Get a month of TabletWise Pro for free! Click here to redeem 
TabletWise.com
 

Why it's used

Fluoxetine 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. Fluoxetine 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.
Fluoxetine 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
Fluoxetine 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

Follow directions on the product label, information guide, and provided by your doctor before using Fluoxetine. Consume this medicine as per your doctor's instructions.
Fluoxetine is consumed with or without food. Fluoxetine is consumed usually taken once a day in the morning or twice a day in the morning and at noon.
The typical adult dose of Fluoxetine is 20-60 mg/day in the morning. The typical dose for children is 20-60 mg/day. The maximum dose for adults of Fluoxetine is 60-80 mg per day. There are no known habit-forming tendencies with this medicine.
You should continue to use this medicine as directed by the doctor even if you feel well.
Tell your doctor if you develop new or worsening symptoms. Talk to 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 Fluoxetine 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 Fluoxetine should be used in patients with abnormal liver functioning and precaution should be taken in such patients. Consult with your doctor before stopping the use of Fluoxetine.
To see the impact of Fluoxetine on the body, your doctor may recommend a lower initial dose. Please follow your doctor's instructions carefully. Older patients may see an increase in the risk of side-effects. Hence, a lower dose may be recommended.
When stopping this medicine, it is possible that 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 Fluoxetine to a child, be sure to use a product that is meant for use in children. Before giving this medicine, use the child's weight or age to find the right dose from the leaflet or 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 drinking alcohol with Fluoxetine.
Before starting this medicine, your doctor may ask you to undergo certain medical or laboratory tests (Electrocardiogram) to monitor for side-effects. After starting the medicine, your doctor should monitor you for these tests to make sure that you do not have side-effects of this medicine. Your doctor may require that certain tests be performed before using Fluoxetine. The doctor may ask you to have Electrocardiogram test. The patients may experience prolonged or change in heartbeat during Fluoxetine therapy.
Medicines may be given for uses other than those listed in the medicine guide. Do not use Fluoxetine for symptoms for which it was not prescribed. Do not give Fluoxetine to others who may have similar symptoms as you. Self-medication can cause harm.
Store Fluoxetine Store at room temperature between 20°C to 25°C (68°F to 77°F), away from moisture, and away from light. Keep this medicine away from children and pets.

Get TabletWise Pro

Thousands of Classes to Help You Become a Better You.

How to take Fluoxetine

Your dose may depend on several personal factors. You should consult with your doctor to find out the dose that is best for you. The dose of Fluoxetine depends on the following factors:
  • patient's age
  • patient's weight
  • patient's health
  • the health of the patient's liver
  • the health of the patient's kidneys
  • medicines recommended by your doctor
  • any other medicines in use
  • herbal supplements consumed
  • response to treatment

Fluoxetine 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 Fluoxetine?
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 Fluoxetine 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 Fluoxetine
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 Fluoxetine, 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 Fluoxetine

Before you use Fluoxetine, 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 Fluoxetine, 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 Fluoxetine may affect the metabolism of Fluoxetine 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 Fluoxetine therapy. In patients with liver and kidney problems, Fluoxetine 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 Fluoxetine. Use of Fluoxetine 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 Fluoxetine 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 height and weight. The children may experience possible slowed growth rate and weight change during Fluoxetine therapy.
The use of Fluoxetine may change ECG monitoring. The patients may experience prolonged heartbeat and increased and decreased heartbeat during Fluoxetine therapy.
Consult with your doctor on the use of Fluoxetine during pregnancy or if you are planning to become pregnant. Use of Fluoxetine 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. Fluoxetine should only be used in pregnancy if potential benefits of medicine justify the possible risks. Consult with your doctor on the use of Fluoxetine during breastfeeding. Fluoxetine may pass into the breast milk and may cause side effects in babies. Discontinuation of breastfeeding should be considered if treatment with Fluoxetine is required. If breastfeeding is required in the baby, the lower effective dose of Fluoxetine should be considered. Consult with your doctor on the use of Fluoxetine, if you are trying to conceive.
Avoid drinking alcohol with Fluoxetine. Consumption of alcohol may cause drowsiness (sleepiness).
Fluoxetine can make you feel sleepy. Be careful, especially while driving, while using heavy machinery, or when doing any activity that needs you to be completely alert. The consumption of alcohol with Fluoxetine can worsen the sleepiness. Fluoxetine may cause seizures in some people. Hence, you should discuss with your doctor before performing any activities where a loss of consciousness may cause harm to you or others.
This medicine may cause stomach bleeding. Regular use of tobacco and alcohol may increase your risk. Discuss with your doctor if you smoke and drink alcohol regularly. This medicine may increase your sensitivity to sunlight and make you prone to sunburn. If this happens, limit your time outdoors to prevent sunburn. Use a sunscreen and cover your skin when you are outdoors. If you get sunburns on your body, consult with your doctor.
Older patients may have a higher incidence of side-effects when using Fluoxetine. 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.
Younger patients may have a higher incidence of side-effects with Fluoxetine. Younger patients 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.

