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Why it's used

Flunil Capsule is used to treat depression (major depressive disorder) in adults and children of 8 to 18 years. This medicine works by increasing the level of a natural substance (serotonin) in the brain. Flunil is also used to treat mental illness with uncontrollable thoughts and repetitive behaviors (known as, Obsessive-compulsive disorder) in adults and children 7 to 18 years, to treat serious eating disorder (bulimia nervosa), to treat panic disorder, with or without fear of places and situations (agoraphobia), and to relieve symptoms of a premenstrual dysphoric disorder including mood swings, bloating, irritability, and breast tenderness.
Flunil Capsule may also be used together with other medicines to treat certain conditions as recommended by the doctor. It is used in combination with Olanzapine to treat episodes of depression in people with bipolar I disorder and manic-depressive disorder.
Selective Serotonin Reuptake inhibitor
Flunil is a prescription medicine that belongs to a class of medicines called Selective Serotonin Reuptake inhibitor. Selective serotonin reuptake inhibitors (SSRIs) are a group of medicine used to treat depression and anxiety disorders. Serotonin is the natural chemical that carries signals between brain cells. SSRIs block the re-absorption of serotonin thus making more serotonin available in the brain.

How to use

Read the directions on the product label, patient guide, or medicine guide provided by the medicine company or your pharmacist before starting to use Flunil Capsule. If you have any questions related to this medicine, ask your doctor or pharmacist. Consume this medicine as recommended by your doctor.
Flunil Capsule is consumed with or without food. Flunil Capsule is consumed usually taken once a day in the morning or twice a day in the morning and at noon.
The typical dose of Flunil is 20-60 mg/day in the morning. The usual dose for children is 20-60 mg/day. The maximum adult dose of Flunil is 60-80 mg in a day. This medicine is not known to be habit-forming.
You should continue to use this medicine as directed by the doctor even if you feel well.
Talk to your doctor if you develop new or worsening symptoms. Tell your doctor if attempts to commit suicide, acting on dangerous impulses, acting aggressive or violent, thoughts about suicide or dying, new or worse depression, new or worse anxiety or panic attacks, feeling agitated, restless, angry, or irritable, insomnia, an increase in activity, and unusual changes in behavior or mood. If you have any kidney disease, The high levels of metabolites of Flunil may be accumulated in the kidney of patients with a history of abnormal functioning of the kidney, so use of a lower or less frequent dose is not routinely required in these patients. If you have issues with the health of your liver, A lower or less frequent dose of Flunil should be used in patients with abnormal liver functioning and precaution should be taken in such patients. You should consult with your doctor before stopping the use of Flunil.
Your doctor may recommend a lower initial dose of this medicine to see the impact of this medicine on the body. Please follow your doctor's directions. Older patients may see an increase in the incidence of side-effects with this medicine. As a result, a lower dose may be recommended for older patients.
When stopping this medicine, you may experience withdrawal symptoms such as anxiety, irritability, high or low mood (dysphoric mood), feeling restless or changes in sleep habits, headache, sweating, nausea, dizziness, tremor, shaking, confusion, and abnormal physical weakness. You may need to gradually decrease the dose of this medicine before stopping.
If you are giving Flunil Capsule to a child, be sure to use a product that is meant for children. Before giving this medicine to a child, use the child's weight or age to find the right dose from the product package. You can also read the dosage section of this page to know the correct dose for your child. Else, consult with your doctor and follow their recommendation.
Avoid the consumption of alcohol with Flunil.
Your doctor may request that specific lab tests be performed before you start using Flunil Capsule. You may need to have Electrocardiogram test. The patients may experience prolonged or change in heartbeat during Flunil therapy. Before starting this medicine, your doctor would require you to undergo medical or laboratory tests (Electrocardiogram) to monitor for side-effects. Once the administration of the medicine starts, your doctor should monitor you for these medical and laboratory tests to make sure that the side-effects of this medicine are not impacting your health.
You should store Flunil Capsule Store at room temperature between 20°C to 25°C (68°F to 77°F), away from moisture, and away from light. Store the medicine away from the reach of children and pets.
Medicines may be prescribed for uses other than those listed in the medicine guide. Do not use Flunil Capsule for conditions for which it was not prescribed. Do not give Flunil Capsule to other people who might have the same conditions or symptoms that you have. Self-medication may harm them.

