Fluoxetine – What it is for, Dosage and Side Effects

Fluoxetine is sometimes used in conjunction with another medication called olanzapine (Zyprexa) to treat manic depression caused by bipolar disorder . This combination is also used to treat depression after at least 2 other drugs have been tried without successful treatment of symptoms.

Important Information:  You should not use fluoxetine if you are also taking pimozide or thioridazine, or if you are being treated with methylene blue injection. Do not use fluoxetine if you have used an MAO inhibitor within the last 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine. You must wait at least 14 days after stopping an MAO inhibitor before taking fluoxetine . You must wait 5 weeks after stopping fluoxetine before taking Thioridazine or MAOIs.

Some young people have thoughts about suicide when they first take an antidepressant. Watch for changes in your mood or symptoms. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety , panic attacks , trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically). ), more Depressed, or have thoughts about suicide or harming yourself.

Before Taking This Medicine:  Do not use fluoxetine if you have taken an MAO inhibitor within the last 14 days. An interaction of dangerous drugs could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline and tranylcypromine. You must wait at least 14 days after stopping an MAO inhibitor before taking fluoxetine. You must wait 5 weeks after stopping fluoxetine before taking Thioridazine or MAOIs.

You should not use fluoxetine if you are allergic to it, if you also take pimozide or thioridazine, or if you are being treated with methylene blue injection. Tell your doctor about all other antidepressants you take, especially Celexa, Cymbalta, Desyrel, Effexor, Lexapro, Luvox, Oleptro, Paxil, Pexeva, Symbyax, Viibryd, or Zoloft.

Some medications can interact with fluoxetine and cause a serious condition called serotonin syndrome . Make sure your doctor knows all the other medications you use. Ask your doctor before making any changes to how or when you take your medications.

To make sure fluoxetine is safe for you, tell your doctor if you have:

• Liver cirrhosis ;
• kidney disease ;
• Diabetes;
• Narrow-angle glaucoma ;
• Seizures or epilepsy ;
• Bipolar disorder (manic depression);
• A history of drug abuse or suicidal thoughts; or
• If you are being treated with electroconvulsive therapy (ECT).

Some young people have thoughts about suicide when they first take an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be aware of changes in your mood or symptoms.

Taking an SSRI antidepressant during pregnancy can cause serious lung problems or other complications in the baby. However, you can have a relapse of depression if you stop taking your antidepressant. Tell your doctor right away if you become pregnant. Do not start or stop taking fluoxetine during pregnancy without your doctor’s advice.

Fluoxetine can pass into breast milk and can harm a baby who is breastfeeding. Tell your doctor if you are breast-feeding a baby. Fluoxetine is not approved for use by people under the age of 18.

How to Take Fluoxetine:  Take fluoxetine exactly as prescribed by your doctor. Follow all instructions on your prescription label. Your doctor may occasionally change your dose. Do not take this medication in larger or smaller amounts or for longer than recommended. Do not crush, chew, break or open a delayed-release capsule. Swallow it whole.

Measure the liquid medicine with the dosing syringe provided, or with a special dose measuring spoon or medicine cup. If you don’t have a dose measuring device, ask your pharmacist for one. To treat premenstrual dysphoric disorder, the usual dose of fluoxetine is once a day while you are having your period or 14 days before you expect your period to start. Follow your doctor’s instructions.

It may take up to 4 weeks before your symptoms improve. Continue using the medication as directed and let your doctor know if your symptoms do not improve. Don’t stop using fluoxetine suddenly, or you could experience unpleasant withdrawal symptoms. Ask your doctor how to safely stop using fluoxetine . Store at room temperature away from moisture and heat.

What Happens if You Miss a Dose:  Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medication to make up for the missed dose.

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

What to Do if Overdose Happens:  Seek emergency medical attention or call the helpline on 192.

What to Avoid While Taking Fluoxetine:  Drinking alcohol may increase certain side effects of fluoxetine . Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis , fever , or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with fluoxetine can cause bleeding or bleeding easily.

This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Fluoxetine Side Effects:  Get emergency medical help if you have signs of an allergic reaction to fluoxetine : rash or hives; difficulty breathing; Swelling of the face, lips, tongue or throat . Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety , panic attacks , trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically). ), more depressed, or have thoughts about suicide or harming yourself.