Fluoxetine Side-effects

The following side-effects may commonly occur when using Fluoxetine. 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 Fluoxetine. 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 Fluoxetine. 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 Fluoxetine may cause the following side-effects:
The following severe side-effects may also occur when using Fluoxetine:
  • 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.
  • 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 Fluoxetine 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 Fluoxetine 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 Fluoxetine therapy.
  • 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.
  • 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.
  • 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
  • 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 Fluoxetine 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.
  • 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.
  • 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
  • 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
  • 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
Your doctor has prescribed this Fluoxetine because they have judged that the benefits outweigh the risks posed by side-effects. Many people using this medicine do not have serious side-effects. This is not a complete list of possible side-effects for Fluoxetine.
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

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 Fluoxetine. 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 Fluoxetine. Symptoms occurring in the patients during Fluoxetine 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 Fluoxetine or changes in the therapy should be considered in such patients. Treatment of Fluoxetine 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 Fluoxetine therapy. Fluoxetine should be prescribed at the lowest effective dose to reduce the risk of overdose. Fluoxetine should not be used in children less than 7 years.

Serotonin-inducing symptoms (Serotonin syndrome)

Patients using Fluoxetine 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 Fluoxetine and within 5 weeks of stopping therapy with Fluoxetine. Also, monoamine oxidase inhibitors should not be used within 14 days of stopping treatment with Fluoxetine. 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. Fluoxetine therapy may be continued 24 hours after the last dose of intravenous methylene blue and linezolid.

Allergic reaction and rash

Patients using Fluoxetine 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 Fluoxetine. Fluoxetine 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 Fluoxetine. Treating such patients with Fluoxetine alone may increase the occurrence of a mixed/manic episode. Before starting the Fluoxetine 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. Fluoxetine 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 Fluoxetine. The use of Fluoxetine may increase the risk of prolonged seizures in these patients. Care and precaution should be taken in such patients. Fluoxetine 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.

Decreased appetite and weight

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

Abnormal bleeding

Patients with a history of bleeding disorders or using Fluoxetine 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. Fluoxetine may interfere with serotonin reuptake which may lead to an additional risk of stomach and intestinal bleeding when using Fluoxetine 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 Fluoxetine 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 Fluoxetine therapy is started or discontinued. Also, dose adjustment should be considered during and after discontinuation of Fluoxetine 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 Fluoxetine. These patients are at an increased risk of dilation of the pupil of the eye and angle closure attack (angle-closure glaucoma). Fluoxetine 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 Fluoxetine. The use of Fluoxetine 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. Fluoxetine should not be used in these patients. Suitable therapy with Fluoxetine should be started in such patients.

Diabetes

Patients with diabetes are at an increased risk when using Fluoxetine. The use or discontinuation of Fluoxetine 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 Fluoxetine therapy. Precaution should be taken in such patients when using Fluoxetine.

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

Patients using Fluoxetine 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 Fluoxetine does not affect their ability to work.

Functioning of liver or kidney

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

Discontinuation of treatment with Fluoxetine

Patients who discontinue using Fluoxetine 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 Fluoxetine. Such patients should be monitored for the symptoms occurring on the discontinuation of Fluoxetine. Fluoxetine 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 Fluoxetine. These patients are at an increased risk of abnormal heartbeat (QT interval prolongation or Torsades de Pointes). The use of Fluoxetine with CYP2D6 inhibitors or highly protein-bound drugs increases the level of Fluoxetine in the blood. Precaution should be taken in such patients. Fluoxetine 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 Fluoxetine and examination of the heart should be considered.

