Fluoxetine Hydrochloride and Tiotropium Bromide

• Generic Name: fluoxetine
• Dosage Forms: n.a.
• Other Brand Names: Prozac, Prozac Weekly, PROzac Pulvules, Sarafem, Rapiflux, Selfemra

Acute and maintenance treatment of major depressive disorder.

APA states that effectiveness of antidepressants is generally comparable between and within classes of medications, including SSRIs, SNRIs, TCAs, MAO inhibitors, and other antidepressants (e.g., bupropion, mirtazapine, trazodone). Choose antidepressant based mainly on patient preference; nature of prior response to medication; safety, tolerability, and anticipated adverse effects; concurrent psychiatric and medical conditions; and specific properties of the medication (e.g., half-life, actions on CYP isoenzymes, other drug interactions). For most patients, an SSRI, SNRI, mirtazapine, or bupropion is considered optimal. Consult APA’s Practice Guidelines for the Treatment of Patients with Major Depressive Disorder for additional information.

Acute and maintenance treatment of OCD.

Management of PMDD (previously late luteal phase dysphoric disorder).

Acute and maintenance treatment of moderate to severe bulimia nervosa (at least 3 bulimic episodes per week for 6 months).

SSRIs usually are preferred drugs in management of bulimia because of more favorable adverse effect profile.

Also has been used for management of anorexia nervosa.

Not recommended as the sole or primary treatment of anorexia nervosa.

Acute treatment of panic disorder with or without agoraphobia.

Short-term treatment of acute depressive episodes (alone or in combination with olanzapine) in patients with bipolar I disorder (bipolar depression).

May cause manic reactions when used as monotherapy in some patients; should not be used without mood stabilizing agents (e.g., lithium, lamotrigine).

Has been used for the short-term treatment of exogenous obesity.

Has been used for the symptomatic management of cataplexy in a limited number of patients with cataplexy and associated narcolepsy.

Has been used in the management of alcohol dependence.

Studies of SSRIs have generally shown modest effects on alcohol consumption.

Has been used for management of intention myoclonus, including postanoxic action myoclonus and progressive action myoclonus in a limited number of patients.

Like some other SSRIs, has been used for the treatment of premature ejaculation.

• Generic Name: tiotropium
• Dosage Forms: n.a.
• Other Brand Names: Spiriva, Spiriva Respimat, Spiriva Handihaler, Spiriva Respimat 30 Dose, Spiriva Respimat 14 Dose, Spiriva Respimat 28 ACT, Spiriva Respimat 60 ACT, Spiriva Respimat 10 ACT

Tiotropium alone (as oral inhalation powder or solution) or tiotropium/olodaterol fixed-combination therapy (as oral inhalation solution): Long-term maintenance treatment of reversible bronchospasm associated with COPD, including chronic bronchitis and emphysema.

Tiotropium alone (as oral inhalation powder or solution): Reduction of COPD exacerbations in patients with a history of exacerbations.

A long-acting bronchodilator (e.g., orally inhaled salmeterol, formoterol, tiotropium) or an inhaled corticosteroid recommended for maintenance monotherapy in patients with moderate to severe COPD (e.g., FEV1 30 to <80% of predicted or, alternatively, <60% of predicted) who have persistent symptoms not relieved by as-needed therapy with a selective, short-acting inhaled β2-adrenergic agonist. Maintenance therapy with long-acting bronchodilators in such patients more effective and more convenient than regular therapy with short-acting bronchodilators. Insufficient data to favor one maintenance monotherapy over another in patients with moderate to severe COPD. In selected patients with inadequate response, may use a combination of several long-acting bronchodilators, such as tiotropium, and a long-acting β2-adrenergic agonist.

In patients with severe to very severe COPD (e.g., FEV1 <30 to <50% of predicted), some clinicians recommend addition of an inhaled corticosteroid to one or more long-acting bronchodilators, given separately or in fixed combination; however, benefits of combination therapy over monotherapy not consistently established. If inadequate response or limiting adverse effects occur, may consider the addition or substitution of extended-release oral theophylline.

Tiotropium alone (as oral inhalation powder or solution) or tiotropium/olodaterol fixed-combination therapy (as oral inhalation solution): Not indicated for initial treatment of acute episodes of bronchospasm or acute deterioration of COPD; a drug with a more rapid onset of action (e.g., a short-acting β-adrenergic agonist) preferred.

Tiotropium alone (as oral inhalation solution): Long-term maintenance treatment of reversible bronchospasm associated with asthma.

Tiotropium oral inhalation solution: Not indicated for treatment of acute episodes of bronchospasm.

Tiotropium/olodaterol fixed-combination therapy: Not indicated for treatment of asthma.