Combined serotonin (5-HT) and noradrenaline (NA) re-uptake inhibitor e.g. Duloxetine

Dosing: Adult

Depression, obsessive-compulsive disorder, premenstrual dysphoric disorder, bulimia: Oral: 20 mg/day in the morning; may increase after several weeks by 20 mg/day increments; maximum: 80 mg/day; doses >20 mg may be given once daily or divided twice daily. Note: Lower doses of 5-10 mg/day have been used for initial treatment.

Usual dosage range:

Bulimia nervosa: Oral:60 mg/day

Depression: Oral: Initial: 20 mg/day; may increase after several weeks if inadequate response (maximum: 80 mg/day). Patients maintained on Prozac® 20 mg/day may be changed to Prozac® Weekly™ 90 mg/week, starting dose 7 days after the last 20 mg/day dose

Depression associated with bipolar disorder (in combination with olanzapine): Oral: Initial: 20 mg in the evening; adjust as tolerated to usual range of 20-50 mg/day. See "Note" below.

Fibromyalgia (unlabeled use): Oral: Range: 20-80 mg/day (Arnold, 2002)

Obsessive-compulsive disorder: Oral: Initial: 20 mg/day; may increase after several weeks if inadequate response; recommended range: 20-60 mg/day (maximum: 80 mg/day)

Panic disorder: Oral: Initial: 10 mg/day; after 1 week, increase to 20 mg/day; may increase after several weeks; doses >60 mg/day have not been evaluated

Post-traumatic stress disorder (PTSD) (unlabeled use): Oral: 20-40 mg/day

Premenstrual dysphoric disorder (Sarafem®): Oral: 20 mg/day continuously, or 20 mg/day starting 14 days prior to menstruation and through first full day of menses (repeat with each cycle)

Raynaud’s phenomena (unlabeled use): Oral: 20 mg/day (Coleiro, 2001)

Social anxiety disorder (unlabeled use): Oral: Target dose: 40 mg/day; range 30-60 mg/day (Davidson, 2004)

Treatment-resistant depression (in combination with olanzapine): Oral: Initial: 20 mg in the evening; adjust as tolerated to usual range of 20-50 mg/day. See "Note."

Note: When using individual components of fluoxetine with olanzapine rather than fixed dose combination product (Symbyax®), approximate dosage correspondence is as follows:

Olanzapine 2.5 mg + fluoxetine 20 mg = Symbyax® 3/25

Olanzapine 5 mg + fluoxetine 20 mg = Symbyax® 6/25

Olanzapine 12.5 mg + fluoxetine 20 mg = Symbyax® 12/25

Olanzapine 5 mg + fluoxetine 50 mg = Symbyax® 6/50

Olanzapine 12.5 mg + fluoxetine 50 mg = Symbyax® 12/50

Note: Upon discontinuation of fluoxetine therapy, gradually taper dose. If intolerable symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate.

Dosing: Pediatric

(For additional information see "Fluoxetine: Pediatric drug information")

Depression: Oral: 8-18 years: 10-20 mg/day; lower-weight children can be started at 10 mg/day, may increase to 20 mg/day after 1 week if needed

Obsessive-compulsive disorder: Oral: 7-17 years: Initial: 10 mg/day; may increase after 2 weeks if inadequate clinical response to 20 mg/day; further increases may be considered after several weeks to recommended range of 20-30 mg/day (lower weight children) or 20-60 mg/day (adolescents and higher weight children)

Selective mutism (unlabeled use): Oral: 5-18 years: Initial: 5-10 mg/day; titrate upwards as needed (usual maximum dose: 60 mg/day)

Note: Upon discontinuation of fluoxetine therapy, gradually taper dose. If intolerable symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate.

Dosing: Geriatric

Oral: Some patients may require an initial dose of 10 mg/day with dosage increases of 10 mg and 20 mg every several weeks as tolerated; should not be taken at night unless patient experiences sedation.