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Alzac 20
Also known as: 56296-78-7, Fluoxetine hcl, Prozac, 59333-67-4, Sarafem, Fluoxeren
Molecular Formula
C17H19ClF3NO
Molecular Weight
345.8  g/mol
InChI Key
GIYXAJPCNFJEHY-UHFFFAOYSA-N
FDA UNII
I9W7N6B1KJ

The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants.
1 2D Structure

Alzac 20

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
N-methyl-3-phenyl-3-[4-(trifluoromethyl)phenoxy]propan-1-amine;hydrochloride
2.1.2 InChI
InChI=1S/C17H18F3NO.ClH/c1-21-12-11-16(13-5-3-2-4-6-13)22-15-9-7-14(8-10-15)17(18,19)20;/h2-10,16,21H,11-12H2,1H3;1H
2.1.3 InChI Key
GIYXAJPCNFJEHY-UHFFFAOYSA-N
2.1.4 Canonical SMILES
CNCCC(C1=CC=CC=C1)OC2=CC=C(C=C2)C(F)(F)F.Cl
2.2 Other Identifiers
2.2.1 UNII
I9W7N6B1KJ
2.3 Synonyms
2.3.1 MeSH Synonyms

1. Fluoxetin

2. Fluoxetine

3. Lilly 110140

4. Lilly-110140

5. Lilly110140

6. N-methyl-gamma-(4-(trifluoromethyl)phenoxy)benzenepropanamine

7. Prozac

8. Sarafem

2.3.2 Depositor-Supplied Synonyms

1. 56296-78-7

2. Fluoxetine Hcl

3. Prozac

4. 59333-67-4

5. Sarafem

6. Fluoxeren

7. Adofen

8. Fluctin

9. Lovan

10. Foxetin

11. Fontex

12. Fluox-puren

13. Fluoxetine (hydrochloride)

14. Fluneurin

15. Reconcile

16. Fluoxetine.hcl

17. Fluctine

18. Fluoxac

19. Fludac

20. Fluxil

21. Ly-110140

22. Fluxet

23. Ly110140

24. Ly 110140

25. Mfcd00214288

26. Selfemra

27. I9w7n6b1kj

28. Hsdb 6633

29. Fluoxetine (as Hydrochloride)

30. Mls000069361

31. Ly-110140 (free Base)

32. Chembl1201082

33. Methyl({3-phenyl-3-[4-(trifluoromethyl)phenoxy]propyl})amine Hydrochloride

34. N-methyl-3-phenyl-3-[4-(trifluoromethyl)phenoxy]propan-1-amine Hydrochloride

35. Affectine

36. Deproxin

37. Digassim

38. Flufran

39. Flunirin

40. Fluoxil

41. Flutine

42. Margrilan

43. Modipran

44. Pragmaten

45. Proctin

46. Rowexetina

47. Smr000058452

48. Erocap

49. Flunil

50. Flutin

51. Fluxen

52. Lorien

53. Neupax

54. Nopres

55. Oxedep

56. Prizma

57. Prodep

58. Sanzur

59. Sinzac

60. Zactin

61. Nuzak

62. Zepax

63. Lilly 110140

64. Prozac 20

65. Fluoxetine Hydrochloride 100 Microg/ml In Acetonitrile

66. Alzac 20

67. Profluzac

68. Prozac Weekly

69. N-methyl-3-phenyl-3-(4-(trifluoromethyl)phenoxy)propan-1-amine Hydrochloride

70. N-methyl-3-phenyl-3-[4-(trifluoromethyl)phenoxy]-1-propylamine Hydrochloride

71. N-methyl-3-[(4-trifluoromethyl)phenoxy]-3-phenylpropylamine Hydrochloride

72. Ccris 6150

73. Fluoxetinehydrochloride

74. Fluoxetine Hydrochloride [usan]

75. Sr-01000002988

76. Einecs 260-101-2

77. Lilly110140

78. Unii-i9w7n6b1kj

79. C17h18f3no.hcl

80. Framex

81. Ly-110,140 Hydrochloride

82. Fluoxetin Hcl

83. Fluoxetine Hcl

84. Fluoxetine, Hcl

85. Prozac(r)

86. Prestwick_798

87. Sarafem (tn)

88. Fluoxetine Hydrochloride [usan:usp]

89. Prozac (tn)

90. Cpd000058452

91. N-methyl-3-phenyl-3-[4-(trifluoromethyl)phenoxy]propan-1-amine;hydrochloride

92. Dsstox_cid_635

93. Opera_id_1538

94. 3-(p-trifluoromethylphenoxy)-n-methyl-3-phenylpropylamine Hydrochloride

95. (+-)-methyl-gamma-(4-(trifluoromethyl)phenoxy)benzenepropanamine Hydrochloride

