The withdrawal plan is to start taking Fluoxetine, but to immediately taper - one day on then one day off for a week. Then one day on two days off and so on...


Has anyone else tapered with Fluoxetine?

#2 fishinghat



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Posted 09 September 2016 - 09:36 AM

Many have Lala. There is a couple problems here though. The every other day thing DOES NOT WORK. Cymbalta has a 12 hour half life so half of the dose is still in your blood stream 24 hours later. At 48 hours you take another higher dose pill, jack your blood levels up and repeat the process every 48 hours. This causes the patient to repeat the Cymbalta withdrawal repeatedly.

The withdrawal symptoms of Prozac (Fluoxetine) is nearly the same as Cymbalta just not near as severe due to its longer half life. Your doctor is right in stating that it is much less likely (but not impossible) for brain zaps to occur. You still need to take it slow when reducing the Prozac.

I would say that a fall pregnancy is out as most take 3 to 4 months to taper off of Prozac.

Medical journal articles on Prozac and pregnancy...

(aafp medical Journal article)
Risks (see Table 1)

(New England Journal of Medicine)
Women who take fluoxetine during pregnancy do not have an increased risk of spontaneous pregnancy loss or major fetal anomalies, but women who take fluoxetine in the third trimester are at increased risk for perinatal complications.

Twenty-one studies met the inclusion criteria. The odds ratio for major malformations associated with maternal fluoxetine use in cohort studies was 1.12 (95% CI 0.98 to 1.28). The studies included were homogeneous. Fifteen cohort studies evaluated cardiac malformations and yielded an overall odds ratio of 1.6 (95% CI 1.31 to 1.95). These studies also were homogeneous. In contrast, two case-control studies assessing cardiac malformations yielded a combined odds ratio of 0.63 (95% CI 0.39 to 1.03).
The apparent increased risk of fetal cardiac malformations associated with maternal use of fluoxetine has recently been shown also in depressed women who deferred SSRI therapy in pregnancy, and therefore most probably reflects an ascertainment bias. Overall, women who are treated with fluoxetine during the first trimester of pregnancy do not appear to have an increased risk of major fetal malformations.

Perinatal Fluoxetine Exposure Impairs the CO2 Chemoreflex. Implications for Sudden Infant Death Syndrome.
We concluded that prenatal-perinatal fluoxetine treatment impairs central respiratory chemoreception during postnatal life. These results are relevant in understanding the pathogenesis of respiratory failures, such as sudden infant death syndrome, associated with brainstem serotonin abnormalities and the failure of respiratory chemoreflexes.

In conclusion, fluoxetine has marginal effects on the timing of developmental stages in embryos, but induces expression and secretion of several proteins in a manner that depends on dose. For these reasons, and in line with current guidelines, the lowest possible dose of SSRI should be used in pregnant women who need to continue treatment.

Serotonin syndrome in a breast-fed neonate.
A late preterm presented with tachypnoea, jitteriness, irritability and low grade fever. Blood gas showed a compensated metabolic acidosis. His mother was taking the selective serotonin reuptake inhibitor (SSRI) fluoxetine, 60 mg/day, and he was exclusively breast-fed. The baby's serum level of fluoxetine on day 8 was within the adult therapeutic range and his symptoms were ascribed to fluoxetine toxicity. On changing to formula feeds, his symptoms resolved. SSRIs are commonly administered during pregnancy, but SSRI toxicity in infants is rarely reported. It is possible that this condition is under diagnosed or, alternatively, misdiagnosed as SSRI withdrawal in breast fed infants whose mothers are on SSRIs. There is limited research looking at serotonin excess in neonates, making case reports such as this important in our learning. Increased awareness may prompt more frequent measurements of blood levels in breast-fed infants whose mothers are on SSRIs.

Our study suggests that the use of fluoxetine during embryogenesis is not associated with an increased risk of major malformations. Women exposed to both fluoxetine and tricyclic antidepressants tended to report higher rates of miscarriage; further studies will be needed to confirm this observation and to separate the effects of the psychiatric condition from the associated drugs. Long-term studies will be warranted to rule out potential developmental teratology of fluoxetine, which affects a central nervous system neurotransmitter.

Fluoxetine hydrochloride (Prozac) toxicity in a neonate.
A case of fluoxetine toxicity in a newborn of 38 weeks' gestation has been presented. The total drug concentration in cord blood was 80 ng/mL. The fluoxetine level, 26 ng/mL, is below the adult therapeutic level; the norfluoxetine cord blood level, 54 ng/mL, is at the adult therapeutic level. At 96 hours the fluoxetine level was not measurable and the norfluoxetine level was 55 ng/mL. The parent compound is fluoxetine, which is metabolized in the liver to norfluoxetine. The half-life of fluoxetine is 2 to 3 days, and that of norfluoxetine is 7 to 9 days. Interestingly, in our patient the fluoxetine was absent in the blood at 4 days, but norfluoxetine was present. The most common side effects of Prozac in adult patients involve primarily the central nervous system and include nervousness, tremor, jitteriness, and occasionally seizures. Central nervous system symptoms were most prominent in this newborn. He also had an increased heart rate. Cardiovascular side effects are less prominent in adults who are taking Prozac. The neonate in this case was asymptomatic at 96 hours of age, indicating that the parent compound, fluoxetine, may be the active part of the drug and side effects may be caused by the parent compound.


And many more articles.

You should also be aware of this info as well. It is an accurate summary on Autism research.


#3 fishinghat



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Posted 09 September 2016 - 12:12 PM

By the way Lala, this is not necessarily a 'bad' review. If you look at other ssri most are even worse. I just thought you would want to know what the research says.

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