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How to take Flunil

The dose and frequency of using Flunil will depend on the following factors:
  • age of the patient
  • the weight of the patient
  • patient's health
  • the health of the patient's liver
  • the health of the patient's kidneys
  • medicines recommended by the doctor
  • any other medicines being used
  • herbal supplements being used
  • response to the medicine

Flunil Dosage

Dosage for depression (major depressive disorder)

Adult
  • Recommended: 20 mg/day in the morning or twice daily schedule (morning and noon)
  • Initial: 20 mg/day in the morning
  • Maximum: 80 mg/day
Children (8 to 18 years)
  • Initial: 10 to 20 mg/day
Older Adults
  • Recommended: 40 mg/day
  • Maximum: 60 mg/day

Dosage for mental illness with uncontrollable thoughts and repetitive behaviors (Obsessive-compulsive disorder)

Adult
  • Recommended: 20 to 60 mg/day in the morning or twice daily schedule (morning and noon)
  • Initial: 20 mg/day in the morning
  • Maximum: 80 mg/day
Children (7 to 17 years)
  • Recommended: 10 to 60 mg/day
  • Initial: 10 mg/day

Dosage for serious eating disorder (bulimia nervosa)

Adult
  • Recommended: 60 mg/day in the morning

Dosage for panic disorder

Adult
  • Recommended: 20 mg/day
  • Initial: 10 mg/day
  • Maximum: 60 mg/day

Minimum Age

7 years

Dosage calculation for children

To calculate the dosage for children please use the weight based dose calculator to calculate the appropriate dosage as per the weight of your child.

Forms

Capsule
Strength: 10 mg, 20 mg, 40 mg
Delayed release capsule
Strength: 90 mg
Tablet
Strength: 10 mg, 15 mg, 20 mg
Film-coated tablet
Strength: 10 mg, 20 mg, 60 mg
Liquid
Strength: 20 mg
Solution
Strength: 20 mg/5mL

Missed Dose

A missed dose should be taken as early as you remember it. However, if the time for the next dose is almost there, then the missed dose should be skipped, and the regular dosing schedule should be continued. Avoid taking a repeated dose to make up for a missed dose.

Overdose

What to do if you overdose on Flunil?
In case of overdose, proper airways, oxygen, and ventilation should be provided to the patients. Pulse rate, temperature, respiration rate and blood pressure (cardiac and vital signs) should be monitored. Forced urine excretion (forced diuresis), dialysis, filtering the blood outside the body (hemoperfusion) and blood change (exchange transfusion) may be useful. No specific antidote is known for Flunil so charcoal with sorbitol may be used for detoxification of stomach which may be more effective than vomit induction (emesis) and stomach cleaning (gastric lavage).
Symptoms of an overdose of Flunil
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
  • ECG abnormalities
  • abnormal blood pressure
  • abnormal heartbeat
  • abnormal pupil functioning
  • abnormality in walking
  • breathing problem (pulmonary dysfunction)
  • coma
  • confusion
  • impotence
  • increased heartbeat
  • kidney failure
  • mania
  • mild mania (hypomania)
  • movement disorder
  • nausea
  • nervousness
  • neuroleptic malignant syndrome-like reactions that involve mental status change, rigidity and fever
  • rise in body temperature
  • seizures
  • sleepiness
  • tremor
  • unconsciousness
  • unresponsiveness
  • vertigo
  • vomiting
If you think you have overdosed on Flunil Capsule, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Flunil

Before you use Flunil Capsule, tell your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information.
Before you use Flunil, tell your doctor of your medical history including treatments such as triptans, tricyclics, lithium, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), antipsychotics, tramadol, fentanyl, amphetamines, tryptophan or St. John’s Wort, electroconvulsive therapy (ECT), liver problems, kidney problems, heart problems, seizures, abnormal mood state (mania), low sodium level in the blood, stroke, bleeding problems, high blood pressure, prolonged or irregular heartbeat, or suicidal thoughts. Patients taking certain drugs with Flunil may affect the metabolism of Flunil which may lead to serotonin syndrome symptoms such as agitation, hallucinations, coma, increased heartbeat, abnormal blood pressure, dizziness, increased sweating, flushing, and fever. Prolonged seizures may be observed in patients taking electroconvulsive therapy (ECT) along with Flunil therapy. In patients with liver and kidney problems, Flunil may not be able to properly metabolized and excreted from the body which may lead to accumulation of metabolites into the body. Patient with a history of a heart problem such as QT prolongation may at an increased risk of abnormal heartbeat while using Flunil. Use of Flunil in patients with the history of mania may increase the risk of developing an elevated and unusually irritable mood behavior (mixed/manic episode). Patients taking Flunil with the history of bleeding disorders are at an increased risk of developing discoloration of the skin, solid blood clot swelling, nose bleeding and rupturing of blood vessels.
The use of this medicine may change ECG monitoring. The patients may experience prolonged heartbeat and increased and decreased heartbeat during Flunil therapy.
The use of Flunil Capsule may change height and weight. The children may experience possible slowed growth rate and weight change during Flunil therapy.
Avoid the consumption of alcohol with Flunil Capsule. Drinking alcohol may cause drowsiness (sleepiness).
Consult with your doctor on the use of Flunil Capsule during pregnancy. Use of Flunil late in the third trimester may cause complications in newborn which include breathing problem during sleep (apnea), respiratory distress, seizures, bluish or purplish skin discoloration (cyanosis), temperature instability, muscle weakness (hypotonia), feeding difficulty, muscle rigidity (hypertonia), vomiting, low blood sugar (hypoglycemia), overactive response (hyperreflexia), tremor, involuntary movements (jitteriness), constant crying, irritability. Flunil should only be used in pregnancy if potential benefits of medicine justify the possible risks. Consult with your doctor on the use of Flunil Capsule during breastfeeding. Flunil may pass into the breast milk and may cause side effects in babies. Discontinuation of breastfeeding should be considered if treatment with Flunil is required. If breastfeeding is required in the baby, the lower effective dose of Flunil should be considered. Consult with your doctor on the use of Flunil Capsule, if you are trying to conceive.
Flunil Capsule can make you feel sleepy. Be careful while driving, using machinery, or doing any other activity that needs you to be alert. The consumption of alcohol with Flunil Capsule can make you feel more sleepy. Flunil Capsule may cause seizures in some people. Discuss with your doctor if you perform activities where a loss of consciousness may cause you or others harm.
This medicine can cause stomach bleeding. The use of alcohol/tobacco with Flunil may increase your stomach bleeding risk. If you drink alcohol or smoke regularly, please discuss with your doctor. This medicine may increase your sensitivity to sunlight. If this happens, limit your time outdoors and do not tan to prevent sunburns. Cover your skin when you are outdoors or use a sunscreen. In case you get a sunburn, consult with your doctor.
Flunil Capsule may cause an increased risk of side-effects in younger patients. Children using this medicine may see an increased risk of abnormal mood (mania), elevated mood or hyperactivity (hypomania), suicidal thinking and behavior, increased thirst, hyperactivity and inability to concentrate (hyperkinesia), personality disorder, bleeding from the nasal cavity (epistaxis), urinary frequency, abnormally heavy bleeding at menstruation, possible slowed growth rate, weight change, unfriendliness (hostility), anxiety, agitation, panic attacks, insomnia, irritability, aggressiveness, impulsivity, and movement disorder.
Flunil Capsule may increase side-effects in older patients. Elderly patients may see an increased risk of a low level of sodium in the blood, headache, difficulty concentrating, memory problem, confusion, weakness, unsteadiness, hallucination, loss of consciousness, seizure, coma, respiratory arrest, and fatal.

