Home' Australian Pharmacist : Australian Pharmacist January 2017 Contents Australian Pharmacist January 2017 I ©Pharmaceutical Society of Australia Ltd. 39
CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
What are the side e ects of the medicine
that I am on?
Fluoxetine (Prozac) is a selective serotonin re-uptake
inhibitor (SSRI) that has a long half-life (due to active
Common side effects of fluoxetine include nausea,
diarrhoea, insomnia, dry mouth, headache, anxiety,
and weight changes. Less frequently, people taking
fluoxetine may experience nose bleeds, sedation,
confusion, and hypotension. In rare cases, hepatic
failure and raised liver enzymes as well as
seizures may be observed.6
Insomnia (as well as anxiety
and nervousness) is
reported as a side
leading to drug
discontinuation in 5%
of people taking fluoxetine.7
Insomnia is more likely to be
experienced if fluoxetine is taken in the evening as
opposed to in the morning.8
What can I do to relieve my symptoms?
Symptoms of insomnia can be relieved by a
number of methods. Fluoxetine is less likely to
cause insomnia if administered in the morning, so
changing the dose timing could be beneficial.
While dose timing of fluoxetine may be the most
likely reason for insomnia symptoms, insomnia can
also be caused by some medical conditions, stress
and lifestyle factors (inadequate sleep hygiene).1
Non-pharmacological treatment options (e.g.
sleep hygiene measures and cognitive behavioural
therapy) may be helpful.3
Sleep hygiene measures allow healthy sleep
habits to develop. These techniques include not
taking afternoon naps, trying not to engage in
mentally stimulating activities close to bedtime,
and reducing stress associated with sleep routines.9
Sleep restriction may also assist in developing a
sleeping pattern. Sleep restriction involves reducing
allocated sleeping time to the amount of hours
currently being slept. For example, if the time in bed
is from 10 pm to 6 am, but sleep is only occurring
for three of those hours, then sleep is restricted to
three hours physically in bed each night only, and
increased in 30-minute intervals from there until a
desired sleep pattern is achieved.3
Doxylamine (Restavit) and diphenhydramine
(Unisom) are Schedule 3 sedating antihistamines
and may assist sleep. Caution should be taken in
recommending these medicines to the elderly,
patients already taking antidepressants (especially
monoamine oxidase inhibitors (MAOIs) and
tricyclic antidepressants [TCAs]), or patients with
acute asthma. Caution should also be taken in
recommending sedating antihistamines if combined
with other medicines that may cause sedation.
The combination of sedating antihistamines with
alcohol and other respiratory depressants is not
recommended. Continuous use for more than
7--10 days is also not recommended.7
P Sleeping 'DOs'
• Remember that your sleep needs
may change over time.
• Sleep in a darkened, quiet room
with plenty of fresh air.
• Use a comfortable, supportive
mattress and pillow.
• Use clean bedding suitable for the
• Allow yourself time to wind down
and relax before bedtime.
• Learn and use relaxation
techniques to manage stress.
• Get enough exercise during the
day to feel physically tired each
• Spend at least 30 minutes
outdoors each day to help set your
• Limit your daily amount of
• Limit your daily amount of alcohol.
• Go to bed at the same time each
night and get up at the same time
each day (this trains your body to
develop a regular sleep cycle).
• Have a calming bedtime routine
- a warm bath or shower
- a warm milk drink or a light
- listening to peaceful music and/
or reading for a while
- slow, deep breathing.
O Sleeping 'DON'Ts'
• Don't nap during the day,
especially after 3 pm. Keep sleep
• Don't work or watch TV in your
bedroom. Keep your bedroom for
sleeping, relaxing and sex.
Don't have pets or equipment with
lights or noise in the bedroom.
• Don't exercise close to bedtime.
• Don't have a heavy meal close to
• Don't drink a lot of fluid in the
evening (to help limit night time
visits to the toilet).
• Don't have caffeine close to
• Don't drink alcohol close to
bedtime (alcohol can affect sleep
• Don't smoke (especially close to
Reference: Sleeping problems10
Box 1. Sleeping problems Self Care Fact Card -- dos and don'ts
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