Fluoxetine Dosing and Administration

Initial Dosing for Depression

• For pediatric patients, the American Academy of Pediatrics recommends starting at 10 mg/day for lower weight children, or 10-20 mg/day for others, with an effective dose of 20 mg/day and a maximum dose of 60 mg/day 1

Therapeutic Drug Monitoring Range

• The therapeutic plasma concentration range for fluoxetine plus norfluoxetine is 120-300 ng/mL, with a level of recommendation of 3 2

Dosing for Obsessive-Compulsive Disorder

• Higher SSRI dosing for OCD is associated with greater efficacy, though also higher dropout rates due to adverse effects, with an effective dose range of 40-60 mg daily and a maximum dose of 60-80 mg daily 3

Special Dosing Considerations

• CYP2D6 poor metabolizers have 3.9-fold higher drug exposure at 20 mg and 11.5-fold higher exposure at 60 mg compared to extensive metabolizers, and consider genetic testing before initiating high-dose therapy in patients with known CYP2D6 poor metabolizer status 3

Maintenance Treatment

• For first episode of major depressive disorder, the American Psychiatric Association recommends continuing treatment for 4-12 months after remission 4

Discontinuation

• The American Psychiatric Association recommends tapering fluoxetine gradually over 10-14 days to limit withdrawal symptoms 4