Flunil Side-effects

The following side-effects may commonly occur when using Flunil Capsule. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
  • abnormal dreams/nightmare
  • abnormal heartbeat (QT prolonged)
  • abnormal vision/vision blurred
  • anxiety
  • change in sleep habits
  • chills
  • constipation
  • decreased sexual desire (decreased libido)
  • diarrhea
  • difficulty in expelling urine from the bladder
  • dilatation of blood vessels (vasodilatation)
  • disturbance in attention
  • dizziness
  • drowsiness
  • dry mouth
  • early morning awakening
  • eating disorder (anorexia)
  • ejaculation delayed
  • ejaculation dysfunction
  • ejaculation failure
  • emotional lability
  • erythema
  • excessive daytime sleepiness (hypersomnia)
  • excessive sweating
  • exfoliative rash
  • feeling jittery
  • feeling tired or fatigue
  • fever
  • flatulence
  • flu syndrome
  • flushing
  • frequent urination
  • gynecological bleeding
  • headache
  • heat rash
  • hives
  • inability in a man to achieve orgasm (impotence/erectile dysfunction)
  • indigestion (dyspepsia)
  • inflammation of the pharynx (pharyngitis)
  • inflammation or swelling of the sinuses (sinusitis)
  • insomnia
  • joint pain (arthralgia)
  • lack of energy
  • lethargy
  • loss of appetite
  • macular-papular rash
  • morbilliform rash
  • nausea
  • nervousness
  • palpitations
  • papular rash
  • premature ejaculation
  • pruritic rash
  • rash erythematous
  • rash follicular
  • rash generalized
  • rash macular
  • restlessness
  • retrograde ejaculation
  • sedation
  • severe skin itching
  • sexual problems in male
  • skin rash
  • taste disturbance
  • tension
  • tremor
  • umbilical erythema rash
  • vesicular rash
  • vomiting
  • weakness
  • weight loss
  • yawn
The following side-effects may commonly occur in older patients on the use of Flunil Capsule. Discuss with your doctor if any of these side-effects last for a long time or are severe:
The following side-effects may commonly occur in children when using Flunil Capsule. Discuss with your doctor if any of these side-effects last for a long time or are severe:
  • abnormal mood (mania)
  • abnormally heavy bleeding at menstruation
  • aggressiveness
  • agitation
  • anxiety
  • bleeding from the nasal cavity (epistaxis)
  • elevated mood or hyperactivity (hypomania)
  • hyperactivity and inability to concentrate (hyperkinesia)
  • impulsivity
  • increased thirst
  • insomnia
  • irritability
  • movement disorder
  • panic attacks
  • personality disorder
  • possible slowed growth rate
  • suicidal thinking and behavior
  • unfriendliness (hostility)
  • urinary frequency
  • weight change
Rarely, the use of Flunil Capsule may cause the following side-effects:
The following severe side-effects may also occur when using Flunil Capsule:
  • immune system disorders such as life-threatening allergic reaction (anaphylactic reaction), allergic reaction to an injection of foreign protein
    Symptoms: trouble breathing (laryngospasm/bronchospasm), swelling of the face, swelling of the tongue, swelling of the eyes, swelling of the mouth, hives, rash, blisters, fever joint pain
    The patient should contact the doctor immediately if such symptoms occur.
  • metabolism and nutrition disorders such as low level of sodium in the blood and low blood sugar
    Symptoms: headache, difficulty concentrating, memory problems, confusion, weakness, unsteadiness, hallucination, loss of consciousness, seizures, coma, respiratory arrest fatal
    Use of Flunil should be discontinued if the symptoms of a low level of sodium in the blood occur. Patients should take immediate medical attention to the occurrence of a low level of sodium in the blood. The use or discontinuation of Flunil may cause low blood sugar or high blood sugar in diabetic patients. In this case, your doctor may adjust the dose of diabetic medicines in starting or during the discontinuation of Flunil therapy.
  • heart and blood vessels disorders (a life-threatening condition)
