플루옥세틴
Fluoxetine
Fluoxetine hydrochloride
다른 이름: Prozac · Reconcile · Sarafem · fluoxetini hydrochloridum · LY110140 · Fluoxetine hydrochloride
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Treatment of canine separation anxiety in conjunction with a behavior modification plan | 1-2 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
| Separation anxiety and noise aversions | 1-2 mg/kg PO once daily | PO | q24h | Continue until 2 months after satisfactory response, then discontinue gradually | 🌎 NA |
| Adjunctive pharmacological intervention for conflict-related aggression | 1-2 mg/kg PO once a day | PO | q24h | — | 🌎 NA |
| Compulsive disorders | 1-2 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
| Adjunctive treatment of behavior disorders | 1-1.5 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
| Adjunctive treatment of behavior disorders | 1 mg/kg PO once daily (up to 3 mg/kg PO once daily) | PO | q24h | — | 🌎 NA |
| Separation anxiety, compulsive disorders, and aggression | 1-2 mg/kg | PO | q24h | Long-term as directed | 🌍 EU |
- Separation anxiety and noise aversions: Use with behavioral therapy. May use long-term. Some dogs require life-long treatment. May add a benzodiazepine during seasonal noise fears.
- Adjunctive pharmacological intervention for conflict-related aggression: May take up to 4 weeks for efficacy.
- Separation anxiety, compulsive disorders, and aggression: Use in association with a behaviour modification plan. Caution with aggression.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Adjunctive treatment of aggression | 0.5-1.5 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
| To help control urine marking or separation anxiety | 0.5-1 mg/kg (2.55 mg per cat) PO once daily | PO | q24h | — | 🌎 NA |
| To control pruritus when other therapies have failed | 1-5 mg/cat PO once daily | PO | q24h | Assess therapy after 1-4 weeks. Taper off dose over 6-8 weeks. | 🌎 NA |
| Generalized anxiety disorder | 0.5-1.5 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
| Urine spraying, psychogenic alopecia, and aggression | 0.5-1.0 mg/kg | PO | q24h | Long-term as directed | 🌍 EU |
- To control pruritus when other therapies have failed: Advise obtaining baseline lab work.
- Urine spraying, psychogenic alopecia, and aggression: Similar precautions for aggression apply as in dogs.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
플루옥세틴(Fluoxetine)은 수의학에서 개와 고양이의 다양한 행동 장애를 관리하는 데 널리 사용되는 선택적 세로토닌 재흡수 억제제(SSRI) 항우울제입니다.
개에서는 행동 교정 프로그램과 병행하여 분리 불안을 치료하는 목적으로 FDA 승인(제품명 Reconcile®)을 받았습니다. 또한 공격성, 상동증(강박 장애) 및 범불안 장애에 오프라벨로 사용되기도 합니다. 고양이의 경우 부적절한 배설(소변 마킹), 공격성, 불안, 심인성 탈모/가려움증에 자주 처방됩니다.
임상 팁: 플루옥세틴은 완전한 임상적 효과가 나타나기까지 보통 4~8주의 상당한 지연 시간이 필요합니다. 이는 시냅스 후 수용체의 하향 조절에 시간이 필요하기 때문입니다. 보호자에게 이 초기 기간 동안 인내심을 갖고 투약을 유지하도록 안내해야 합니다.
작용 기전
Fluoxetine acts by selectively binding to and inhibiting the presynaptic serotonin transporter (SERT) in the central nervous system.
- Inhibition of Reuptake: Blockade of SERT prevents the reuptake of serotonin (5-HT) into the presynaptic neuron.
- Increased Synaptic Serotonin: This leads to an accumulation of serotonin in the synaptic cleft → prolonged activation of postsynaptic 5-HT receptors.
- Receptor Downregulation: Chronic elevation of synaptic serotonin eventually leads to the downregulation and desensitization of autoreceptors (e.g., 5-HT1A), which correlates with the onset of anxiolytic, anticompulsive, and anti-aggressive clinical effects.
