Provided by You Health for patients

Generic for Prozac® (Fluoxetine)

In this medication overview

Fluoxetine is a prescription medicine used to treat major depressive disorder (MDD), obsessive compulsive disorder (OCD), panic disorder, bulimia nervosa, and premenstrual dysphoric disorder (PMDD). Fluoxetine may also be helpful when prescribed “off-label” for body dysmorphic disorder, dysthymia, or posttraumatic stress disorder (PTSD).

Usage

It’s important to take your medication as directed by your provider and to review the directions on your prescription label.

The delayed release form should be swallowed whole. Do not break, crush or chew it.

If you miss a dose of fluoxetine that you take daily, take it as soon as you remember, unless it is closer to the time of your next dose. If you take fluoxetine once weekly, take it as soon as possible, then go back to your regular schedule the next week. Discuss this with your healthcare provider. Do not double your next dose or take more than what is prescribed.

Do not abruptly stop taking fluoxetine without first checking with your healthcare provider, even when you feel better. Abruptly stopping can cause discontinuation symptoms including: vomiting, irritability, dizziness, headaches, sensation of tingling skin, or nightmares. Studies have shown that a taper can reduce possible discontinuation symptoms. Your healthcare provider can provide individualized guidance on tapering your medication. If you choose to discontinue fluoxetine without consulting your provider, the following are general tapering guidelines for fluoxetine:

• If you are taking fluoxetine 80mg (two 40mg capsules), take 1 capsule (40mg) daily for 1 week, then 1 capsule (40mg) every other day for 1 week, then you may stop your medication.

• If you are taking fluoxetine 60mg (three 20mg capsules), take 2 capsules (40mg) daily for 1 week, then 1 capsule daily for 1 week (20 mg), then you may stop your medication.

• If you are taking fluoxetine 40mg, take 1 capsule (40mg) every other day for 1 week, then you may stop your medication.

• If you are taking fluoxetine 20mg, take 1 capsule (20mg) every other day for 1 week, then you may stop your medication.

Monitor for improvements

Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.

Warnings

SUICIDALITY AND ANTIDEPRESSANT DRUGS

Fluoxetine and other antidepressant medicines may increase suicidal thoughts or actions, especially in some people 24 years of age and younger within the first few months of treatment or when the dose is changed. If you are experiencing a mental health crisis, please call or text 988 to be connected with help, or go to your nearest hospital emergency department. Pay particular attention to such changes when fluoxetine is started or when the dose is changed.

Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or healthcare professional. All patients being treated with antidepressants for any indication should watch for and notify their healthcare provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.

IMPORTANT SAFETY INFORMATION

Do not take fluoxetine if you:

• Are allergic to fluoxetine, or any of the ingredients in fluoxetine

• Take any medication for Parkinson’s Disease or depression called monoamine oxidase inhibitors (MAOI), or if you have stopped taking an MAOI in the last 14 days as they may cause a dangerous increase in blood pressure. MAOIs include, but are not limited to: isocarboxazid, phenelzine, rasagiline, selegiline, tranylcypromine

• Take other medication that may cause an increase in serotonin levels such as linezolid, methylene blue, tryptophan

• Take St John’s Wort or 5-Hydroxytryptophan (5-HTP)

• Take tamoxifen

• Are drinking large amounts alcohol

• Are using or abusing recreation drugs or prescription medications

Before you take fluoxetine, tell your healthcare provider if you:

• Have thoughts of suicide or harming yourself

• Have a history of psychiatric or medical problems, including bipolar disorder

• Have taken any medication in the past for your condition, whether effective or not

• Have suffered adverse or side effects from previous medication therapies

• Drink alcohol or use/abuse recreational or prescription drugs

• Are pregnant, plan to become pregnant, or are breastfeeding

Inform your healthcare provider

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, herbal supplements, and recreational drugs.

Fluoxetine may affect the way other medicines work, and other medicines may affect the way fluoxetine works, causing side effects. Especially tell your healthcare provider if you take any of the following:

• Aspirin or nonsteroidal anti-inflammatory drugs (e.g. ibuprofen, naproxen, celecoxib, diclofenac)

• Warfarin or other anticoagulants

• Any other serotonergic medications including: trazodone, migraine medications (triptans), pain medications (tramadol), antibiotic linezolid, amphetamines

• Anticonvulsants (phenytoin, carbamazepine)

• Antipsychotics (haloperidol, aripiprazole)

• Atomoxetine

• Tricyclic antidepressants (imipramine, desipramine)

• Beta blockers (metoprolol, propranolol)

• Tamoxifen

Fluoxetine may increase the risk of bleeding when taking blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs). If you are currently taking blood thinners or NSAIDs, we strongly recommend that you inform your primary care provider that you have started taking this mental health medication and be sure to report any signs of abnormal bleeding to your provider, such as bleeding gums, unexplained bruising, or black, tarry stools.