    Symptoms: high blood pressure in the arteries, inflammation of a blood vessel (vasculitis), heart arrest, increased, decreased, or irregular heartbeat, shortness of breath, dizziness, fainting, breathing difficulty, loss of consciousness dizziness
    Use of Flunil should be discontinued if the patient develops symptoms and signs along with the increased or decreased heartbeat. Patients should be monitored for heart function parameters.
  • skin disorders
    Symptoms: sun allergic reactions (photosensitivity reaction), skin allergic reaction caused by infection (erythema multiforme), life-threatening skin reaction (Stevens-Johnson Syndrome) life-threatening drug-induced skin reaction
  • stomach and intestinal disorders
    Symptoms: stomach inflammation (gastritis), small intestine ulcer (duodenal ulcer), esophageal ulcer, stomach ulcer, stomach ulcer bleeding (stomach ulcer hemorrhage/gastric ulcer hemorrhage) bloody diarrhea/diarrhea hemorrhagic
  • Symptoms: abnormally low levels of thrombocytes, clot formation in the blood vessel, low count of neutrophils, low levels of white blood cells, destruction of red blood cells, deficiency of blood cells, deficiency of red blood cells, white blood cells and platelets in the blood
  • mental disorders such as abnormally elevated mood (mania), suicidal thoughts and behavior
    Symptoms: depression suicidal, intentional self-injury, self-injurious ideation, suicidal behaviour, suicidal ideation, suicide attempt, morbid thoughts, self-injurious behaviour, hallucinations, confusion, serious mental illness (delusions), acting violent, anxiety or panic attacks, feeling agitated, restless, irritable or angry, problem in sleeping, increase in the activity or talking more than normal, unusual changes in behavior, mood, actions, thoughts or feelings
    If these symptoms occur then contact your doctor immediately.
  • nervous system disorders such as serotonin-inducing symptoms (serotonin syndrome) (can be possibly fatal)
    Symptoms: agitation, hallucinations, acute confusional state (delirium), coma, rapid heartbeat, dizziness, flushing, tremor, rigidity, uncontrolled jerky contraction of muscles, incoordination, seizures, nausea, vomiting, diarrhea, coordination problems or muscle twitching (overactive reflexes/hyperreflexia), sweating, fever muscle rigidity
    If these symptoms occur then contact your doctor immediately.
  • eye disorder such as optic nerve damage (angle-closure glaucoma) and cataract
    Symptoms: eye pain, changes in vision swelling or redness in or around the eye
    The patients may have an eye examination to estimate the risk of such events.
  • liver and kidney disorders
    Symptoms: inability to empty the bladder, inflammation of the liver (hepatitis), bile flow obstruction (cholestatic jaundice), liver failure/necrosis kidney failure
Your doctor has prescribed Flunil Capsule because they judge that the benefit is greater than the risk posed by side-effects. Many people using this medicine do not have serious side-effects. This page does not list all possible side-effects of Flunil Capsule.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Functioning of liver or kidney

Patients with abnormal functioning of the liver are at an increased risk when using Flunil. The clearance of Flunil is decreased in such patients. A lower dose or taking Flunil at alternate days is recommended in such patients.

Discontinuation of treatment with Flunil

Patients who discontinue using Flunil suddenly are at an increased risk. These patients may develop symptoms including mental discomfort (dysphoric mood), irritability, nausea, nervousness (agitation), tremor, headache, dizziness, sensory disturbances (electric shock sensations), anxiety, confusion, vomiting, lack of energy (lethargy), emotional changes (lability), insomnia, and hyperactivity (hypomania) within few days after discontinuation of Flunil. Such patients should be monitored for the symptoms occurring on the discontinuation of Flunil. Flunil should not be discontinued immediately. Its dose should be decreased gradually according to the patient's need. On the occurrence of intolerable symptoms following dose reduction or discontinuation, treatment should be continued with the previously prescribed dose.