96. (+-)-n-methyl-3-phenyl-3-(4-(trifluoromethyl)phenoxy)propylamine Hydrochloride

97. (+/-)-n-methyl-&gamma

98. Dsstox_rid_75706

99. Dsstox_gsid_20635

100. Schembl33384

101. Mls001076338

102. Mls002222264

103. Spectrum1504173

104. Fluoxetine Hydrochloride, Solid

105. Dtxsid7020635

106. Hy-b0102a

107. Chebi:145458

108. Hms1569h03

109. Hms1922f07

110. Pharmakon1600-01504173

111. Bcp19962

112. Npl-2008

113. Fluoxetine Hydrochloride (jan/usp)

114. Tox21_200182

115. Tox21_500558

116. Ccg-39084

117. Fluoxetine Hydrochloride [mi]

118. Methyl(3-phenyl-3-(4-(trifluoromethyl)phenoxy)propyl)ammonium Chloride

119. Nsc714457

120. Nsc758685

121. Prozac; Ly-110,140 Hydrochloride

122. S1333

123. Fluoxetine Hydrochloride [jan]

124. Akos015894939

125. Propylamine, N-methyl-3-phenyl-3-(p-trifluoromethylphenoxy)-, Hydrochloride

126. Ab04860

127. Ac-1697

128. Cs-1838

129. Fluoxetine Hydrochloride [hsdb]

130. Ks-1061

131. Lp00558

132. Nc00715

133. Nsc-714457

134. Benzenepropanamine, N-methyl-gamma-(4-(trifluoromethyl)phenoxy)-, Hydrochloride

135. Fluoxetine Hydrochloride [vandf]

136. N-methyl-3-phenyl-3-{[4-(trifluoromethyl)phenyl]oxy}propan-1-amine Hydrochloride

137. Fluoxetine Hydrochloride [usp-rs]

138. Fluoxetine Hydrochloride [who-dd]

139. Ncgc00093943-01

140. Ncgc00093943-02

141. Ncgc00093943-03

142. Ncgc00093943-04

143. Ncgc00093943-05

144. Ncgc00257736-01

145. Ncgc00261243-01

146. Bf163653

147. Sy035644

148. Cas-56296-78-7

149. Eu-0100558

150. F-132

151. F0750

152. Fluoxetine Hydrochloride [green Book]

153. Ft-0626490

154. Ft-0652216

155. Ft-0668749

156. Ft-0668750

157. Ft-0668751

158. Sw196934-4

159. Fluoxetine Hydrochloride [orange Book]

160. D00823

161. Fluoxetine Hydrochloride [ep Monograph]

162. Fluoxetine Hydrochloride [usp Impurity]

163. Fluoxetine Hydrochloride [usp Monograph]

164. Symbyax Component Fluoxetine Hydrochloride

165. 910f893

166. A830990

167. Fluoxetine Hydrochloride 100 Microg/ml In Methanol

168. Fluoxetine Hydrochloride Component Of Symbyax

169. J-521372

170. Sr-01000002988-2

171. Sr-01000002988-4

172. Sr-01000002988-9

173. Q27280620

174. Z1741982921

175. Fluoxetine Hydrochloride, Vetranal(tm), Analytical Standard

176. Fluoxetine Hydrochloride 1.0 Mg/ml In Methanol (as Free Base)

177. Fluoxetine Hydrochloride, British Pharmacopoeia (bp) Reference Standard

178. Fluoxetine Hydrochloride, European Pharmacopoeia (ep) Reference Standard

179. Methyl-[(3r)-3-phenyl-3-[4-(trifluoromethyl)phenoxy]propyl]ammonium

180. Methyl-[3-phenyl-3-(4-trifluoromethyl-phenoxy)-propyl]-amine Hydrochloride

181. N-methyl-3-phenyl-3-(p-trifluoromethylphenoxy)-propylaminhydrochloride

182. N-methyl-3-phenyl-3-[4-(trifluoromethyl)phenoxy]propylamine Hydrochloride

183. Fluoxetine Hydrochloride, Pharmaceutical Secondary Standard; Certified Reference Material

184. Fluoxetine Hydrochloride, United States Pharmacopeia (usp) Reference Standard

