Fluoxetine

What are the side effects of Prozac (Fluoxetine)?

• Major Depressive Disorder
• Obsessive Compulsive Disorder
• Bulimia
• Panic Disorder
• abnormal dreams
• abnormal ejaculation
• anorexia
• anxiety
• asthenia
• diarrhea
• dry mouth
• dyspepsia
• flu syndrome
• impotence
• insomnia
• libido decreased
• nausea
• nervousness
• pharyngitis
• rash
• sinusitis
• somnolence
• sweating
• tremor
• vasodilatation, and yawn

Monoamine Oxidase Inhibitors (MAOIs):

• Drugs Metabolized by CYP2D6: Fluoxetine is a potent inhibitor of CYP2D6 enzyme pathway

• Tricyclic Antidepressants (TCAs): Monitor TCA levels during coadministration with PROZAC or when PROZAC has been recently discontinued (5.2, 7.7)

• CNS Acting Drugs: Caution should be used when taken in combination with other centrally acting drugs

• Benzodiazepines: Diazepam – increased t½, alprazolam – further psychomotor performance decrement due to increased levels

• Antipsychotics: Potential for elevation of haloperidol and clozapine levels

• Anticonvulsants: Potential for elevated phenytoin and carbamazepine levels and clinical anticonvulsant toxicity

• Suicidal Thoughts and Behaviors in Children, Adolescents, and Young Adults: Monitor for clinical worsening and suicidal thinking and behavior

• Serotonin Syndrome: Serotonin syndrome has been reported with SSRIs and SNRIs, including PROZAC, both when taken alone, but especially when co-administered with other serotonergic agents (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort). If such symptoms occur, discontinue PROZAC and initiate supportive treatment. If concomitant use of PROZAC with other serotonergic drugs is clinically warranted, patients should be made aware of a potential increased risk for serotonin syndrome, particularly during treatment initiation and dose increases.

• Allergic Reactions and Rash: Discontinue upon appearance of rash or allergic phenomena

• Activation of Mania/Hypomania: Screen for Bipolar Disorder and monitor for mania/hypomania • Seizures: Use cautiously in patients with a history of seizures or with conditions that potentially lower the seizure threshold

• Altered Appetite and Weight: Significant weight loss has occurred

• Abnormal Bleeding: May increase the risk of bleeding. Use with NSAIDs, aspirin, warfarin, or other drugs that affect coagulation may potentiate the risk of gastrointestinal or other bleeding

• Angle-Closure Glaucoma: Angle-closure glaucoma has occurred in patients with untreated anatomically narrow angles treated with antidepressants.

• Hyponatremia: Has been reported with PROZAC in association with syndrome of inappropriate antidiuretic hormone (SIADH). Consider discontinuing if symptomatic hyponatremia occurs

• Anxiety and Insomnia: May occur • QT Prolongation: QT prolongation and ventricular arrhythmia including Torsades de Pointes have been reported with PROZAC use. Use with caution in conditions that predispose to arrhythmias or increased fluoxetine exposure. Use cautiously in patients with risk factors for QT prolongation

• Potential for Cognitive and Motor Impairment: Has potential to impair judgment, thinking, and motor skills. Use caution when operating machinery

• Long Half-Life: Changes in dose will not be fully reflected in plasma for several weeks

• PROZAC and Olanzapine in Combination: When using PROZAC and olanzapine in combination, also refer to the Warnings and Precautions section of the package insert for Symbyax