Abnormal heartbeat (QT interval prolongation)

Patients with existing heart rhythm disorder (congenital long QT syndrome), abnormal heartbeat (QT prolongation), family history of heart rhythm disorder, decreased level of potassium or magnesium in the blood, CYP2D6 poor metabolizer status, heart failure, heart attack, abnormal functioning of the liver, taking highly protein bound drugs, overdose, pimozide, thioridazine, antipsychotics (chlorpromazine, ziprasidone, iloperidone, mesoridazine, haloperidol, phenothiazine and droperidol), certain antihistamines (astemizole, mizolastine), antibiotics (erythromycin, moxifloxacin, gatifloxacin and sparfloxacin), procainamide, quinidine, sotalol, amiodarone, pentamidine, methadone, levomethadyl acetate, halofantrine, dolasetron mesylate, probucol, mefloquine, or tacrolimus are at an increased risk when using Flunil. These patients are at an increased risk of abnormal heartbeat (QT interval prolongation or Torsades de Pointes). The use of Flunil with CYP2D6 inhibitors or highly protein-bound drugs increases the level of Flunil in the blood. Precaution should be taken in such patients. Flunil should not be used in combination with pimozide, thioridazine, antipsychotics, certain antihistamines, antibiotics, drugs used to treat heart rhythm, pentamidine, methadone, levomethadyl acetate, halofantrine, dolasetron mesylate, probucol, mefloquine, or with tacrolimus. Evaluation and monitoring of the electrocardiogram should be considered in patients with risk factors for prolonged or changes in heartbeat (QT prolongation and ventricular arrhythmia). If the patient develops symptoms and signs along with the increased or decreased heartbeat, discontinuation of Flunil and examination of the heart should be considered.

Disturbances in memory and movement activities (cognitive and motor performance)

Patients using Flunil are at an increased risk. These patients may suffer from disturbed thinking, judgment, or movement (motor) skills. The patients should be cautious about operating heavy machinery until they almost sure that Flunil does not affect their ability to work.

Decreased appetite and weight

Underweight depressed patients or patients with an eating disorder (bulimic patients) are at an increased risk when using Flunil. The use of Flunil may cause weight loss and anorexia (decreased appetite) in such patients. These patients should be monitored for the change in weight during Flunil therapy.

Abnormal bleeding

Patients with a history of bleeding disorders or using Flunil with nonsteroidal anti-inflammatory drugs, aspirin, clozapine, phenothiazines, most tricyclic antidepressants, anticoagulants, and warfarin are at an increased risk. Using selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors such as fluoxetine increase the risk of bleeding reactions such as stomach or intestinal, skin, and mucous bleeding. Flunil may interfere with serotonin reuptake which may lead to an additional risk of stomach and intestinal bleeding when using Flunil with nonsteroidal anti-inflammatory drugs, aspirin, anticoagulants, and warfarin. Bleeding reactions related to selective norepinephrine reuptake inhibitors and serotonin reuptake inhibitors use have been ranged from discoloration of the skin (ecchymoses), solid blood clot swelling (hematomas), nose bleeding (epistaxis) and rupturing of the blood vessels (hemorrhage). Precaution is advised in patients with a history of bleeding disorders or using Flunil with nonsteroidal anti-inflammatory drugs, aspirin, clozapine, anticoagulants, phenothiazines, warfarin, and most tricyclic antidepressants. Patients taking warfarin should be monitored carefully for international normalized ratio when Flunil therapy is started or discontinued. Also, dose adjustment should be considered during and after discontinuation of Flunil therapy.

Eye disorder (angle-closure glaucoma)

Patients with increased intraocular pressure or with narrow angles without eye surgery (iridectomy) are at an increased risk when using Flunil. These patients are at an increased risk of dilation of the pupil of the eye and angle closure attack (angle-closure glaucoma). Flunil should be used cautiously in such patients.

Low level of sodium in the blood

Elderly patients or patients with an inappropriate amount of hormone responsible for regulating the level of water in the blood (antidiuretic hormone), with volume-depletion, or taking diuretics are at an increased risk when using Flunil. The use of Flunil may cause low levels of sodium in the blood. Signs and symptoms of low levels of sodium are difficulty in concentrating, headache, weakness, loss of memory, confusion, and unsteadiness which may lead to falls. Symptoms of more severe or acute cases are hallucinations, loss of consciousness, seizure, respiratory arrest, coma, and fatal. Flunil should not be used in these patients. Suitable therapy with Flunil should be started in such patients.

Diabetes

Patients with diabetes are at an increased risk when using Flunil. The use or discontinuation of Flunil may cause an alteration in glycemic control such as low blood sugar or high blood sugar respectively in such patients. Dose adjustment should be considered in starting or during the discontinuation of Flunil therapy. Precaution should be taken in such patients when using Flunil.