185. N-methyl-3-phenyl-3-(4-(trifluoromethyl)phenoxy)propan-1-amine Hydrochloride1

186. N-methyl-3-phenyl-3-(4-(trifluoromethyl)phenoxy)propan-1-aminehydrochloride1

187. N-methyl-3-phenyl-3-[4-(trifluoromethyl)phenoxy]-1-propanamine Hydrochloride (1:1)

188. N-methyl-3-phenyl-3-[4-(trifluoromethyl)phenoxy]propan-1-amine;hydrochloride.

189. (+/-)-n-methyl-3-phenyl-3-((.alpha.,.alpha.,.alpha.-trifluoro-p-tolyl)oxy)propylamine, Hydrochloride

190. Benzenepropanamine, N-methyl-.gamma.-(4-(trifluoromethyl)phenoxy)-, Hydrochloride (1:1)

191. Benzenepropanamine, N-methyl-.gamma.-(4-(trifluoromethyl)phenoxy)-, Hydrochloride, (+/-)-

192. Fluoxetine Hydrochloride Solution, 1.0 Mg/ml In Methanol (as Free Base), Ampule Of 1 Ml, Certified Reference Material

2.4 Create Date
2005-03-26
3 Chemical and Physical Properties
Molecular Weight 345.8 g/mol
Molecular Formula C17H19ClF3NO
Hydrogen Bond Donor Count2
Hydrogen Bond Acceptor Count5
Rotatable Bond Count6
Exact Mass345.1107264 g/mol
Monoisotopic Mass345.1107264 g/mol
Topological Polar Surface Area21.3 Ų
Heavy Atom Count23
Formal Charge0
Complexity308
Isotope Atom Count0
Defined Atom Stereocenter Count0
Undefined Atom Stereocenter Count1
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count2
4 Drug and Medication Information
4.1 Drug Information
1 of 8  
Drug NameFluoxetine hydrochloride
Active IngredientFluoxetine hydrochloride
Dosage FormTablet; Capsule; Capsule, delayed rel pellets; Solution
RouteOral
Strengtheq 20mg base; eq 40mg base; eq 90mg base; eq 20mg base/5ml; eq 10mg base; eq 60mg base
Market StatusPrescription
CompanyRanbaxy; Mylan Pharms; Wockhardt; Silarx; Ani Pharms; Edgemont Pharms; Teva; Pharm Assoc; Alembic Pharms; Aurobindo Pharma; Teva Pharms Usa; Mallinckrodt; Sandoz; Par Pharm; Ivax Sub Teva Pharms; Lannett; Aurobindo Pharm; Landela Pharm; Dr Reddys Labs; My

2 of 8  
Drug NameProzac
PubMed HealthFluoxetine (By mouth)
Drug ClassesAntidepressant, Central Nervous System Agent
Drug LabelSARAFEM (fluoxetine hydrochloride tablets) is a selective serotonin reuptake inhibitor(SSRI) for oral administration. It is designated ()-N-methyl-3-phenyl-3-[(,,-trifluoro-p-tolyl)oxy]propylamine hydrochloride and has the empirical formula...
Active IngredientFluoxetine hydrochloride
Dosage FormCapsule
RouteOral
Strengtheq 20mg base; eq 40mg base; eq 10mg base
Market StatusPrescription
CompanyEli Lilly And

3 of 8  
Drug NameSarafem
Drug LabelFluoxetine hydrochloride is a psychotropic drug for oral administration. It is also marketed for the treatment of premenstrual dysphoric disorder (Sarafem, fluoxetine hydrochloride). It is designated ()-N-methyl-3-phenyl-3-[(a,a,a-trifluoro-p-tol...
Active IngredientFluoxetine hydrochloride
Dosage FormTablet; Capsule
RouteOral
Strengtheq 20mg base; eq 15mg base; eq 10mg base
Market StatusPrescription
CompanyWarner Chilcott; Eli Lilly And