Medication disposal

If you no longer need your medication, the best way to dispose of most types of old, unused, unwanted, or expired medicines (both prescription and over the counter) is to drop off the medicine at a drug take back site, location, or program immediately. You can use the DEA DIVERSION CONTROL DIVISION LOOKUP to find your nearest drug disposal site.

If no drug take back sites, locations, or programs are available in your area, and there are no specific disposal instructions (such as flushing) in the medication guide or package insert, you can visit FDA- Disposal of Unused Medicines for more information or follow these simple steps to dispose of most medicines in your trash at home:

• Mix medicines (liquid or pills; do not crush tablets or capsules) with an unappealing substance such as dirt, cat litter, or used coffee grounds;

• Place the mixture in a container such as a sealed plastic bag;

• Throw away the container in your trash at home; and

• Delete all personal information on the prescription label of empty medicine bottles or medicine packaging, then trash or recycle the empty bottle or packaging.

Side effects

Fluoxetine can cause serious side effects and should be reported to your provider immediately. Rarely reported side effects include:

• Low sodium blood levels (symptoms may include headache, weakness, difficulty remembering or concentrating, feeling confused, seizures, change in balance, a significant weight gain or loss)

• Angle closure glaucoma (symptoms of angle closure glaucoma may include eye pain, changes in vision, swelling or redness in or around eye)

• Serotonin syndrome (symptoms may include shivering, diarrhea, confusion, severe muscle tightness, fever, seizures, and death)

• Increased bleeding (gums)

• Seizures

• Dizziness

• Slow heartbeat

• Menstrual changes

• Passing urine more often

• Trouble controlling body movements

• Erection that lasts more than 4 hours

• Teeth grinding

• QT prolongation and ventricular arrhythmia including Torsades de Pointes (changes in the electrical activity of your heart; symptoms may include fast, slow or irregular heartbeat, shortness of breath, and dizziness or fainting)

• Increased risk of bleeding events when combined with use of aspirin, nonsteroidal anti-inflammatory drugs (e.g. ibuprofen, naproxen), warfarin, and other anticoagulants

During treatment with this medication, common side effects of this medication may go away as your body adjusts to the medication. The most common side effects of fluoxetine are:

• Headache

• Nausea

• Diarrhea

• Vomiting

• Constipation

• Upset stomach

• Decreased appetite

• Flu-like symptoms

• Nose or throat irritation

• Dry mouth

• Increased sweating

• Feeling nervous

• Restlessness

• Fatigue

• Sleepiness or having trouble sleeping (insomnia).

• Sexual side effects, such as problems with orgasm or ejaculatory delay often do not diminish over time.

Where to find more side effects information

For more information, read the drug information that comes with your medication, ask your healthcare provider, or ask your pharmacist.

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Frequently Asked Questions

Can I continue taking this medication if I become pregnant?

The safety of this medication during pregnancy has not been evaluated. If you become pregnant or decide to try to conceive, please alert your provider who will direct you to follow up with your primary care provider or OBGYN for continued management.

Can I drink alcohol while taking this medication?

Drinking alcohol while taking mental health medication is not advised. While many people use alcohol to try to help with anxiety and depression, research shows that over time alcohol actually worsens anxiety and depression. It can also increase the side effects of some medications, such as drowsiness, dizziness and coordination problems. It is recommended to avoid drinking alcohol while taking your medication, especially if you will be driving, operating dangerous machinery, or participating in dangerous activities. If you find that you are binge drinking on a daily or almost daily basis, our recommendation is to try to cut back on alcohol use to a healthier level.

Can I take cannabis while taking this medication?

Using cannabis products can worsen depression and increase the side effects of some medications, such as drowsiness, dizziness and coordination problems. It is recommended to avoid cannabis use while taking your medication, especially if you will be driving, operating dangerous machinery, or participating in dangerous activities.

Is it safe to stop taking Xanax now that I’m going to start my daily mental health medication?

If you are taking a benzodiazepine (Ativan, Xanax, Klonopin, Valium, etc) and you start feeling better, you should talk to your prescriber about tapering down from the benzodiazepine. Abruptly stopping the daily use of a benzodiazepine can lead to dangerous side effects such as seizures, so careful monitoring by your primary care provider is recommended.

Is this medication safe to take with my medication for ADHD?

Medication for anxiety and depression can increase the blood level of medications used to treat ADHD (Adderall, Vyvanse, Concerta, or other stimulants). Please monitor closely for side effects such as anxiety and insomnia and make sure the provider prescribing your ADHD medication is aware of all medications you are taking.