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Thread: First day on Prozac

  1. #1
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    First day on Prozac

    Hello
    i am on my first day of Prozac for anxiety. I am going away on holiday in a week and am really worried about when the side effects will kick in. I have been told symptoms will get worse before they get better. I have been taking propanalol 20 x 2 per day for the last two years fro anxiety but this does not seem to be enough now. I have also been given 14 x 2mg Diazipam for emergency use.
    how can I minimise the side effects from the Prozac? Any tips?
    Thanks.

  2. #2
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    Re: First day on Prozac

    Quote Originally Posted by mazza27 View Post
    how can I minimise the side effects from the Prozac? Any tips?
    Thanks.
    The first thing to keep in mind is that severe initial side-effects are not the norm. Most experience no to only mild side-effects at the beginning. Nor are all side-effects necessarily caused by the med. Believe you will suffer severe symptoms and an anxious mind is very capable of producing the whole catastrophe all on its own, no med required.

    Most initial side-effects can be successfully treated, for example benzodiazepines, sparingly, or the prescription antihistamine hydroxyzine (Vistaril) for increased anxiety, ginger and/or vitamin B6 supplements for nausea, loperamide (Imodium) for diarrhoea, small doses of mirtazapine or trazodone for insomnia, paracetamol, aka acetaminophen, for headaches, etc.
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  3. #3
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    Re: First day on Prozac

    Thank you. That makes a lot of sense. I am watching and waiting for side effects! What you said has made me think and I know how powerful my mind is at giving me strange bodily symptoms.
    i have been prescribed 20mg per day.
    i have been given a mixture of 10mg and 20mg capsules (stock shortage apparently)

    After reading through lots of other threads in hear I am wondering if I would be better taking 10mg for 7 days then upping to 20mg to minimise side effects.

    Any thoughts on that please?
    Last edited by Lady Penelope; 08-02-20 at 12:38.

  4. #4
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    Re: First day on Prozac

    Quote Originally Posted by mazza27 View Post
    i have been prescribed 20mg per day.
    i have been given a mixture of 10mg and 20mg capsules (stock shortage apparently)

    After reading through lots of other threads in hear I am wondering if I would be better taking 10mg for 7 days then upping to 20mg to minimise side effects.
    There is only one reason why 10mg capsules exist and that is to ease people onto fluoxetine. Eli Lilly resisted making it available in doses smaller than 20mg for many years, and then began backtracking once they realised how the problems people were having, especially those with anxiety, were affecting sales. Initially they promoted dissolving the 20mg capsule contents in a measure amount of fruit juice (but not of grapefruit) and drinking half the mixture to arrive at 10mg while they hurriedly sought FDA approval to release the med in 10mg capsules. So, yes, generally I think it might be better to start on 10mg, but you should okay this with the prescribing physician first.

    That said, the very long fluoxetine half-life renders starting on a smaller initial dose less effective than it is for other SSRIs. The rule of thump is that it takes about 5 times the half-life of a med for its blood plasma levels to stabilize to a steady-state. Increasing doses before steady-state is achieved may significantly raise side-effect severity above that which would have occurred with the full 5x wait (but delaying longer won't usually significantly diminish any post increase spike).

    The problem is fluoxetine's half-life is up to 6 days, so ideally doses should be raised no sooner than every 30 days. That is a long time to be on a sub therapeutic dose not doing much when fighting severe anxiety and/or depression. To complicate it even further most of the med's activity comes from its active metabolite which has a half-life of up to 16 days! Apply the 5x rule and people could be waiting up to 6 months for the med to kick-in which is not only impracticable, but also potentially harmful. So I'd up the dose to 20mg within 10 days if side-effects are mild to moderate, or 14 days if they are severe. That may generate worse side-effects than if you waited 30 days, but they should still be less than from starting on 20mg.
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  5. #5
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    Re: First day on Prozac

    Thank you so much for taking the time and trouble to give such a detailed reply.

  6. #6
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    Re: First day on Prozac

    Third day and feeling worse than I have for years. Standing in the kitchen and developed blurry visions and felt faint. Could not focus at all. Went to bed and then about half an hour later got zig zag lights in vision. Took 2mg Diazipam and fell asleep for an hour or so.
    i took 20mg Prozac first day and then 10mg second and third day.
    Scared to get out of bed now

  7. #7
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    Re: First day on Prozac

    Quote Originally Posted by mazza27 View Post
    Standing in the kitchen and developed blurry visions and felt faint. Could not focus at all. Went to bed and then about half an hour later got zig zag lights in vision.
    Sounds like an ocular migraine which have the aura, but are painless, exacerbated by the anxiety it triggered. Fluoxetine is often prescribed to treat migraine, but paradoxical reactions can sometimes happen. Or it might just be a coincidence.

    If it is a fluoxetine side-effect is will likely be short lived. Serotonin isn't only a brain neurotransmitter, in fact that is one of its lesser roles. One of the other things it does is mediate blood vessel tone, constriction and dilation. Serotonergic ADs such as fluoxetine may affect this function at the beginning until the body adjusts. They are also mild anticoagulants. While scary, ocular migraines are usually harmless provided care is taken in potentially hazard situation.
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  8. #8
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    Re: First day on Prozac

    Thank you. I decided to take one of the Diazipam first thing. Previous days I have been taking it when I feel anxious but though it would be good to pre-emp.
    I have only been prescribed 14 x 2mg and that was reluctantly so can’t imagine I could get any more. Just want them to help get me through the first two weeks of taking fluoxetine. Day 4 now and feeling ok so far. Going away on holiday for a week on Friday so really need to get through the next 10 days.

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    Re: First day on Prozac

    Quote Originally Posted by mazza27 View Post
    I have only been prescribed 14 x 2mg and that was reluctantly so canít imagine I could get any more.
    Try asking your GP for *hydroxyzine (Vistaril). It is a prescription antihistamine with pretty good anti anxiety properties. Not quite as potent as the BZDs, but often potent enough.

    *Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums.
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  10. #10
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    Re: First day on Prozac

    Thank you. I have never heard of anti histamine being used for anxiety. I was given one a couple of months ago for labyrinthitis- Cyclizine Hydrocloride. Would that be similar?

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