Suicidal thoughts and behaviors

Children and young adults (age 18 to 24 years) with depression or other psychotics disorders are at an increased risk when using Flunil. These patients may experience worsening of the depression, decreased height, weight gain and are at an increased risk of suicide-related behaviors (suicidal thoughts and suicide attempt) and hostility (oppositional behavior, predominantly aggression, and anger) when using Flunil. Symptoms occurring in the patients during Flunil therapy are agitation, anxiety, panic attacks, irritability, insomnia, aggressiveness, unfriendly (hostility), acting instantly without thinking (impulsivity), hypomania, movement disorder, and mania. Patients should be monitored closely for the suicidal thoughts, height, weight, and for unusual changes in behavior in the starting of therapy or during dose adjustment. Discontinuation of Flunil or changes in the therapy should be considered in such patients. Treatment of Flunil should be discontinued slowly, rather discontinuing suddenly, which may lead to the occurrence of the symptoms. Caregivers and family should be informed about the need to monitor the patients daily for the irritability, agitation, unusual changes in behavior, suicidal thoughts, and for symptoms occurring during Flunil therapy. Flunil should be prescribed at the lowest effective dose to reduce the risk of overdose. Flunil should not be used in children less than 7 years.

Serotonin-inducing symptoms (Serotonin syndrome)

Patients using Flunil with neuroleptic drugs, serotonergic drugs (tricyclic antidepressants, triptans, lithium, tramadol, tryptophan, fentanyl, buspirone, St. John’s Wort, and amphetamines), drugs altering the metabolism of serotonin, those intended to treat psychiatric disorders (linezolid and intravenous methylene blue) are at an increased risk. These patients are at an increased risk of serotonin syndrome or neuroleptic malignant syndrome-like events. Symptoms of serotonin syndrome are nausea, diarrhea, vomiting, hallucinations, agitation, delirium, increased heartbeat, borderline high blood pressure, coma, sweating (diaphoresis), increased body temperature, dizziness, rigidity, flushing, overactive reflexes (hyperreflexia), seizures, jerky contraction of muscles (myoclonus) and incoordination. Such patients should be made aware of increased risk for serotonin syndrome in the starting of therapy and during increased dose. Discontinuation of this combination and starting of suitable treatment is recommended on the occurrence of symptoms of serotonin syndrome. Also, when using or discontinuing this combination, dose reductions and monitoring of tricyclic antidepressants levels in the blood should be considered. Precaution along with close and frequent monitoring is recommended in patients using this combination. Monoamine oxidase inhibitors should not be used in patients who are intended to treat mental disorders with Flunil and within 5 weeks of stopping therapy with Flunil. Also, monoamine oxidase inhibitors should not be used within 14 days of stopping treatment with Flunil. The patient should be monitored for signs of serotonin syndrome for 5 weeks and until 24 hours after the last dose of intravenous methylene blue and linezolid. Flunil therapy may be continued 24 hours after the last dose of intravenous methylene blue and linezolid.

Allergic reaction and rash

Patients using Flunil are at an increased risk. These patients are at an increased risk of rash, hives, trouble breathing (bronchospasm/laryngospasm), swelling of the lower layer of the skin, anaphylaxis, breathing difficulty (dyspnea) and progressive systemic events (such as inflammation of a blood vessel/ vasculitis and autoimmune disorder/lupus-like syndrome) involving liver, kidney or lung. Diagnostic finding reported in association with rash include increased white blood cells (leukocytosis), fever, pain in joints (arthralgias), swelling due to accumulation of fluid, painful condition of the hands or fingers (carpal tunnel syndrome), fluid-buildup in the lungs (respiratory distress), swollen and enlarged lymph nodes, presence of protein in urine, and increase in transaminase in the blood. Patients may improve on discontinuation of Flunil. Flunil should not be used on the occurrence of rash for which different cause is not identified.

Bipolar disorder (major depressive episode)

Patients with major depressive episode are at an increased risk when using Flunil. Treating such patients with Flunil alone may increase the occurrence of a mixed/manic episode. Before starting the Flunil treatment, such patients should be examined for the risk of bipolar disorder which includes a detailed psychiatric history such as family history of suicide, depression, and bipolar disorder. Flunil monotherapy should not be used for the treatment of depressive episodes associated with Bipolar I Disorder. Precaution should be taken in patients with a history of bipolar disorder (hypomania/mania).

Seizures

Patients with a history of seizures or receiving electroconvulsive therapy (ECT) are at an increased risk when using Flunil. The use of Flunil may increase the risk of prolonged seizures in these patients. Care and precaution should be taken in such patients. Flunil therapy should be discontinued on the occurrence of seizures or increased frequency of seizures. This medicine should not be used in patients with unstable seizure. Monitoring of the patients with epilepsy should be considered.