4 of 8  
Drug NameSelfemra
PubMed HealthFluoxetine (By mouth)
Drug ClassesAntidepressant, Central Nervous System Agent
Drug LabelDESCRIPTIONProzac (fluoxetine capsules, USP and fluoxetine oral solution, USP) is a psychotropic drug for oral administration. It is also marketed for the treatment of premenstrual dysphoric disorder (Sarafem, fluoxetine hydrochloride). It is des...
Active IngredientFluoxetine hydrochloride
Dosage FormTablet
RouteOral
Strengtheq 20mg base; eq 15mg base; eq 10mg base
Market StatusPrescription
CompanyTeva Pharms Usa

5 of 8  
Drug NameFluoxetine hydrochloride
Active IngredientFluoxetine hydrochloride
Dosage FormTablet; Capsule; Capsule, delayed rel pellets; Solution
RouteOral
Strengtheq 20mg base; eq 40mg base; eq 90mg base; eq 20mg base/5ml; eq 10mg base; eq 60mg base
Market StatusPrescription
CompanyRanbaxy; Mylan Pharms; Wockhardt; Silarx; Ani Pharms; Edgemont Pharms; Teva; Pharm Assoc; Alembic Pharms; Aurobindo Pharma; Teva Pharms Usa; Mallinckrodt; Sandoz; Par Pharm; Ivax Sub Teva Pharms; Lannett; Aurobindo Pharm; Landela Pharm; Dr Reddys Labs; My

6 of 8  
Drug NameProzac
PubMed HealthFluoxetine (By mouth)
Drug ClassesAntidepressant, Central Nervous System Agent
Drug LabelSARAFEM (fluoxetine hydrochloride tablets) is a selective serotonin reuptake inhibitor(SSRI) for oral administration. It is designated ()-N-methyl-3-phenyl-3-[(,,-trifluoro-p-tolyl)oxy]propylamine hydrochloride and has the empirical formula...
Active IngredientFluoxetine hydrochloride
Dosage FormCapsule
RouteOral
Strengtheq 20mg base; eq 40mg base; eq 10mg base
Market StatusPrescription
CompanyEli Lilly And

7 of 8  
Drug NameSarafem
Drug LabelFluoxetine hydrochloride is a psychotropic drug for oral administration. It is also marketed for the treatment of premenstrual dysphoric disorder (Sarafem, fluoxetine hydrochloride). It is designated ()-N-methyl-3-phenyl-3-[(a,a,a-trifluoro-p-tol...
Active IngredientFluoxetine hydrochloride
Dosage FormTablet; Capsule
RouteOral
Strengtheq 20mg base; eq 15mg base; eq 10mg base
Market StatusPrescription
CompanyWarner Chilcott; Eli Lilly And

8 of 8  
Drug NameSelfemra
PubMed HealthFluoxetine (By mouth)
Drug ClassesAntidepressant, Central Nervous System Agent
Drug LabelDESCRIPTIONProzac (fluoxetine capsules, USP and fluoxetine oral solution, USP) is a psychotropic drug for oral administration. It is also marketed for the treatment of premenstrual dysphoric disorder (Sarafem, fluoxetine hydrochloride). It is des...
Active IngredientFluoxetine hydrochloride
Dosage FormTablet
RouteOral
Strengtheq 20mg base; eq 15mg base; eq 10mg base
Market StatusPrescription
CompanyTeva Pharms Usa

4.2 Therapeutic Uses

Antidepressive Agents, Second-Generation; Serotonin Uptake Inhibitors

National Library of Medicine's Medical Subject Headings online file (MeSH, 1999)


Fluoxetine is indicated for the treatment of obsessions and compulsions in patients with obsessive-compulsive disorder. /Included in US product labeling/

MICROMEDEX Thomson Health Care. USPDI - Drug Information for the Health Care Professional. 23rd ed. Volume 1. MICROMEDEX Thomson Health Care, Greenwood Village, CO. 2003. Content Reviewed and Approved by the U.S. Pharmacopeial Convention, Inc., p. 1359


Fluoxetine is used to relieve the symptoms of premenstrual dysphoric disorder (PMDD). PMDD was formerly known as late luteal phase dysphoric disorder (LLPDD) and is distinguishable from the cyclic changes in mood commonly known as premenstrual syndrome (PMS) by its greater severity of symptoms. (Evidence rating: B-1) /Included in US product labeling/