Call your doctor right away if you have:

• Blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights
• High levels of serotonin in the body: Agitation, hallucinations, fever , rapid heart rate, hyperactive reflexes, nausea , vomiting, diarrhea , loss of coordination, fainting;
• Low levels of sodium in the body: Headache , confusion, slurred speech, severe weakness, vomiting , loss of coordination, feeling unsteady;
• Severe nervous system reaction: very stiff (stiff) muscles, high fever , sweating, confusion, fast or irregular heartbeat, tremors, feeling like you might pass out;
• Severe skin reaction – fever , sore throat , swelling of the face or tongue, burning in the eyes, pain in the skin, followed by a red or purple rash that spreads (especially on the face or upper body) and causes blisters and peeling.

Common Fluoxetine Side Effects May Include:

• Sleep problems ( insomnia ), strange dreams;
• Headache , dizziness, vision changes;
• Tremors or tremors, feeling anxious or nervous;
• Pain, weakness, yawning, feeling tired;
• Bad mood, loss of appetite, nausea , vomiting, diarrhea ;
• Dry mouth, perspiration, hot flashes;
• Changes in weight or appetite;
• Stuffy nose, sinus pain, sore throat , flu-like symptoms;
• Decreased sexual desire, impotence or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for advice on side effects. You can report side effects to the FDA at 1-800-FDA-1088.

Fluoxetine Dosage Information: 

Usual adult Fluoxetine dose for bulimia:

Immediate release oral formulations:

Recommended dose: 60 mg orally once daily

Comments:  Some patients may need to be started on a lower dose and titrated over several days to the recommended dose:
Daily doses greater than 60 mg have not been systematically studied for the treatment of bulimia use: acute treatment and maintenance of binge eating behaviors and vomiting in moderate to severe bulimia nervosa.

Usual Adult Fluoxetine Dose for Depression:

Immediate-release oral formulations:
Initial dose: 20 mg orally once daily, increased after several weeks if insufficient clinical improvement is observed
Maintenance dose: 20 to 60 mg orally daily
Maximum dose: 80 mg orally per day

Delayed-Release Oral Capsules:
Initial Dose: 90 mg orally once weekly, started 7 days after the last daily dose of 20 mg fluoxetine immediate-release formulations.

Comments:  Doses above 20 mg per day can be given in divided doses, morning and noon. The full effect may be delayed until after at least 4 weeks of treatment.

If a satisfactory response with once-weekly oral fluoxetine is not maintained, a switch to daily administration of fluoxetine using immediate-release oral formulations should be considered. Cardiac episodes of major depressive disorder require several months or more of sustained drug therapy.

Whether the dose needed to induce remission is the same as the dose needed to maintain and/or sustain euthymia is unknown.

Use: Acute and Maintenance Treatment of Major Depressive Disorder (MDD)

Usual Adult Dose for Obsessive Compulsive Disorder:

Immediate-release oral formulations:
Initial dose: 20 mg orally once daily, increased after several weeks if insufficient clinical improvement is observed.
Maintenance dose: 20 to 60 mg orally per day.
Maximum dose: 80 mg orally.

Comments:  Doses above 20 mg per day can be given in divided doses, morning and noon.
Full effect may be delayed until after at least 5 weeks of treatment

Use: Acute and Maintenance Treatment of Obsessions and Compulsions in Patients with Obsessive-Compulsive Disorder (OCD)

Usual Adult Dose of Fluoxetine for Panic Disorder:

Immediate-release oral formulations:
Starting dose: 10 mg orally once daily, increased after one week to 20 mg orally once daily.
Maintenance dose: 20 to 60 mg orally per day.
Maximum dose: 60 mg orally.

Comments: Dose above 20 mg per day can be given in divided doses, morning and noon. A dose increase may be considered after several weeks if no clinical improvement is observed. Doses greater than 60 mg daily have not been systematically studied for the treatment of panic disorder use: acute treatment of panic disorder

Usual Adult Dose for Premenstrual Dysphoric Disorder:

Immediate-release oral formulations:
Starting dose: Continuous regimen: 20 mg orally, once daily, every day of the menstrual cycle.
Cyclic: 20 mg orally once daily starting 14 days before the anticipated start of menstruation until the first full day of menstruation and repeated with each new cycle.

