May 29, 2023

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Hello friends i’m dr harvinder singh welcome to our next podcast and the topic for today’s podcast is comparing long-acting formulations for antidepressants you’re right this is not long-acting antipsychotics but long acting antidepressants and in this podcast i will be comparing only those antidepressants which have their long acting formulation available

And fda approved for treatment of depression we all know i think most of us used few of these medications in our daily practice but this podcast will be summarized into three medication sections first is fluoxetine second is paroxetine and third is when the vaccine just to reduce the length of this video i will first talk about fluoxetine only but the section

For paroxetine and venlafaxine will be available to our course subscribers but the section on fluoxetine is available for free preview so let’s continue our discussion on fluoxetine so we know that fluoxetine is the longest acting antidepressant that we know and this property is the main reason why fluoxetine is used or is actually the recommended treatment

For antidepressant withdrawal symptoms management but fluoxetine can be given as a weekly formulation not a daily medication but weekly formulation and the dosages that it comes in is actually only one dosage it’s 90 milligram weekly dosing it’s a it’s not an injection it’s a medication so you give that on a weekly basis but there is one important thing that

You should be mindful of and that is when you initiate this medication it should be given with a gap of at least seven days between the last fluoxetine dosing and the package insert actually recommends they mention 20 milligram but i believe it can be any other dosages also but at least seven day gap before you initiate this medication on a weekly basis

Now also one of the property of this fluoxetine weekly capsule is that this is enteric coated capsules and this actually prevents the dissolution until these capsule reaches a certain segment of the gi tract and the ph should exceed 5.5 before these medications are dissolved in the gi tract and this actually delays the onset of absorption of fluoxetine by one

To two hours relative to the immediate release formulation of fluoxetine now let’s talk about various studies comparing this weekly formulation of fluoxetine in terms of its efficacy response and side effect and other factors so the first study that i will talk about um was published uh in 2001 this was the open label treatment with fluoxetine uh 20 milligram

Uh daily for seven weeks so all patients received this medication and they knew that they are getting 20 milligram for seven weeks so open label and patients who responded to fluoxetine and they were actually out of 114 70 patients responded to this and this patient population was randomized by a double-blind design to receive either of the three options and

These three options were either they will receive 20 milligram of fluoxetine daily so they will continue with what they were getting or they will get 60 milligram of fluoxetine weekly dosing or they will receive placebo and these patients were followed for additional seven weeks what did the study found well the study found that there was no statistical

Statistically significant difference in terms of the clinical measures that they see and the tolerability was similar in all the groups the dropout rates were no different and adverse events were no different so this is an important lesson because most of us will think once you switch from daily to weekly medication either psy um efficacy is one thing that

We worry about more than side effect i think they were significantly similar there was no difference so the lesson from this study is that efficacy is similar for both weekly formulation and daily formulation of fluoxetine so worth considering now moving on to the next section in this is relapse do patients relapse more when you switch them from daily to

Weekly formulation this will be answered by another similar study which was published in 2000 again like the previous study the authors first did the open label where all patients received fluoxetine 20 milligram daily for 13 weeks this was longer than the first one like the first one was very short weeks so they received 13 weeks open label and patients who

Responded to this they were randomized in a double-blind manner to receive either 20 milligram of fluoxetine daily or 90 milligram of fluoxetine weekly or placebo and they were actually followed for longer duration 25 weeks like a real life scenario the duration made sense here what did this study found so i know we are talking about relapse but this study

Actually showed many uh results the main results were first efficacy was similar like we talked before even when you do it for long duration use this dosing no difference in the efficacy from daily and weekly how about relapse after 25 weeks here are the result the relapses on weekly were 37 on daily were 26 percent although the difference was there but they

Were similar in efficacy so this number is an important this was the only study that i found in terms of relapse you see uh almost 10 percent difference in them but the efficacy is similar here how about compliance does compliance changes when you give a weekly formulation versus daily formulation i think this is one of the main reason why we will choose this

Weekly over daily medication of fluoxetine so this will be answered by another study which was published in 2001. this study used a very similar design in this patients received fluoxetine 20 milligram daily for 13 weeks and then they were switched to 90 milligram of fluoxetine weekly for 25 weeks and the results were first talking about relapse that we just

Talked about this study found the relapse rate were similar for both the formulation and the relapse rate were definitely much lower than what placebo group had and talking about compliance these are the numbers that they found so patient on weekly fluoxetine their compliance was actually maintained at 87.5 percent from a baseline of 84.4 percent so this was

Good and compared to daily fluoxetine you can see for daily fluoxetine uh it was maintained at 87.3 percent from a baseline of 79.4 percent so compliance is very similar or actually more for the weekly fluoxetine group compared to daily fluoxetine group this is our brief summary of what weekly fluoxetine medication means clinically so we know the dosage 90

Milligram weekly we know that it should be started at least seven days after last daily dose of oral fluoxetine efficacy is similar between weekly and daily fluoxetine dosing relapse rates in one study showed a difference of 10 percent but the next study showed the relapse rate were similar and compliance is definitely more in the weekly fluoxetine group

Compared to daily fluoxetine group and in the end i will actually talk about this so we talked about switching somebody from oral fluox sorry daily fluoxetine to weekly fluoxetine how about switching a patient from other antidepressant and i actually found only one study that did this this study was published in 2002 and they looked at switching patients

From three antidepressants so let’s talk about this study this study in this study patients um were on following antidepressants for six to 52 weeks and they had positive response and these are the three antidepressants cetalopram between 20 to 40 milligram per day peroxide in between 20 milligram sorry at 20 milligram per day or sotroline uh between 50 to

100 milligram per day so patients who responded to these antidepressants and these antidepressants were continued for one week and then they were switched to weekly fluoxetine 90 milligram per week for 12 weeks what did this study found so first they found close to 80 percent patients were successfully switched to the weekly fluoxetine group only 9.3 percent

Discontinued due to relapse or lack of efficacy but overall the weekly formulation was well tolerated and this switch did not resulted in any significant increase in depression or quality of life measures so you can do this switch from other antidepressant also very important medication to be mindful of in certain patients so this actually ends our podcast

Uh on fluoxetine but core subscribers can continue um in our course chapter the chapter this podcast is available with other medication details also including peroxitine and venlafaxine please let me know if you like this podcast please share your experience if you use this medication and if you also if you agree or disagree with these findings in terms of

Efficacy compliance side effects and other factors thank you again i’m doctor saying thanks for listening to the video take care bye

Transcribed from video
Comparing Long Acting Antidepressants: Fluoxetine Weekly By Psychiatry Education Forum