MICROMEDEX Thomson Health Care. USPDI - Drug Information for the Health Care Professional. 23rd ed. Volume 1. MICROMEDEX Thomson Health Care, Greenwood Village, CO. 2003. Content Reviewed and Approved by the U.S. Pharmacopeial Convention, Inc., p. 1359


Fluoxetine is indicated for the treatment of major depressive disorder. Treatment of acute depressive episodes typically requires 6 to 12 months of antidepressant therapy. Patients with recurrent or chronic depression may require long-term treatment. Fluoxetine has shown effective maintenance of antidepressant response for up to 50 weeks of treatment in a placebo-controlled trial. /Included in US product labeling/

MICROMEDEX Thomson Health Care. USPDI - Drug Information for the Health Care Professional. 23rd ed. Volume 1. MICROMEDEX Thomson Health Care, Greenwood Village, CO. 2003. Content Reviewed and Approved by the U.S. Pharmacopeial Convention, Inc., p. 1359


For more Therapeutic Uses (Complete) data for FLUOXETINE HYDROCHLORIDE (10 total), please visit the HSDB record page.


4.3 Drug Warning

Pregnancy risk category: C /RISK CANNOT BE RULED OUT. Adequate, well controlled human studies are lacking, and animal studies have shown risk to the fetus or are lacking as well. There is a chance of fetal harm if the drug is given during pregnancy; but the potential benefits may outweigh the potential risk./

Physicians Desk Reference. 58th ed. Thomson PDR. Montvale, NJ 2004., p. 1843


Fluoxetine potentially may alter blood glucose concentrations. Hypoglycemia has occurred in less than 1% of patients receiving fluoxetine and hypoglycemic reaction has occurred rarely. In addition, hyperglycemia has developed following discontinuance of the drug. Therefore, the possibility that insulin and/or oral sulfonylurea antidiabetic agent dosage adjustments may be necessary when fluoxetine therapy is initiated or discontinued in patients with diabetes mellitus should be considered.

McEvoy, G.K. (ed.). American Hospital Formulary Service - Drug Information 2003. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2003 (Plus Supplements)., p. 2206


The most frequent adverse effect associated with fluoxetine therapy is nausea, which occurs in about 21% of patients. Nausea generally is mild, occurs early in therapy, and usually subsides after a few weeks of continued therapy with the drug. ... Diarrhea occurs in about 12%, anorexia in about 9%, and dyspepsia in about 6% of patients receiving the drug; limited evidence suggests that the incidence of anorexia may be dose-related. Other adverse GI effects associated with fluoxetine therapy include abdominal pain and change in taste perception, which occur in approximately 3 and 2% of patients, respectively; taste loss has been reported rarely. Vomiting, melena, and flatulence reportedly occur in about 2% and gastroenteritis in about 1% of patients receiving the drug. Increased appetite has been reported in more than 1% of patients receiving fluoxetine, but has not been definitely attributed to the drug. Other adverse GI effects, including aphthous stomatitis, dysphagia, eructation, esophagitis, gastritis, gingivitis, glossitis, melena, stomatitis, and thirst, have been reported in less than 1% of fluoxetine-treated patients; however, a causal relationship to the drug has not been established. Bloody diarrhea, colitis, duodenal or gastric ulcer, enteritis, fecal incontinence, hematemesis, hyperchlorhydria, increased salivation, mouth ulceration, salivary gland enlargement, tongue discoloration, and tongue edema have occurred rarely, but have not been definitely attributed to fluoxetine.

McEvoy, G.K. (ed.). American Hospital Formulary Service - Drug Information 2003. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2003 (Plus Supplements)., p. 2206


Because of the possibility of suicide in depressed patients, close supervision of high risk patients is recommended during initial fluoxetine therapy. To reduce the risk of overdosage, the drug should be prescribed in the smallest quantity consistent with good patient management. Suicidal ideation may persist until substantial remission of the depressive disorder occurs.

McEvoy, G.K. (ed.). American Hospital Formulary Service - Drug Information 2003. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2003 (Plus Supplements)., p. 2207


For more Drug Warnings (Complete) data for FLUOXETINE HYDROCHLORIDE (14 total), please visit the HSDB record page.