Fluoxetine has minimal affinity for other neurotransmitter receptors (such as dopamine, norepinephrine, histamine, or acetylcholine), which accounts for its relatively favorable side effect profile compared to tricyclic antidepressants (TCAs).
안전성·주의사항
금기사항
- Known hypersensitivity to fluoxetine
- Concurrent use of Monoamine Oxidase Inhibitors (MAOIs), including selegiline and amitraz (found in some tick collars)
- Patients with epilepsy or a history of seizures
- Concurrent use with drugs that lower the seizure threshold (e.g., acepromazine, chlorpromazine)
- Known sensitivity to fluoxetine or other SSRIs
- History of seizures or epilepsy
부작용
- Anorexia or decreased appetite (common, often transient)
- Lethargy or depression
- Gastrointestinal upset (vomiting, diarrhea)
- Anxiety, irritability, or restlessness
- Insomnia or hyperactivity
- Panting (dogs)
- Changes in elimination patterns (cats)
- Paradoxical aggressive behavior (in previously unaggressive animals)
- Seizures (rare but possible)
- Weight loss
- Trembling
- Gastrointestinal disturbances
- Paradoxical increase in anxiety
- Increased aggression
주의
- Seizure Disorders: Use is contraindicated in patients with a history of seizures.
- Diabetes Mellitus: Use with caution as fluoxetine may alter blood glucose levels, necessitating insulin adjustments.
- Hepatic Impairment: Dosages may need to be reduced in patients with severe liver disease due to decreased clearance.
- Tapering: Because of the long half-life of the active metabolite (norfluoxetine), tapering off the drug is generally only necessary when a patient has been on the drug long-term (>8 weeks).
- Pregnancy/Nursing: Safety is not fully established (FDA Category C in humans). Excreted in milk at 20-30% of plasma levels; use caution in nursing animals.
약물 상호작용
Increased risk for serotonin syndrome
May decrease or reverse the effects of SSRIs (acts as a serotonin antagonist)
Fluoxetine may increase diazepam and alprazolam plasma levels
Increased risk for hyponatremia
May alter insulin requirements (can alter blood glucose)
Increased risk for serotonin syndrome
High risk for serotonin syndrome; use contraindicated. A 5-week washout is required after stopping fluoxetine before starting an MAOI, and a 2-week washout if switching from an MAOI to fluoxetine.
Serotonin syndrome-like adverse effects possible
Increased plasma levels of phenytoin possible
Fluoxetine may increase these beta-blocker's plasma levels; atenolol may be safer to use
SSRIs can inhibit the metabolism of tramadol to active metabolites, decreasing efficacy and increasing toxicity risk (serotonin syndrome, seizures)
Fluoxetine may increase TCA blood levels and increase the risk for serotonin syndrome
Increased plasma levels of trazodone possible
Fluoxetine may increase the risk for bleeding
Risk of fatal serotonin syndrome. Fluoxetine should not be used within 2 weeks of MAOI treatment, and MAOIs should not be used within 6 weeks of fluoxetine treatment.
Fluoxetine antagonizes the effects of anticonvulsants and lowers the seizure threshold.
Lowers seizure threshold, increasing the risk of seizures.
Increased risk of bleeding in the case of tissue trauma.
Increased risk of serotonin syndrome. Use alongside trazodone may be considered in exceptional cases only with careful monitoring.
Increased risk of serotonin syndrome.
모니터링
- Efficacy of the behavior modification plan and reduction of clinical signs
- Appetite and body weight (due to risk of anorexia)
- Signs of adverse effects (GI upset, lethargy, paradoxical aggression, seizures)
- Behavioral response and changes in aggression
- Signs of serotonin syndrome (tremors, agitation, hyperthermia)
- Gastrointestinal tolerance
약동학
반감기
흡수
Well absorbed after oral administration. In dogs, ~70% of an oral dose reaches systemic circulation. Food alters the rate, but not the extent, of absorption. Transdermal bioavailability in cats is poor (~10% of oral route).
분포
Widely distributed throughout the body with highest levels in the lungs and liver. CNS concentrations are detected within 1 hour. Highly protein-bound (~95% in humans). Crosses the placenta and enters maternal milk (20-30% of plasma levels).
