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Fluoxetine (Prozac) is an antidepressant used to treat various mental health conditions but comes with important safety considerations. This information outlines critical warnings and precautions related to its use. If you have concerns, please discuss them with your healthcare provider.

• Worsening Depression and Suicidal Thoughts: Fluoxetine can exacerbate depression and increase suicidal thoughts, especially in individuals under 25 years old, during the first few weeks of treatment, or when changing doses. Be vigilant for symptoms like anxiety, panic attacks, insomnia, irritability, or restlessness. Seek immediate medical attention if suicidal thoughts or unusual behaviors occur.

• Anxiety and Sleep Issues: Some individuals may experience heightened anxiety or trouble sleeping while on fluoxetine. If these issues are severe, consult your healthcare provider.

• Serotonin Syndrome: There is a risk of a rare but serious condition called serotonin syndrome, particularly when fluoxetine is combined with other medications that elevate serotonin levels. Symptoms include rapid heartbeat, sweating, muscle stiffness, fever, and confusion. Seek urgent medical help if these occur.

• Severe Allergic Reactions: Serious allergic reactions, such as facial swelling, rash, or difficulty breathing, are possible. Stop taking fluoxetine and get emergency medical help if these symptoms develop.

• Bipolar Disorder: Fluoxetine should not be used alone in individuals with bipolar disorder, as it may trigger manic episodes. It should only be used in combination with olanzapine (Zyprexa) for treating depression associated with bipolar disorder. Monitor for unusual behavioral changes.

• Increased Bleeding Risk: Fluoxetine can raise the risk of bleeding, especially when taken with blood-thinning medications. Look out for unexplained bruising, black stools, or blood in vomit, and seek medical help if they occur.

• Glaucoma: The medication may worsen or cause angle-closure glaucoma. Regular eye exams are recommended if you have a history of this condition.

• Low Blood Sodium Levels: Fluoxetine can cause low sodium levels in the blood, a potentially dangerous condition. Symptoms include confusion, weakness, or memory problems. Get medical help if these arise.

• Heart Rhythm Changes (QT Prolongation): Fluoxetine may affect heart rhythm, posing a serious risk. Those with a history of heart issues or taking medications affecting heart rhythm should be closely monitored. Report symptoms such as chest pain or fainting immediately.

• Contraindications: Do not use fluoxetine if you have taken MAOIs, linezolid, methylene blue, pimozide, or thioridazine recently, as these combinations can be dangerous.

Always inform your healthcare provider about all medications you are taking to avoid harmful interactions. In case of overdose, seek emergency medical attention promptly.

Common side effects:

• Nausea
• Headache
• Weakness
• Diarrhea
• Low appetite
• Drowsiness
• Anxiety
• Nervousness
• Tremor
• Dry mouth
• Throat pain
• Yawning

Less common but important to monitor:

• Abnormal dreams
• Flu-like symptoms
• Allergic rash
• Low blood sodium levels
• Blood sugar fluctuations

Serious side effects:

• Suicidal thoughts or behaviors
• Serotonin syndrome
• Seizures
• Allergic reaction
• Severe bleeding
• Prolonged or painful erection

Interactions with high risk of serious adverse effects and should be avoided:

• MAO inhibitors (isocarboxazid, Linezolid, Metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, Rasagiline, safinamide, Selegiline, Tranylcypromine)
• Pimozide
• Thioridazine

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Antiplatelet drugs (Clopidogrel)
• NSAIDs (Ibuprofen, Naproxen)
• Blood thinners (Dabigatran, Warfarin)
• Serotonin-increasing drugs (MDMA, Citalopram, paroxetine, Duloxetine, Venlafaxine)

Interactions with low risk that usually do not require a change in therapy:

• Alcohol
• Marijuana (cannabis)
• Antihistamines (Cetirizine, diphenhydramine)
• Drugs for sleep or anxiety (Alprazolam, Diazepam, Zolpidem)
• Muscle relaxants
• Opioid pain relievers (codeine)