4.4 Drug Indication

As an aid in the treatment of separation-related disorders in dogs manifested by destruction and inappropriate behaviours (vocalisation and inappropriate defecation and / or urination) and only in combination with behavioural-modification techniques.


5 Pharmacology and Biochemistry
5.1 MeSH Pharmacological Classification

Cytochrome P-450 CYP2D6 Inhibitors

Drugs and compounds which inhibit or antagonize the biosynthesis or actions of CYTOCHROME P-450 CYP2D6. (See all compounds classified as Cytochrome P-450 CYP2D6 Inhibitors.)


Selective Serotonin Reuptake Inhibitors

Compounds that specifically inhibit the reuptake of serotonin in the brain. (See all compounds classified as Selective Serotonin Reuptake Inhibitors.)


Antidepressive Agents, Second-Generation

A structurally and mechanistically diverse group of drugs that are not tricyclics or monoamine oxidase inhibitors. The most clinically important appear to act selectively on serotonergic systems, especially by inhibiting serotonin reuptake. (See all compounds classified as Antidepressive Agents, Second-Generation.)


5.2 FDA Pharmacological Classification
5.2.1 Pharmacological Classes
Serotonin Uptake Inhibitors [MoA]; Serotonin Reuptake Inhibitor [EPC]
5.3 ATC Code

QN06AB03


5.4 Absorption, Distribution and Excretion

Fluoxetine hydrochloride appears to be well absorbed from the GI tract following oral administration. The oral bioavailability of fluoxetine in humans has not been fully elucidated to date, but at least 60-80% of an oral dose appears to be absorbed. However, the relative proportion of an oral dose reaching systemic circulation unchanged currently is not known. Limited data from animals suggest that the drug may undergo first-pass metabolism and extraction in the liver and/or lung following oral administration. In these animals (beagles), approximately 72% of an oral dose reached systemic circulation unchanged. Food appears to cause a slight decrease in the rate, but not the extent of absorption of fluoxetine in humans.

McEvoy, G.K. (ed.). American Hospital Formulary Service - Drug Information 2003. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2003 (Plus Supplements)., p. 2214


Distribution of fluoxetine and its metabolites into human body tissues and fluids has not been fully characterized. Limited pharmacokinetic data obtained during long term administration of fluoxetine to animals suggest that the drug and some of its metabolites, including norfluoxetine, are widely distributed in body tissues, with highest concentrations occurring in the lungs and liver. The drug crosses the blood-brain barrier in humans and animals. In animals, fluoxetine: norfluoxetine ratios reportedly were similar in the cerebral cortex, corpus striatum, hippocampus, hypothalamus, brain stem, and cerebellum 1 hr after administration of single dose of the drug.

McEvoy, G.K. (ed.). American Hospital Formulary Service - Drug Information 2003. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2003 (Plus Supplements)., p. 2214


In order to confirm embryonic/fetal exposure to fluoxetine and/or metabolites, dissection and whole-body autoradiographic techniques were utilized to determine the placental transfer and fetal distribution in 12 and 18 day pregnant Wistar rats 1, 4, 8, and 24 hr following a single oral 12.5 mg/kg dose of (14)C fluoxetine. On gestation Days 12 (organogenesis) and 18 (postorganogenesis), peak concentrations of radiocarbon occurred 4-8 hr after dose administration in the placenta, embryo/fetus, amniotic fluid, and maternal kidney, brain, and lung, and declined slightly at 24 hr postdose. Maternal lung contained the highest tissue concentration of radiocarbon at all time points. Placenta and maternal brain, kidney, and liver contained moderate levels of radioactivity, while embryonic/fetal tissue, amniotic fluid, and maternal plasma contained low levels of radioactivity. Mean fetal concentrations of radiocarbon at 4, 8, and 24 hr on gestation Day 18 were higher than mean embryonic concentrations on Day 12 of gestation. Analytical characterization of radioactivity indicated that combined fluoxetine and norfluoxetine concentrations accounted for 63-80% of the total radiocarbon concentrations in embryonic/fetal tissue. Results indicated that embryonic/fetal and maternal tissue levels of fluoxetine were greatest at early time points and declined with time, while norfluoxetine tissue levels were highest at the 24 hr time point. Whole-body autoradiographic techniques demonstrated that radioactivity associated with (14)C fluoxetine and/or its metabolites traversed the placenta and distributed throughout the 18 day fetus 4 hr following dose administration. Visual and quantitative evaluations of the autoradiograms indicated that the highest fetal concentrations of radiocarbon were associated with brain and thymus. Results from these studies indicate that fluoxetine and norfluoxetine traverse the placenta and distribute within the embryo/fetus during the periods of organogenesis and postorganogenesis and confirm embryonic/fetal exposure of parent and metabolite in previous negative rat teratology and reproductive studies.

