|Selective Serotonin Reuptake
In a controlled clinical study, melatonin levels were reduced significantly
in study participants treated with fluoxetine (20 mg/day) for six weeks (Childs
et al. 1995). The decrease in melatonin levels associated with this drug may be
explained by down-regulation of b-adrenoreceptors,
reduction in cAMP accumulation, or interference with suprachiasmatic nucleus
Alterations in melatonin levels have been associated with disturbances in the
sleep-wake cycle and jet lag (Avery et al. 1998).
Optimal doses for melatonin therapy have not been established (Avery et al.
1998). Commonly available doses range from 0.3 to 5 mg. Physiological blood
levels are achieved with doses of 0.3 mg; higher doses (1 mg) result in
supraphysiological levels of melatonin in the blood. The efficacy of melatonin
supplementation is dependent upon the time of administration, as effects are
related to circadian rhythms.
|Protein & Amino
Fluoxetine reduces leucine absorption by 37% in vitro and 30%
in vivo; it may affect the nutritional status of patients by reducing
absorption of neutral amino acids (Urdaneta et al. 1998). More research is
needed to confirm these effects.
Deficiencies of protein are characterized by compromised immune status,
generalized decreases in function and strength, apathy, weight loss, increased
susceptibility to infection, impaired wound healing, and growth retardation in
children (Covington 1999). Severe depletion may be characterized by muscle
wasting, deterioration in skin and hair, decreased heart rate, blood pressure,
and body temperature.
Nutritional repletion through dietary means is the preferred treatment
approach in cases of protein depletion or deficiency (Covington 1999). Adopting
a balanced diet consisting of high levels of calories, protein, vitamins, and
minerals is one option available for the treatment of patients with depleted
levels of protein. Oral or parenteral supplementation offers another therapeutic
approach to restore nutritional status, maintain caloric intake, and achieve
recommended dietary allowances for protein (generally 600 to 800 mg/kg protein)
(Reeds and Beckett 1996).
This information is intended to serve as a concise reference for healthcare
professionals to identify substances that may be depleted by many commonly
prescribed medications. Depletion of these substances depends upon a number of
factors including medical history, lifestyle, dietary habits, and duration of
treatment with a particular medication. The signs and symptoms associated with
deficiency may be nonspecific and could be indicative of clinical conditions
other than deficiency. The material presented in these monographs should not in
any event be construed as specific instructions for individual
Avery D, Lenz M, Landis C. Guidelines for prescribing melatonin. Ann
Childs PA, Rodin I, Martin NJ, et al. Effect of fluoxetine on melatonin in
patients with seasonal affective disorder and matched controls. Br J
Covington T, ed. Nonprescription Drug Therapy Guiding Patient
Self-Care. St Louis, MO: Facts and Comparisons; 1999:467-545.
Reeds P, Beckett P. Protein and amino acids. In: Ziegler E, Filer LJ, eds.
Present Knowledge in Nutrition. 7th ed. Washington, DC:
International Life Sciences Institute; 1996:67-86.
Urdaneta E, Idonte I, Larraldo J. Drug-nutrient interactions: inhibition of
amino acid intestinal absorption by fluoxetine. Br J Nutr.
Copyright © 2000 Integrative Medicine
CommunicationsThis publication contains
information relating to general principles
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