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Prozac treats depression, panic attacks, obsessive-compulsive disorder, a specific eating disorder (bulimia), and a severe form of premenstrual syndrome (premenstrual dysphoric disorder). This medication can improve your mood, sleep, appetite, and energy levels, and can help restore your interest in daily life. It can reduce anxiety, worry, unwanted thoughts, and the number of panic attacks.

It can also reduce the urge to perform repetitive tasks (compulsions such as hand washing, counting, and checking) that disrupt daily life. Fluoxetine can reduce premenstrual symptoms such as irritability, increased appetite, and depression. It can also reduce binge eating and purging in bulimia.

How to use fluoxetine orally

Read your pharmacist’s medication guide before you start taking fluoxetine each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth as directed by your doctor, usually once a day in the morning. If you are taking this medication twice a day, your doctor may tell you to take it in the morning and afternoon.

If you’re taking fluoxetine for premenstrual problems, your doctor may advise you to take it every day of the month, or only for the two weeks before your period, up to and including the first full day. Mark your calendar to help you remember.

If you’re using the liquid form of this medication, carefully measure the dose using a special measuring cup/spoon. Do not use a household spoon, as you may not get the correct dose.

The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may advise you to start this medication at a low dose and gradually increase it. Follow your doctor’s instructions carefully. Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.

Continue taking this medication even if you feel well. Do not stop taking this medication without first consulting your doctor. Some conditions may worsen if the medication is stopped abruptly. Your dose may need to be gradually reduced.

You should see some improvement within 1 to 2 weeks. It may take 4 to 5 weeks before you feel the full benefit.

Tell your doctor if your condition does not improve or worsens.

Fluoxetine side effects

Nausea, drowsiness, dizziness, anxiety, trouble sleeping, loss of appetite, fatigue, sweating, or yawning may occur. Tell your doctor immediately if any of these effects persist or worsen.

Remember, this medication has been prescribed because your doctor has determined that the benefit outweighs the risk of side effects. Many people who use this medication do not experience serious side effects.

Tell your doctor right away if you have any serious side effects, including unusual or severe mental/mood changes (such as agitation, unusually high energy/excitement, thoughts of suicide), easy bleeding/bruising, muscle weakness/spasm, shaking (tremor), decreased interest in sex, changes in sexual ability, unusual weight loss.

Seek immediate medical attention if you have any serious side effects, including black stools, vomit that looks like coffee grounds, seizures, signs of kidney problems (such as a change in the amount of urine), eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night, blurred vision).

If you have diabetes, fluoxetine can affect your blood sugar levels. Check your blood sugar regularly and share the results with your doctor. Your doctor may need to adjust your medication, diet, and exercise when you start or stop taking fluoxetine.

This medication can  increase serotonin levels  and rarely cause a serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other medications that increase serotonin levels, so tell your doctor or pharmacist about all the medications you are taking. Seek immediate medical attention if you experience symptoms such as: rapid heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, muscle twitching, unexplained fever, and unusual agitation/restlessness.

Rarely, men may experience a painful or prolonged erection lasting four hours or longer. If this happens, stop taking this medication and seek immediate medical attention, otherwise, permanent problems may occur.

A serious allergic reaction to this medication is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, or difficulty breathing.

Precautionary measures

Before taking fluoxetine, tell your doctor or pharmacist if you are allergic to Prozac fluoxetine or have any other allergies. This product may contain inactive ingredients that can cause allergic reactions or other problems. Talk to your pharmacist for more information.

Before using this medication , tell your doctor or pharmacist your medical history, especially of: personal or family history of bipolar/manic-depressive disorder, personal or family history of suicide attempts, liver problems, diabetes, low sodium levels in the blood (such as may occur while taking “water pills” – diuretics), severe dehydration, seizures, intestinal ulcers/bleeding (stomach ulcer), personal or family history of closed-angle glaucoma.

This medication may make you dizzy or drowsy. Alcohol or marijuana ( cannabis ) can make you more dizzy or drowsy. Do not drive, operate machinery, or do anything that requires alertness until you can do so safely. Avoid alcoholic beverages. Talk to your doctor if you  are using marijuana  (cannabis).

The liquid form of this medication contains alcohol. Caution is advised if you have diabetes, alcohol dependence, or liver disease. Some medications (such as metronidazole, disulfiram) can cause a serious reaction when combined with alcohol. Ask your doctor or pharmacist how to use this product safely.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Children may be more sensitive to the side effects of this medication, especially weight loss. Monitor the weight and height of children taking this medication.

Older adults may be more sensitive to the side effects of this medication, especially bleeding and loss of coordination. Loss of coordination can increase the risk of falls. Older adults may also be more likely to have low blood sodium levels, especially if they take “water pills” (diuretics).

During pregnancy, this medication should be used only when needed. It may harm an unborn baby. In rare cases, babies born to mothers who used this medication during the last three months of pregnancy may experience withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying. Tell your doctor right away if you notice any of these symptoms in your newborn.

Because untreated mental/mood problems (such as depression, panic attacks, and obsessive-compulsive disorder) can be serious, do not stop taking this medication unless directed by your doctor. If you are planning to become pregnant, become pregnant, or think you may be pregnant, discuss the benefits and risks of taking this medication during pregnancy with your doctor right away.

This medication passes into breast milk and may harm a nursing baby. Consult your doctor before breastfeeding.

Interactions

Drug interactions can change how your medications work or increase your risk of serious side effects. This document does not contain all possible drug interactions. Keep a list of all your products (including prescription and over-the-counter medications and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medications without your doctor’s approval.

Prozac fluoxetine can remain in your body for weeks after your last dose and can interact with many other medications. Tell your doctor or pharmacist before taking this medication if you have taken Prozac fluoxetine in the past five weeks.

Some products that may interact with this medicine include other medicines that can cause bleeding/bruising (including antiplatelet agents such as clopidogrel, NSAIDs such as ibuprofen/naproxen, “blood thinners” such as dabigatran/warfarin).

Taking MAOIs with this medication can cause a serious (potentially fatal) drug interaction. Avoid taking MAOIs (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) while taking Prozac. Most MAOIs should also not be taken for two weeks before and at least five weeks after treatment with this medication. Ask your doctor when you should start or stop taking this medication.

This medication can slow the removal of other medications from your body, which may affect how they work. Examples of affected medications include pimozide, thioridazine, vinblastine, antiarrhythmics (such as propafenone and flecainide), and tricyclic antidepressants (such as desipramine and imipramine).

Aspirin can increase the risk of bleeding when used with this medication. For example, if your doctor has prescribed low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams daily), you should continue taking it unless your doctor tells you otherwise.

The risk of serotonin syndrome/toxicity increases if you also use other medications that increase serotonin levels. Examples include street drugs such as MDMA/ecstasy, St. John’s wort, certain antidepressants (including other SSRIs such as citalopram/paroxetine, SNRIs such as duloxetine/venlafaxine), and tryptophan, among others. The risk of serotonin syndrome/toxicity may be greater when you start or increase the dose of these medications.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness, including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine). Check the labels on all your medications (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist how to use these products safely.

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