PMID:2785300 Pohland RC et al; Toxicol Appl Pharmacol 98 (2): 198-205 (1989)


Elimination: Renal: 80% excreted in the urine (11.6% fluoxetine, 7.4% fluoxetine glucuronide, 6.8% norfluoxetine, 8.2% norfluoxetine glucuronide, >20% hippuric acid, 46% other); Biliary: Approximately 15% in the feces; In dialysis--Not dialyzable because of high protein binding and large volume of distribution.

MICROMEDEX Thomson Health Care. USPDI - Drug Information for the Health Care Professional. 23rd ed. Volume 1. MICROMEDEX Thomson Health Care, Greenwood Village, CO. 2003. Content Reviewed and Approved by the U.S. Pharmacopeial Convention, Inc., p. 1359


For more Absorption, Distribution and Excretion (Complete) data for FLUOXETINE HYDROCHLORIDE (6 total), please visit the HSDB record page.


5.5 Metabolism/Metabolites

The present study was designed to define the kinetic behavior of fluoxetine N-demethylation in human liver microsomes and to identify the isoforms of cytochrome p450 (CYP) involved in this metabolic pathway. The kinetics of Ne formation of norfluoxetine was determined in human liver microsomes from six genotyped CYP2C19 extensive metabolizers (EM). The correlation studies between the fluoxetine N-demethylase activity and various CYP enzyme activities were performed. Selective inhibitors or chemical probes of various cytochrome P-450 isoforms were also employed. The kinetics of norfluoxetine formation in all liver microsomes were fitted by a single-enzyme Michaelis-Menten equation (mean Km=32 umol/L +/- 7 umol/L). Significant correlations were found between N-demethylation of fluoxetine at both 25 umol/L and 100 umol/L and 3-hydroxylation of tolbutamide at 250 micromol/L (r1=0.821, P1=0.001; r2=0.668, P2=0.013), respectively, and S-mephenytoin 4'-hydroxylase activity (r=0.717, P=0.006) at high substrate concentration of 100 umol/L. S-mephenytoin (SMP) (a CYP2C19 substrate) at high concentration and sulfaphenazole (SUL) (a selective inhibitor of CYP2C9) substantially inhibited norfluoxetine formation. The reaction was minimally inhibited by coincubation with chemical probe, inhibitor of CYP3A4 (triacetyloleandomycin, TAO). The inhibition of fluoxetine N-demethylation at high substrate concentration (100 umol/L) was greater in PM livers than in EM livers (73 % vs 45 %, P < 0.01) when the microsomes were precoincubated with SUL plus TAO. Cytochrome p450 CYP2C9 is likely to be a major CYP isoform catalyzing fluoxetine N-demethylation in human liver microsomes at a substrate concentration close to the therapeutic level, while polymorphic CYP2C19 may play a more important role in this metabolic pathway at high substrate concentration.

PMID:11730569 Liu ZQ et al; Acta Pharmacol Sin 22 (1): 85-90 (2001)


The exact metabolic fate of fluoxetine has not been fully elucidated. The drug appears to be metabolized extensively, probably in the liver, to norfluoxetine and several other metabolites. Norfluoxetine (desmethylfluoxetine) the principal metabolite, is formed by N-demethylation of fluoxetine, which may be under polygenic control. The potency and selectivity of norfluoxetine's serotonin-reuptake inhibiting activity appear to be similar to those of the parent drug. Both fluoxetine and norfluoxetine undergo conjugation with glucuronic acid in the liver, and limited evidence from animals suggests that both the parent drug and its principal metabolite also undergo O-dealkylation to form p-trifluoromethylphenol, which subsequently appears to be metabolized to hippuric acid.

McEvoy, G.K. (ed.). American Hospital Formulary Service - Drug Information 2003. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2003 (Plus Supplements)., p. 2214


5.6 Biological Half-Life

The half-life of fluoxetine reportedly is prolonged (to approximately 4-5 days) after administration of multiple versus single doses, suggesting a nonlinear pattern of drug accumulation during long-term administration.