Interactions with Fluoxetine

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.
Fluoxetine may interact with the central nervous system acting drug and drugs inducing low levels of sodium (desmopressin, diuretics, oxcarbazepine, and carbamazepine). Using Fluoxetine 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 Fluoxetine 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.
There may be an interaction of Fluoxetine with monoamine oxidase inhibitors such as linezolid and methylene blue, which are used to treat depression. When Fluoxetine 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 Fluoxetine and within 5 weeks of stopping therapy with Fluoxetine. Also, monoamine oxidase inhibitors should not be used within 14 days of stopping treatment with Fluoxetine. 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. Fluoxetine therapy may be continued 24 hours after the last dose of intravenous methylene blue or linezolid.
Fluoxetine 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 Fluoxetine 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 Fluoxetine therapy is started or discontinued. Precaution is advised in patients using selective serotonin reuptake inhibitors such as Fluoxetine 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 Fluoxetine therapy.
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 Fluoxetine 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 Fluoxetine, it may change the blood level of #Name#.
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 Fluoxetine is used with pimozide and thioridazine, it can cause abnormal heart rhythm (QT-prolongation). Fluoxetine decreases the metabolism of pimozide and thioridazine which may lead to an incraesed level of these drugs in the blood. Using thioridazine with Fluoxetine may increase the risk of increased and decreased heartbeat (Torsades de Pointes), which can be possibly fatal. Fluoxetine should not be used with pimozide. Thioridazine should not be used within a minimum of 5 weeks after discontinuing Fluoxetine.
Fluoxetine may interact with antipsychotics (droperidol, chlorpromazine, ziprasidone, mesoridazine, or iloperidone), and pentamidine which are used to treat mental disorders and microbial infections respectively. When Fluoxetine 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 Fluoxetine 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 Fluoxetine and examination of the heart should be considered.
There may be an interaction of Fluoxetine 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 Fluoxetine 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 Fluoxetine 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 Fluoxetine and examination of the heart should be considered.
Fluoxetine 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 Fluoxetine 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 Fluoxetine 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 Fluoxetine and examination of the heart should be considered. Patients should not use mequitazine with Fluoxetine.
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 Fluoxetine with these medicines may prevent the activity of CYP2D6. Precaution should be taken in patients using Fluoxetine 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 Fluoxetine in the previous five weeks.
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 Fluoxetine 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 Fluoxetine. The use of Fluoxetine 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 Fluoxetine 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.
Fluoxetine may interact with benzodiazepines (alprazolam and diazepam), which are used to treat anxiety disorders. The use of Fluoxetine with diazepam may increase the half-life of diazepam. Also, the use of Fluoxetine with alprazolam may increase the level of this medicine in the blood which may result in decreased movement or muscular activity.
There may be an interaction of Fluoxetine with antipsychotics (haloperidol and clozapine) and anticonvulsants (carbamazepine and phenytoin) which are used to treat the mental disorder and seizures respectively. The use of Fluoxetine 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 Fluoxetine with phenytoin and carbamazepine.
Fluoxetine 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 Fluoxetine with lithium may also interfere with the levels of lithium in the blood, which may lead to harmful effects of drugs. Patients using Fluoxetine 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.
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 Fluoxetine with metoprolol may increase the risk of harmful effects such decreased heartbeat. Also, using Fluoxetine with cyproheptadine may decrease the antidepressant effects of Fluoxetine. Patients should avoid the use of metoprolol with Fluoxetine.
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 Fluoxetine with tamoxifen may decrease the active metabolite of tamoxifen, which may lead to decrease in the effectiveness of this medicine. Also, the use of Fluoxetine with olanzapine may increase the level in the blood or decrease the clearance of olanzapine. The use of Fluoxetine with tamoxifen should be avoided.
This page does not contain all the possible interactions of Fluoxetine. 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 Fluoxetine 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.

Sign Up