From the Guidelines
The treatment for a Prozac (fluoxetine) overdose requires immediate medical attention at an emergency department, with a focus on supportive care and management of specific symptoms as they arise. The initial management includes close monitoring of vital signs, cardiac function, and neurological status. Activated charcoal may be administered if the patient presents within 1-2 hours of ingestion to reduce drug absorption, as noted in general overdose management principles 1.
Some key considerations in the management of a fluoxetine overdose include:
- Intravenous fluids to maintain hydration and support blood pressure
- Benzodiazepines for seizures or agitation
- Cooling measures for hyperthermia
- Cardiac monitoring for arrhythmias
- Potential treatment for serotonin syndrome, which may include benzodiazepines, cyproheptadine (a serotonin antagonist), and in severe cases, muscle paralysis with mechanical ventilation, although the specific details on serotonin syndrome management in the context of fluoxetine overdose are not directly addressed in the provided evidence 1.
It's crucial to note that there is no specific antidote for fluoxetine overdose. The drug's long half-life (1-3 days for fluoxetine, 7-15 days for its active metabolite norfluoxetine) means that monitoring may be required for several days. Hemodialysis is generally not effective due to the drug's large volume of distribution and high protein binding. The severity of overdose depends on the amount ingested, whether other substances were taken simultaneously, and individual patient factors. Given the potential for serious adverse effects, including suicidal thinking and behavior, behavioral activation/agitation, and serotonin syndrome, as discussed in the context of SSRI use 1, careful monitoring and prompt intervention are essential in managing a fluoxetine overdose.
From the FDA Drug Label
Management of OverdoseTreatment should consist of those general measures employed in the management of overdosage with any drug effective in the treatment of major depressive disorder Ensure an adequate airway, oxygenation, and ventilation. Monitor cardiac rhythm and vital signs. General supportive and symptomatic measures are also recommended. Induction of emesis is not recommended. Gastric lavage with a large–bore orogastric tube with appropriate airway protection, if needed, may be indicated if performed soon after ingestion, or in symptomatic patients Activated charcoal should be administered. Due to the large volume of distribution of this drug, forced diuresis, dialysis, hemoperfusion, and exchange transfusion are unlikely to be of benefit. No specific antidotes for fluoxetine are known.
The treatment for a Prozac (fluoxetine) overdose involves:
- General supportive and symptomatic measures
- Ensuring an adequate airway, oxygenation, and ventilation
- Monitoring cardiac rhythm and vital signs
- Administering activated charcoal
- Considering gastric lavage if performed soon after ingestion or in symptomatic patients
- No specific antidotes are known for fluoxetine 2 2.
From the Research
Treatment for Prozac Overdose
- The treatment for a Prozac (fluoxetine) overdose is primarily focused on supportive care, as symptoms are often minor and of short duration 3.
- In cases of serotonin syndrome, which can occur with fluoxetine overdose, treatment with cyproheptadine, a serotonin antagonist, has been shown to be effective in resolving symptoms 4, 5.
- Supportive care measures may include monitoring of vital signs, cardiac rhythm, and mental status, as well as management of any symptoms that arise, such as nausea, vomiting, or tremors 6, 3.
- In general, patients who ingest fluoxetine alone are less likely to experience severe symptoms, and asymptomatic patients are unlikely to develop symptoms if the interval between ingestion and initial call to a poison center is greater than 6 hours 7, 3.
- In cases of mixed overdose, such as with other serotonergic agents or antidepressants, the treatment approach may need to be adjusted, and patients should be closely monitored for potential complications 4, 7.