McEvoy, G.K. (ed.). American Hospital Formulary Service - Drug Information 2003. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2003 (Plus Supplements)., p. 2214


Following a single oral dose of fluoxetine in healthy adults, the elimination half-life of fluoxetine reportedly averages approximately 2-3 days (range: 1-9 days) and that of norfluoxetine averages about 7-9 days (range: 3-15 days).

McEvoy, G.K. (ed.). American Hospital Formulary Service - Drug Information 2003. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2003 (Plus Supplements)., p. 2214


The mean half-life /for fluoxetine/ was 6.6 vs 2.2 days ... for patients with cirrhosis vs normal volunteers.

PMID:3262026 Schenker S et al; Clin Pharmacol Ther 44 (3): 353-9 (1988)


5.7 Mechanism of Action

The precise mechanism of antidepressant action of fluoxetine is unclear, but the drug has been shown to selectively inhibit the reuptake of serotonin (5-HT) at the presynaptic neuronal membrane. Fluoxetine-induced inhibition of serotonin reuptake causes increased synaptic concentrations of serotonin in the CNS, resulting in numerous functional changes associated with enhanced serotonergic neurotransmission.

McEvoy, G.K. (ed.). American Hospital Formulary Service - Drug Information 2003. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2003 (Plus Supplements)., p. 2212


Monoamine oxidase-B has been determined to be the enzyme responsible for the conversion of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine into its toxic metabolite 1-methyl-4-phenylpyridine ion. Since this enzyme has been localized primarily in astrocytes and serotonergic neurons, it would appear that 1-methyl-4-phenylpyridine ion is being produced outside the dopaminergic neurons. To investigate this possibility, the administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine was preceded by systemically administered fluoxetine. In keeping with its demonstrated ability to inhibit uptake into serotonergic neurons and serotonin uptake into astrocytes, fluoxetine pretreatment resulted in a significant attenuation of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine induced depletions of striatal dopamine and serotonin concentration. These results support the extra-dopaminergic production of 1-methyl-4-phenylpyridine ion.

PMID:3258013 Brooks WJ et al; J Neural Transm 71 (2): 85-90 (1988)


Fluoxetine is a potent and selective inhibitor of the neuronal serotonin-uptake carrier and is a clinically effective antidepressant. Although fluoxetine is used therapeutically as the racemate, there appears to be a small but demonstrable stereospecificity associated with its interactions with the serotonin-uptake carrier. The goals of this study were to determine the absolute configurations of the enantiomers of fluoxetine and to examine whether the actions of fluoxetine in behavioral tests were enantiospecific. (S)-Fluoxetine was synthesized from (S)-(-)-3-chloro-1-phenylpropanol by sequential reaction with sodium iodide, methylamine, sodium hydride, and 4-fluorobenzotrifluoride. (S)-Fluoxetine is dextrorotatory (+1.60) in methanol, but is levorotatory (-10.85) in water. Fluoxetine enantiomers were derivatized with (R)-1-(1-naphthyl)ethyl isocyanate, and the resulting ureas were assayed by 1H NMR or HPLC to determine optical purities of the fluoxetine samples. Both enantiomers antagonized writhing in mice; following sc administration of (R)- and (S)-fluoxetine, ED50 values were 15.3 and 25.7 mg/kg, respectively. Moreover, both enantiomers potentiated a subthreshold analgesic dose (0.25 mg/kg) of morphine, and ED50 values were 3.6 and 5.7 mg/kg, respectively. Following ip administration to mice, the two stereoisomers antagonized p-chloroamphetamine-induced depletion of whole brain serotonin concentrations. ED50 values for (S)- and (R)-fluoxetine were 1.2 and 2.1 mg/kg, respectively. The two enantiomers decreased palatability-induced ingestion following ip administration to rats; (R)- and (S)-fluoxetine reduced saccharin-induced drinking with ED50 values of 6.1 and 4.9 mg/kg, respectively. Thus, in all biochemical and pharmacological studies to date, the eudismic ratio for the fluoxetine enantiomers is near unity.

PMID:3260286 Robertson DW et al; J Med Chem 31 (7): 1412-7 (1988)


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