Prozac weekly?

[ryerica22]

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Hi,
I have a young lady in my outpatient clinic who is always wanting something as needed for anxiety and always forgets to take her Lexapro. She states that she just forgets after 3-4 days. She states she wants something that she can take just once a week. I thought about using Prozac weekly for her. However, I was reading on Epocrates that it has to be 1 week after the last 20mg dose. Does this mean I must give her 20 mg for a couple of weeks of regular Fluoxetine?

Thanks

 

[WisNeuro]

You know, there's another weekly treatment option that works wonders in the anxiety population... 😉

 

[NickNaylor]

You know, there's another weekly treatment option that works wonders in the anxiety population... 😉

But weekly Prozac takes 3 seconds, therapy takes 50 minutes and is, like, hard, man.

 

[WisNeuro]

But weekly Prozac takes 3 seconds, therapy takes 50 minutes and is, like, hard, man.

It is quite the conundrum. Getting patients to do something that will actually lead to long-term positive change. Maybe if we do like a reverse VA system. Where, instead of paying people to act sick/impaired/etc, we pay people for treatment gains and incentivize improvements in QOL and like indicators? Come, join my mental health utopia! Now, if only I can find a backer who has a spare few billion lying around.

 

[ryerica22]

Unfortunately I’ve tried to refer this lady to CBT but time is an issue due to her job.

 

[WisNeuro]

Priorities, if they wanted it fixed bad enough, they'd make it happen. Also, lots of places offer evening and weekend appointments these days.

 

[DisorderedDoc417]

Similarly if someone tells me they can't afford their 3$ a month anti-depressant, I will often ask how they afford the cigarettes, booze, and junk food. That line usually catches people off-guard 😀

 

[ryerica22]

I completely agree with everyone on this thread, but unfortunately, this patient is not going to budge when I suggest therapy. The weekly prozac is the best alternative I can think of.

 

[clozareal]

Well, you have to see whether fluoxetine actually works for her anxiety first, which can take weeks. But yeah, I was taught that it's best to have the patient stable on fluoxetine 20mg daily before starting once weekly fluoxetine delayed release 90mg.

Although with pharmacokinetics, the active metabolite norfluoxetine's half-life is 4-16 days so I'm wondering if you can't just give the regular fluoxetine weekly and wait 5 half-lives for steady state for it to take effect?

Also, if she has a smart phone, make her set a daily alarm to take her medication while she's in the office with you.

 

[st2205]

You know, there's another weekly treatment option that works wonders in the anxiety population... 😉

Ativan? It’s taken QID, but weekly, too, technically.

 

[hamstergang]

Although with pharmacokinetics, the active metabolite norfluoxetine's half-life is 4-16 days so I'm wondering if you can't just give the regular fluoxetine weekly and wait 5 half-lives for steady state for it to take effect?

My understanding is that Prozac weekly works out once per week due to the half-lives of fluoxetine and norfluoxetine. It's different than the regular pill in that it stretches out the delivery of the drug in order to avoid GI side effects from taking such a large dose all at once.

However, I don't know how to reconcile that understanding with the facts that Prozac weekly is 90mg yet we already give 80mg daily without issue, and somehow the 90mg per week works out to be equivalent to 20mg per day.

 

[DisorderedDoc417]

I believe it’s also expensive. Like Sarafem. $600 a month for that one!

 

[OldPsychDoc]

Although with pharmacokinetics, the active metabolite norfluoxetine's half-life is 4-16 days so I'm wondering if you can't just give the regular fluoxetine weekly and wait 5 half-lives for steady state for it to take effect?

Shhh..."Prozac Weekly" IS just regular fluoxetine, in a 90 mg capsule.
Just write 'fluoxetine, 20 mg; sig: 5 caps q Monday, disp #20, 11 refills' and sell your Lilly stock.

 

[NickNaylor]

Shhh..."Prozac Weekly" IS just regular fluoxetine, in a 90 mg capsule.
Just write 'fluoxetine, 20 mg; sig: 5 caps q Monday, disp #20, 11 refills' and sell your Lilly stock.

Srs? There’s not even a spiffy new binder or matrix in the q1week formulation?

 

[OldPsychDoc]

Srs? There’s not even a spiffy new binder or matrix in the q1week formulation?

Two words: patent extension.

 

[MacDonaldTriad]

Prozac Monthly

 

[Attending1985]

It is quite the conundrum. Getting patients to do something that will actually lead to long-term positive change. Maybe if we do like a reverse VA system. Where, instead of paying people to act sick/impaired/etc, we pay people for treatment gains and incentivize improvements in QOL and like indicators? Come, join my mental health utopia! Now, if only I can find a backer who has a spare few billion lying around.

There’s actually an hbo documentary on a program that paid young adults in a poor, crime ridden neighborhood to make good choices like getting and keeping a job as well as giving them mentors. The state actually saved money by reducing incarceration.

 

[WisNeuro]

There’s actually an hbo documentary on a program that paid young adults in a poor, crime ridden neighborhood to make good choices like getting and keeping a job as well as giving them mentors. The state actually saved money by reducing incarceration.

I don't doubt it. Just think of how much money we could save from the disability system and the VA welfare system if we implanted the right incentives in those patient populations.

 

[clausewitz2]

There’s actually an hbo documentary on a program that paid young adults in a poor, crime ridden neighborhood to make good choices like getting and keeping a job as well as giving them mentors. The state actually saved money by reducing incarceration.

Richmond, VA has/had a program where they identified people at high risk of violent offenses and basically paid them a monthly stipend on the condition that they were not arrested for any violent offenses. Seems like a sensible approach for harnessing the imbalance in effectiveness of reward v punishment learning in ASPD.