Is Prozac (Fluoxetine) on the Beers List?
No, fluoxetine (Prozac) is not formally listed on the American Geriatrics Society Beers Criteria as a medication to avoid in all older adults, but it should not be used in older adults due to its greater risk of agitation and overstimulation. 1
Clinical Recommendation for Older Adults
Fluoxetine should be avoided in older adults and is not considered a preferred antidepressant for this population. 1
Why Fluoxetine Should Be Avoided
The American Family Physician guidelines explicitly state that fluoxetine has a greater risk of agitation and overstimulation and should not be used in older adults 1
While fluoxetine is not on the formal Beers list of medications to completely avoid, it is specifically called out as inappropriate for geriatric use due to its adverse effect profile 1
The long elimination half-life of fluoxetine (1-4 days) and its active metabolite norfluoxetine (7-15 days) creates prolonged drug exposure in older adults, increasing the risk of accumulation and adverse effects 2
Preferred Antidepressant Alternatives
The preferred SSRIs for older adults include: 1
- Citalopram - favorable adverse effect profile
- Escitalopram (Lexapro) - favorable adverse effect profile
- Sertraline (Zoloft) - favorable adverse effect profile
Other appropriate alternatives include: 1
- Bupropion
- Mirtazapine
- Venlafaxine
Important Distinction About SSRIs on Beers Criteria
SSRIs as a class are NOT listed on the Beers Criteria as medications to avoid in older adults 3
The 2019 Beers Criteria update added SNRIs (not SSRIs) to the list of antidepressants to avoid in persons with a history of falls or fractures 3
However, individual SSRIs like paroxetine (due to anticholinergic effects) and fluoxetine (due to agitation/overstimulation) are specifically discouraged despite the class being generally acceptable 1
Clinical Pitfalls to Avoid
Do not assume all SSRIs are equally appropriate for older adults - while the class is generally acceptable, fluoxetine and paroxetine have specific concerns that make them inappropriate 1
Do not confuse "not on Beers list" with "appropriate for use" - fluoxetine's exclusion from formal Beers listing does not make it suitable for geriatric patients given explicit guideline recommendations against its use 1
Start with lower doses - when using any antidepressant in older adults, approximately 50% of the adult starting dose is recommended due to increased risk of adverse drug reactions 1