Interactions with Flunil

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
Your doctor's guidelines may need to be followed while taking this medicine along with pimozide and thioridazine, which are used to treat the mental disorder (schizophrenia). When Flunil is used with pimozide and thioridazine, it can cause abnormal heart rhythm (QT-prolongation). Flunil decreases the metabolism of pimozide and thioridazine which may lead to an incraesed level of these drugs in the blood. Using thioridazine with Flunil may increase the risk of increased and decreased heartbeat (Torsades de Pointes), which can be possibly fatal. Flunil should not be used with pimozide. Thioridazine should not be used within a minimum of 5 weeks after discontinuing Flunil.
Flunil Capsule interacts with drugs that interfere with blood clotting system (nonsteroidal anti-inflammatory drugs, aspirin and warfarin). Use of psychotropic drugs interferes with serotonin reuptake and increases the upper stomach and intestinal tract bleeding when used in combination with aspirin, non-steroidal anti-inflammatory drugs, oral anticoagulants, phenothiazines, clozapine, or with a most tricyclic antidepressant. Using serotonin and norepinephrine reuptake inhibitors or selective serotonin reuptake inhibitors such as Flunil with warfarin increases the risk of bleeding reactions. These bleeding reactions may range from discoloration of the skin (ecchymosis), a collection of blood outside the blood vessels (hematoma), nose bleeding (epistaxis), and a red or purple spot on the skin (petechiae) to life-threatening bleeding. Patients taking warfarin should be monitored carefully for international normalized ratio when Flunil therapy is started or discontinued. Precaution is advised in patients using selective serotonin reuptake inhibitors such as Flunil with warfarin, oral anticoagulants, aspirin, non-steroidal anti-inflammatory drugs, phenothiazines, clozapine, or with most tricyclic antidepressants. Also, dose adjustment should be considered during and after discontinuation of Flunil therapy.
There may be an interaction of Flunil with monoamine oxidase inhibitors such as linezolid and methylene blue, which are used to treat depression. When Flunil is used with monoamine oxidase inhibitors, patients have an increased risk of developing a life-threatening serotonin-inducing symptoms (serotonin syndrome) such as agitation, hallucinations, acute confusional state (delirium), coma, rapid heartbeat, dizziness, flushing, tremor, muscle rigidity, uncontrolled jerky contraction of muscles (myoclonus), incoordination, seizures, nausea, vomiting, diarrhea, coordination problems or muscle twitching (overactive reflexes/hyperreflexia, sweating (diaphoresis) and fever. Monoamine oxidase inhibitors are not recommended in patients who are intended to treat mental disorders with Flunil and within 5 weeks of stopping therapy with Flunil. Also, monoamine oxidase inhibitors should not be used within 14 days of stopping treatment with Flunil. The patient should be monitored for signs of serotonin syndrome for 5 weeks and until 24 hours after the last dose of intravenous methylene blue or linezolid. Flunil therapy may be continued 24 hours after the last dose of intravenous methylene blue or linezolid.
Flunil Capsule may interact with the central nervous system acting drug and drugs inducing low levels of sodium (desmopressin, diuretics, oxcarbazepine, and carbamazepine). Using Flunil with drugs inducing a low level of sodium may increase the risk of low sodium level in the blood. Precaution should be taken in such patients when using Flunil with central nervous acting drugs and drugs inducing low levels of sodium. When combination treatment is required, therapy should be started at the lowest effective dose. Also, dose adjustment and monitoring of the clinical effectiveness should be considered.
Special instructions need to be followed while taking this medicine along with drugs tightly bound to the proteins present in the blood (coumadin and digitoxin), which are used to treat heart diseases. The use of Flunil in patients taking another drug that is tightly bound to protein may change the effect of these medicines. In some cases, when drugs that are tightly bound to proteins are given to patient taking Flunil, it may change the blood level of #Name#.
Your doctor's guidelines may need to be followed while taking this medicine along with tricyclic antidepressants (desipramine and imipramine), which are used to treat depression. The use of Flunil with imipramine and desipramine may increase 2 to 10 fold level of these medicines in the blood, which may last for 3 weeks or longer after discontinuation of Flunil. The use of Flunil with desipramine and imipramine may increase the risk of serotonin syndrome. Symptoms of serotonin syndrome are nausea, diarrhea, vomiting, hallucinations, agitation, delirium, increased heartbeat, blood pressure, coma, sweating (diaphoresis), increased body temperature, dizziness, rigidity, flushing, overactive reflexes (hyperreflexia), seizures, jerky contraction of muscles (myoclonus) and incoordination. Patients using Flunil and imipramine or desipramine should be made aware of increased risk for serotonin syndrome in the starting of therapy and during increased dose. Discontinuation of this combination and starting of suitable treatment is recommended on the occurrence of symptoms of serotonin syndrome. Also, when using or discontinuing this combination, dose reductions and monitoring of tricyclic antidepressants levels in the blood should be considered.
Flunil Capsule interacts with antihistamines (astemizole, mizolastine, and mequitazine), levomethadyl acetate, and tacrolimus, which are used to treat allergic reactions, opiate addiction, and skin problems respectively. When Flunil is used with antihistamines (astemizole, mizolastine), levomethadyl acetate, tacrolimus, it may lead to an additive effect on abnormal heartbeat (QT prolongation). Precaution should be taken in patients using Flunil with these medicines. Evaluation and monitoring of the electrocardiogram should be considered in such patients. If the patient develops symptoms and signs along with the increased or decreased heartbeat, discontinuation of Flunil and examination of the heart should be considered. Patients should not use mequitazine with Flunil.
