Generic Name:
fluoxetine (floo-OX-e-teen)

Brand Names:
Prozac®, Prozac Weekly®, Sarafem®

Classification:
Antidepressant - Selective Serotonin Reuptake Inhibitors (SSRIs)

Issue Date:
1988

Fluoxetine is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Fluoxetine affects chemicals in the brain that may become unbalanced and cause depression, panic, anxiety, or obsessive-compulsive symptoms.

Fluoxetine is used to treat major depressive disorder, bulimia nervosa (an eating disorder) obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD).

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.

Do not break, chew, or open an extended-release capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

Measure the liquid form of fluoxetine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.

Try to take the medicine at the same time each day. Follow the directions on your prescription label.

It may take 4 weeks or longer before you start feeling better. Do not stop using fluoxetine without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly.

To treat premenstrual dysphoric disorder, the usual dose of fluoxetine is once daily while you are having your period, or 14 days before you expect your period to start. Follow your doctor's instructions.

Store fluoxetine at room temperature away from moisture and heat.

You may have an increased risk of suicidal thoughts or behavior at the start of treatment with an antidepressant medication, especially if you are under 18 years old. Talk with your doctor about this risk.

While you are taking fluoxetine you will need to be monitored for worsening symptoms of depression and/ or suicidal thoughts during the first weeks of treatment, or whenever your dose is changed.

In addition to you watching for changes in your own symptoms, your family or other caregivers should be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks

Do not use fluoxetine if you are using any of the following drugs:

• pimozide (Orap®)
• thioridazine (Mellaril®)
• isocarboxazid (Marplan®)
• tranylcypromine (Parnate®)
• phenelzine (Nardil®)
• rasagiline (Azilect®)
• selegiline (Eldepryl®, Emsam®)

Serious and sometimes fatal reactions can occur when these medicines are taken with fluoxetine. You must wait at least 14 days after stopping an MAO inhibitor before you can take fluoxetine. You must wait 5 weeks after stopping fluoxetine before you can take thioridazine (Mellaril®) or an MAOI.

Before taking fluoxetine, tell your doctor if you are allergic to any drugs, or if you have:

• Cirrhosis of the liver
• Kidney disease
• Diabetes
• Seizures or epilepsy
• Bipolar disorder (manic depression)
• History of drug abuse or suicidal thoughts

If you have any of these conditions, you may not be able to use fluoxetine, or you may need a dosage adjustment or special tests.

SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking fluoxetine, do not stop taking the medication without first talking to your doctor.

Fluoxetine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

If you miss a dose of Prozac Weekly, take the missed dose as soon as you remember and take the next dose 7 days later. However, if it is almost time for the next regularly scheduled weekly dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.

Seek emergency medical attention if you think you have taken too much of this medication. Symptoms of a fluoxetine overdose may include:

• Nausea
• Vomiting
• Fever
• Sleepiness
• Rapid or uneven heartbeat
• Confusion
• Fainting
• Seizures
• Coma

Avoid drinking alcohol, which can increase some of the side effects of fluoxetine. Avoid using other medicines that make you sleepy such as:

• cold medicine
• pain medication
• muscle relaxers
• medicine for seizures
• medication for depression or anxiety

They can add to sleepiness caused by fluoxetine. Fluoxetine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Side Effects

Get emergency medical help if you have any of these signs of an allergic reaction:

• Hives
• Difficulty breathing
• Swelling of your face, lips, tongue, or throat

Contact your doctor promptly if you have any of the following side effects, especially if they are new symptoms or if they get worse:

• Mood changes
• Anxiety, panic attacks
• Trouble sleeping
• Irritability
• Agitation
• Aggressiveness
• Severe restlessness
• Mania (mental and/ or physical hyperactivity)
• Thoughts of suicide or hurting yourself

Stop using cyclobenzaprine and call your doctor at once if you have any of these serious side effects:

• Seizure (convulsions)
• Tremors, shivering, muscle stiffness or twitching
• Red, blistering, peeling skin rash
• Fast, Pounding, or Uneven Heartbeats
• Unusual Thoughts or Behavior
• Hallucinations (seeing things)
• Sweating
• Confusion
• Weakness
• Lack of Coordination
• Unusual thoughts or behavior

Other less serious side effects are more likely to occur, such as:

• Dry Mouth
• Increased sweating
• Feeling Nervous or Irritable
• Drowsiness, Dizziness, Tired Feeling
• Runny nose, sore throat, headache, flu symptoms
• Nausea
• Diarrhea
• Changes in appetite
• Weight changes
• Decreased sex drive, impotence, or difficulty having an orgasm

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Talk to your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes:

• aspirin
• ibuprofen (Advil®, Motrin®)
• naproxen (Aleve®, Naprosyn®)
• diclofenac (Voltaren®)
• indomethacin
• piroxicam (Feldene®)
• nabumetone (Relafen®)
• etodolac (Lodine®)

Taking any of these drugs with fluoxetine may cause you to bruise or bleed easily.

Before taking fluoxetine, tell your doctor if you are using any of the following medicines:

• alprazolam (Xanax®)
• clozapine (Clozaril®, Fazaclo®)
• digitoxin (Crystodigin®)
• flecainide (Tambocor®)
• haloperidol (Haldol®)
• phenytoin (Dilantin®)
• carbamazepine (Tegretol®)
• tryptophan (also called L-tryptophan®)
• vinblastine (Velban®)
• warfarin (Coumadin®)
• almotriptan (Axert®)
• frovatriptan (Frovav)
• sumatriptan (Imitrex®)
• naratriptan (Amerge®)
• rizatriptan (Maxalt®)
• zolmitriptan (Zomig®)
• amitriptyline (Elavil®)
• citalopram (Celexa®)
• escitalopram (Lexapro®)
• fluvoxamine (Luvox®)
• desipramine (Norpramin®)
• imipramine (Tofranil®)
• nortriptyline (Pamelor®)
• sertraline (Zoloft®)

If you are using any of these drugs, you may not be able to use fluoxetine, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect fluoxetine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.