대사
Primarily metabolized in the liver to a variety of metabolites, including the active metabolite norfluoxetine.
배설
Both fluoxetine and norfluoxetine are eliminated slowly. Renal impairment does not substantially affect elimination, but liver impairment decreases clearance rates.
과다투여
The LD50 for rats is 452 mg/kg.
Clinical Signs of Toxicity:
- Dogs: Vomiting, mydriasis (dilated pupils), lethargy, hyperactivity, and seizures. Seizures have been reported at doses twice the highest recommended human dose.
- Cats: Hypersalivation, vomiting, mydriasis, and excessive vocalization.
Treatment:
- Treatment is symptomatic and supportive.
- Gut emptying techniques (emesis, activated charcoal) should be employed if recent and not contraindicated (e.g., patient is seizing or comatose).
- Diazepam is the treatment of choice for controlling seizures.
- Cyproheptadine can be administered as a serotonin antagonist if serotonin syndrome is suspected.
제품
제형
- Chewable tablets
- Oral capsules
- Oral solution
- Transdermal gel (compounded - note: poor bioavailability in cats)
- Oral tablets: 8 mg, 16 mg, 20 mg, 32 mg, 64 mg
동물용의약품
- Fluoxetine Chewable Tablets: 8 mg, 16 mg, 32 mg, & 64 mg; Reconcile® (Lilly)
- Reconcile (8 mg, 16 mg, 32 mg, 64 mg chewable tablets)
인용의약품
- Fluoxetine HCl Oral Tablets: 10 mg, 15 mg & 20 mg
- Fluoxetine HCl Oral Capsules: 10 mg, 20 mg, 40 mg & 90 mg (delayed-release); Prozac®, Sarafem®
- Fluoxetine HCl Oral Solution: 20 mg/5 mL (may contain alcohol, sucrose); Prozac®
- Prozac (10 mg, 20 mg, 60 mg capsules/tablets)
규제 현황
Veterinary formulation (Reconcile) is licensed within Europe.
POM-V, POM. Monograph notes veterinary formulation is not currently available in the UK, though human generics may be used under the cascade.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Capsules and tablets should be stored in well-closed containers at room temperature. The oral liquid should be stored in tight, light-resistant containers at room temperature.
보호자 정보
- 인내심이 중요합니다: 이 약물이 완전한 효과를 나타내기까지는 보통 4~8주가 걸립니다. 즉각적인 결과가 보이지 않는다고 해서 투약을 중단하지 마십시오.
- 행동 교정: 플루옥세틴은 수의사가 권장하는 행동 교정 및 훈련 프로그램과 함께 사용할 때 가장 효과적입니다.
- 부작용: 가장 흔한 부작용으로는 무기력, 식욕 감소, 구토, 떨림, 안절부절못함, 설사, 과도한 짖음/울음 등이 있습니다. 이러한 증상이 심하거나 지속되면 수의사에게 연락하십시오.
- 식욕 부진: 반려동물의 식욕이 떨어지면 손으로 직접 먹여주거나 일시적으로 음식의 기호성을 높여보십시오(예: 습식 사료나 저나트륨 육수 소량 첨가).
- 갑자기 중단하지 마십시오: 수의사의 지시 없이 이 약물을 갑자기 중단하지 마십시오. 금단 증상이나 행동 문제의 재발을 유발할 수 있습니다.
- 발작 경고: 드물게 이 약을 복용하는 동안 개에서 발작이 발생할 수 있습니다. 발작이 발생하면 즉시 수의사에게 연락하십시오.
- 진드기 목걸이: 진드기 목걸이를 사용하는 경우 수의사에게 알리십시오. 일부 목걸이에는 아미트라즈(amitraz)가 포함되어 있어 플루옥세틴과 함께 사용할 경우 위험한 약물 상호작용(세로토닌 증후군)을 일으킬 수 있습니다.
- 이 약물은 어린이와 다른 반려동물의 손이 닿지 않는 안전한 곳에 보관하십시오.
VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.