Maintenance dose: 20 to 60 mg daily for continuous or intermittent regimens.
Maximum dose: 80 mg orally per day.

Duration: 20 mg daily dosage has been shown to be effective for up to 6 months of treatment

Comments:  A daily dose of 60 mg has not been shown to be significantly more effective than 20 mg daily.
Daily doses greater than 60 mg have not been systematically studied in patients with this condition.

Usual Pediatric Dose of Fluoxetine for Depression:

Immediate-release oral formulations:
8 to 18 years:
Starting dose: 10 to 20 mg orally once daily; The daily dose of 10 mg can be increased after a week to 20 mg orally once a day.

Underweight:
Initial dose: 10 mg orally once daily, increased to 20 mg orally once daily after several weeks if insufficient clinical improvement is observed

Maintenance Dose: 10 to 20 mg orally once daily.

Comments:  Full effect may be delayed up to at least 4 weeks of treatment. Potential risks in relation to clinical need should be evaluated before using this drug in children and adolescents.

Use: Acute and maintenance treatment of major depressive disorder (MDD)

Usual Pediatric Dose of Fluoxetine for Obsessive-Compulsive Disorder:

7 to 18 years:
immediate-release oral formulations:
adolescents and children of overweight:
starting dose: 10 mg orally once daily, increased to 20 mg orally once daily after 2 weeks.
Maintenance dose: 20 to 60 mg orally per day.
Maximum dose: 60 mg orally per day

Less in Weight:
Initial dose: 10 mg orally once daily, increased after several weeks if insufficient clinical improvement is observed.
Maintenance dose: 20 to 30 mg orally once daily.
Maximum dose: 60 mg orally.

Comments:  Further dose increases may be considered after several weeks if clinical improvement is insufficient. Dose above 20 mg per day can be given in divided doses, morning and noon. In underweight children, there is minimal experience with doses greater than 20 mg per day and none with doses greater than 60 mg per day.
The full effect can be delayed until at least 5 weeks of treatment. Potential risks in relation to clinical need should be evaluated before using this drug in children and adolescents.

Use: Acute and maintenance treatment of obsessions and compulsions in patients with Obsessive-Compulsive Disorder. And none at doses greater than 60 mg per day – Full effect may be delayed until after at least 5 weeks of treatment – ​​Potential risks against clinical need should be evaluated before using this drug in children and adolescents

Use: Acute and maintenance treatment of obsessions and compulsions in patients with Obsessive Compulsive Disorder. And none at doses greater than 60 mg per day – Full effect may be delayed until after at least 5 weeks of treatment – ​​Potential risks against clinical need should be evaluated before using this drug in children and adolescents

Use: acute and maintenance treatment of obsessions and compulsions in patients with Obsessive Compulsive Disorder

Other Drugs That Will Affect Fluoxetine:  Taking fluoxetine with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking a sleeping pill, narcotic pain medication, cough medicine, a muscle relaxant, or medication for anxiety, depression, or seizures.

Many drugs can interact with fluoxetine . Not all possible interactions are listed here. Tell your doctor about all your current medications and any you start or stop using, especially:

• Any other antidepressant;
• St. John’s Wort ;
• Tryptophan (sometimes called L-tryptophan);
• A blood thinner – warfarin, Coumadin, Jantoven;
• Medicines to treat anxiety, mood disorders, thinking disorders or mental illness – amitriptyline, buspirone, desipramine, lithium, nortriptyline and many others;
• Medications to treat ADHD or narcolepsy – Adderall, Concerta, Ritalin, Vyvanse, Zenzedi and others;
• Migraine headache medication – rizatriptan, sumatriptan, zolmitriptan and others; or
• Drug against narcotic pain – fentanyl, tramadol.

This list is not complete and many other drugs can interact with fluoxetine . This includes prescription and over-the-counter medications, vitamins, and herbal products. Give a list of all your medications to any healthcare professional who treats you.