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Fluoxetine Compounded Oral Suspension for People and Pets (Liquid Fluoxetine)

Oral Suspension Formulation

Fluoxetine made into a custom strength liquid, dosed by volume. For people and pets. Chino, CA.

Reviewed by Linda Pungpravat, PharmD, RPh Mixwell Compounding Pharmacy, Chino, CA. Updated

  • USP <795> compliant
  • USP <800> hazardous drug lab
  • PCCA member

Clinical Advantages

  • Liquid dose measured by volume
  • Strength set by the prescriber or veterinarian
  • Option for patients who cannot swallow capsules or tablets
  • Flavor and dye free options on request
  • Non sterile preparation

How It Works

What is fluoxetine?

Fluoxetine is an SSRI. The FDA label for fluoxetine oral solution lists major depressive disorder, obsessive compulsive disorder, bulimia nervosa, and panic disorder. The labeled liquid is 20 mg per 5 mL [1].

For dogs, the FDA approved Reconcile chewable tablets of 8, 16, 32, and 64 mg for canine separation anxiety, along with a behavior modification plan [2]. A compounded suspension is not FDA approved, and the FDA has not reviewed it [3].

What is an oral suspension?

It's a liquid that is swallowed. The medicine is spread through a liquid base, so the bottle gets shaken before each dose. The pharmacy makes it to the prescriber's order, and the dose is measured in milliliters with an oral syringe.

What a liquid gives a prescriber

  • A choice of strength in mg per mL. The Reconcile label dose is 1 to 2 mg/kg once daily, and the tablets come in four sizes, so a liquid can fit a weight outside those bands [2]
  • A form for patients that can't swallow capsules or tablets
  • A choice of base, flavor, and dye made with the pharmacist

A water based liquid has a short shelf life. The USP 795 default is 35 days if it's preserved and 14 days if it isn't [4]. The pharmacist sets the date for each bottle.

For prescribers and veterinarians

  • Psychiatry, primary care, pediatrics, and adolescent medicine prescribers (MD, DO, NP, PA), and veterinarians and veterinary behavior practices
  • Send the species or age, weight, strength in mg per mL, the total volume, and flavor or dye needs. Call (909) 378-7301 to talk with our pharmacist
  • The Reconcile label covers dogs and puppies 6 months or older and 4.0 kg or heavier, and does not describe use in cats [2]
  • For animals, our pharmacist confirms the source of the fluoxetine used. Compounded animal drugs are not made from bulk drug substances

For patients and pet owners

  • Shake the bottle well, and measure each dose with the syringe we give you
  • Fluoxetine stays in the body for weeks, so dose changes build up slowly. Never stop or change a dose without asking your prescriber [1]
  • Pet medicine is not for people. Keep it away from children [2]

Clinical Details

What does the evidence show?
  • Fluoxetine oral solution is FDA labeled at 20 mg per 5 mL for depression, OCD, bulimia nervosa, and panic disorder [1].
  • Reconcile chewable tablets are FDA approved for canine separation anxiety, with a behavior modification plan [2].
  • The FDA has not reviewed a compounded fluoxetine suspension [3].

Findings come from the cited studies and do not promise any individual outcome.

Why is it compounded, and how is it typically used?

Why it is compounded

The labeled liquid for people comes in one strength [1]. The labeled dog product is a chewable tablet in four strengths [2]. A prescriber or veterinarian may order a different strength, a different flavor, or a liquid for a patient who can't take a tablet or capsule.

Dosage forms and strengths

  • Strength in mg per mL set by the prescriber or veterinarian
  • Suspending base chosen with the pharmacist, with flavor, sugar free, or dye free options
  • Volumes matched to the prescription

Dosing is the prescriber's or veterinarian's decision.

How Mixwell prepares it

Mixwell compounds this liquid in Chino, California under USP 795 rules for non sterile preparations [4]. Our pharmacist confirms the strength and base with the prescriber and sets the beyond use date. We ship across California, including Chino Hills, Ontario, Pomona, Diamond Bar, and Rancho Cucamonga.

Paying for it

Mixwell doesn't accept insurance. Compounded medications for people can usually be charged to an HSA or FSA account. Veterinary prescriptions can't be charged to these accounts. Call (909) 378-7301 for pricing.

Safety information

The human label has a boxed warning for increased risk of suicidal thinking and behavior in children, adolescents, and young adults. It is contraindicated with MAOIs, pimozide, thioridazine, and starting linezolid or intravenous methylene blue. It warns about serotonin syndrome, bleeding, mania, seizures, low sodium, and QT prolongation [1].

The Reconcile label is for dogs only. It says not for use in humans and to keep it out of reach of children. It is contraindicated in dogs with epilepsy or a seizure history, with drugs that lower the seizure threshold such as phenothiazines, and with MAOIs such as selegiline or amitraz. It notes seizures can happen even without a history, and it is not recommended for aggression [2].

Patient selection, dosing, and monitoring are the prescriber's or veterinarian's responsibility. Patients and pet owners should talk with their own healthcare professional or veterinarian before using any medication.

References
  1. Fluoxetine oral solution. Prescribing information. DailyMed
  2. Reconcile (fluoxetine hydrochloride) chewable tablets. Veterinary label. DailyMed
  3. U.S. Food and Drug Administration. Dear pharmacy professional letter explaining the benefits of using Amodip (amlodipine besylate) tablets. FDA
  4. United States Pharmacopeia. General Chapter 795, Pharmaceutical Compounding: Nonsterile Preparations. USP NF. Official November 1, 2023.

What to include on the prescription

  • APIs and strengths
  • Base or vehicle
  • Quantity
  • Directions for use
  • Refills
  • Allergies or dye free needs
Call (909) 378-7301 Fax (909) 378-7071

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Compounded in Chino, CA. Delivered across California.

  • Chino
  • Chino Hills
  • Ontario
  • Pomona
  • Diamond Bar
  • Rancho Cucamonga
  • Eastvale
Mixwell Compounding Pharmacy 13788 Roswell Ave, Ste 158, Chino, CA 91710
(909) 378-7301

Compounded medications are not reviewed or approved by the FDA. Dispensed only with a valid prescription. Mixwell is a non sterile pharmacy and does not prepare sterile products or injectables. Compounded preparations are not presented as superior to commercially available products, and nothing here promises a specific result. Mixwell does not accept insurance. Call for pricing.

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