From the FDA Drug Label
It is also marketed for the treatment of premenstrual dysphoric disorder (Sarafem®, fluoxetine hydrochloride).
The best treatment for Premenstrual Dysphoric Disorder (PMDD) in a patient who cannot take oral contraceptives is fluoxetine.
- Fluoxetine is a psychotropic drug that is also marketed for the treatment of PMDD.
- The patient can take fluoxetine orally, in the form of capsules or oral solution. 1
From the Research
The best treatment for Premenstrual Dysphoric Disorder (PMDD) in patients who cannot take oral contraceptives is selective serotonin reuptake inhibitors (SSRIs), specifically fluoxetine (20mg daily), sertraline (50-150mg daily), or escitalopram (10-20mg daily) as first-line options. These medications can be taken either continuously throughout the month or intermittently during the luteal phase (typically starting 7-14 days before menses and continuing until menstruation begins) 2. For many women, intermittent dosing is effective and minimizes side effects. If SSRIs are ineffective or not tolerated, alternative options include serotonin-norepinephrine reuptake inhibitors like venlafaxine (75-150mg daily), anxiolytics such as alprazolam (0.25mg three times daily during the luteal phase), or spironolactone (100mg daily during the luteal phase) to address fluid retention symptoms.
Key Points to Consider
- SSRIs are particularly effective for PMDD because they address the heightened sensitivity to normal hormonal fluctuations by regulating serotonin, which influences mood, sleep, and pain perception 3.
- Lifestyle modifications including regular exercise, stress management techniques, dietary changes (reducing caffeine, salt, and alcohol), and calcium supplements (1200mg daily) can provide additional symptom relief when combined with pharmacological treatment.
- Cognitive Behavioral Therapies (CBT) also appear to be effective in reducing the functional impact of PMDD, and could become a first-line treatment with more evidence of their effectiveness 2.
Treatment Options
- Fluoxetine (20mg daily) has been reported to be effective for emotional and physical premenstrual symptoms with continuous daily dosing and with luteal phase daily dosing 3.
- Sertraline (50-150mg daily) and escitalopram (10-20mg daily) are also effective options for PMDD treatment 2.
- Intermittent dosing of fluoxetine seems to be effective and mostly free of side effects in women with PMDD, and may offer an attractive treatment option for a disorder that is itself intermittent 4.