Modipran

Indications

Modipran is prescribed for:

• Depressive Illness: Effective in managing major depressive disorder.
• Bulimia Nervosa: Helps in reducing symptoms of bulimia nervosa.
• Obsessive-Compulsive Disorder (OCD): Assists in controlling symptoms of OCD.

Pharmacology

Modipran contains fluoxetine, a selective serotonin reuptake inhibitor (SSRI). It works by blocking the reuptake of serotonin at the presynaptic neuronal membrane, which enhances serotonin levels in the central nervous system. Unlike other antidepressants, fluoxetine does not affect norepinephrine or dopamine reuptake and does not exhibit anticholinergic, antihistaminic, or α1 adrenergic blocking effects at standard therapeutic doses.

Dosage & Administration

Initial Treatment: Start with 20 mg/day of fluoxetine, administered in the morning. If there is no improvement after several weeks, the dose may be increased, but should not exceed 80 mg/day. For doses above 20 mg/day, split the dosage into morning and noon. The full antidepressant effect may take up to 4 weeks to manifest. Adjust doses for patients with renal or hepatic impairment, and consider lower doses for the elderly. The recommended maximum dose for elderly patients is 60 mg per day.

Maintenance Treatment: For ongoing management of depressive episodes, several months or more of treatment may be necessary. Fluoxetine is also used at 60 mg daily for bulimia nervosa.

Use in Children: Fluoxetine is not recommended for children due to lack of established safety and efficacy.

Interaction

• MAO Inhibitors: Risk of serious, potentially fatal reactions; avoid concurrent use.
• Other Antidepressants: Can significantly alter plasma levels of other antidepressants.
• Lithium: May affect lithium levels; monitor closely.
• Antipsychotics: Can elevate blood levels of haloperidol and clozapine.
• Anticonvulsants: May increase plasma concentrations and toxicity of phenytoin and carbamazepine.
• CNS Active Drugs: Caution is advised when combining with other CNS-active medications.

Contraindications

• Hypersensitivity: Do not use if allergic to fluoxetine or related SSRIs.
• Monoamine Oxidase Inhibitors (MAOIs): Avoid use with MAOIs or within 14 days of stopping MAOIs. Allow at least 5 weeks after discontinuing fluoxetine before starting MAOIs due to its long elimination half-life.

Side Effects

• Gastrointestinal: Nausea, vomiting, dyspepsia, dry mouth, and diarrhea.
• Neurological: Anxiety, nervousness, insomnia or drowsiness, and fatigue.
• Others: Excessive sweating, itching, and skin rashes. Discontinue use if a rash develops.

Pregnancy & Lactation

• Pregnancy: Use only if clearly needed, as fluoxetine has not shown teratogenic effects in animal studies but should be used cautiously.
• Lactation: Not recommended for nursing mothers due to excretion in breast milk.

Precautions & Warnings

• Hepatic and Renal Impairment: Use with caution and adjust doses accordingly.
• Epilepsy: Use cautiously in patients with a history of seizures.
• Diabetes: Monitor blood glucose levels as Modipran may affect glycemic control.
• Suicidal Tendencies: Close supervision is necessary for patients with suicidal thoughts.
• Bipolar Disorder: Modipran may induce mania in patients with bipolar disorder and is not usually recommended.

Therapeutic Class

• Phenothiazine-related drugs.

Storage Conditions

• Store in a cool, dry place, protected from light and moisture. Keep below 30°C and out of reach of children.