Special instructions need to be followed while taking this medicine along with drug metabolized by CYP2D6 such as certain tricyclic antidepressants, antipsychotics (most atypicals, risperidone, and phenothiazines), vinblastine, and carbamazepine, which are used to treat depression, mental disorders, cancer and epilepsy respectively. The use of Flunil with these medicines may prevent the activity of CYP2D6. Precaution should be taken in patients using Flunil with tricyclic antidepressants, antipsychotics, vinblastine, or carbamazepine. A low dose of drugs metabolized by CYP2D6 should be recommended in such patients. It may also apply in case of patients who have taken Flunil in the previous five weeks.
There may be an interaction of Flunil with drugs used to treat heart rhythm (amiodarone, quinidine, procainamide, or sotalol), and antimalarial drugs (halofantrine and mefloquine), which are used to treat increased or decreased heartbeat and malaria. When Flunil is used with drugs used to treat heart rhythm and antimalarial drugs, it may lead to an additive effect on abnormal heartbeat (QT prolongation). Precaution should be taken in patients using Flunil with drugs used to treat heart rhythm and antimalarial drugs. Evaluation and monitoring of the electrocardiogram should be considered in such patients. If the patient develops symptoms and signs along with the increased or decreased heartbeat, discontinuation of Flunil and examination of the heart should be considered.
Flunil Capsule may interact with antipsychotics (droperidol, chlorpromazine, ziprasidone, mesoridazine, or iloperidone), and pentamidine which are used to treat mental disorders and microbial infections respectively. When Flunil is used with antipsychotics, or with antimicrobial agents, it may lead to an additive effect on abnormal heartbeat (QT prolongation). Precaution should be taken in patients using Flunil with antipsychotics, or with antimicrobial agents. Evaluation and monitoring of the electrocardiogram should be considered in such patients. If the patient develops symptoms and signs along with the increased or decreased heartbeat, discontinuation of Flunil and examination of the heart should be considered.
Flunil Capsule may interact with benzodiazepines (alprazolam and diazepam), which are used to treat anxiety disorders. The use of Flunil with diazepam may increase the half-life of diazepam. Also, the use of Flunil with alprazolam may increase the level of this medicine in the blood which may result in decreased movement or muscular activity.
Your doctor's guidelines may need to be followed while taking this medicine along with olanzapine and tamoxifen, which are used to treat mood disorders and breast cancer respectively. Using Flunil with tamoxifen may decrease the active metabolite of tamoxifen, which may lead to decrease in the effectiveness of this medicine. Also, the use of Flunil with olanzapine may increase the level in the blood or decrease the clearance of olanzapine. The use of Flunil with tamoxifen should be avoided.
Special instructions need to be followed while taking this medicine along with metoprolol and cyproheptadine, which are used to treat high blood pressure and allergy respectively. The use of Flunil with metoprolol may increase the risk of harmful effects such decreased heartbeat. Also, using Flunil with cyproheptadine may decrease the antidepressant effects of Flunil. Patients should avoid the use of metoprolol with Flunil.
Flunil Capsule interacts with serotonergic drugs (lithium, St. John's Wort, triptans, tramadol, tricyclic antidepressants, fentanyl, buspirone, tryptophan, selegiline, and amphetamines), which are used to treat depression. The use of selective serotonin reuptake inhibitors with serotoninergic drugs may increase the risk of serotonin syndrome. Symptoms of serotonin syndrome are nausea, diarrhea, vomiting, hallucinations, agitation, delirium, increased heartbeat, blood pressure, coma, sweating (diaphoresis), increased body temperature, dizziness, rigidity, flushing, overactive reflexes (hyperreflexia), seizures, jerky contraction of muscles (myoclonus), incoordination. The use of Flunil with lithium may also interfere with the levels of lithium in the blood, which may lead to harmful effects of drugs. Patients using Flunil and serotoninergic drugs should be made aware of increased risk for serotonin syndrome in the starting of therapy and during increased dose. Discontinuation of this combination and starting of suitable treatment is recommended on the occurrence of symptoms of serotonin syndrome. Also, when using or discontinuing this combination, dose reductions and monitoring of tricyclic antidepressants and lithium levels in the blood should be considered. Precaution along with close and frequent monitoring is recommended in patients using this combination.
There may be an interaction of Flunil with antipsychotics (haloperidol and clozapine) and anticonvulsants (carbamazepine and phenytoin) which are used to treat the mental disorder and seizures respectively. The use of Flunil with clozapine, haloperidol, carbamazepine, and phenytoin may increase the level of these medicines in the blood which may lead to harmful effects of these drugs. Dose adjustment and monitoring of drug effectiveness should be considered in patients using Flunil with phenytoin and carbamazepine.
This page does not contain all the possible interactions of Flunil Capsule. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Flunil is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.

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