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Fluoxetine is a type of antidepressant belonging to the selective serotonin reuptake inhibitor (SSRI) group of medicines. It is widely prescribed to treat depression and other mental health conditions like panic disorder and obsessive-compulsive disorder. Fluoxetine helps many people to recover from depression by improving their mood and relieving anxiety and tension. It is also used to treat bulimia nervosa (an eating disorder), where it reduces binge-eating and purging (vomiting). The dose and how often you need it will be decided by your doctor so that you get the right amount to control your symptoms. Your doctor may start you on a lower dose and increase it gradually. Do not change the dose or stop taking it without talking to your doctor, even if you feel well. Doing so may make your condition worse or you may suffer from unpleasant withdrawal symptoms (anxiety, restlessness, palpitations, dizziness, sleep disturbances, etc). To get the most benefit, take this medicine regularly at the same time each day. It may take a few weeks before you start feeling better. Let your doctor know if you do not see any improvement even after 4 weeks. Some common side effects of Fluoxetine include nausea, indigestion, dry mouth, fatigue, loss of appetite, increased sweating, sinusitis, insomnia (difficulty in sleeping), yawning, and abnormal dreams. Sexual side effects like decreased sexual drive delayed ejaculation, and erectile dysfunction may also be seen. Let your doctor know straight away if you develop any sudden worsening of mood or any thoughts about harming yourself. Before taking this medicine, you should tell your doctor if you have epilepsy (seizure disorder or fits), diabetes, liver or kidney disease, heart problems, or glaucoma. These may affect your treatment. Pregnant or breastfeeding women should also consult their doctor before taking it. Some other medicines may affect the way it works, especially other antidepressants and medicines called MAO inhibitors. Please tell your doctor about all the medicines you are taking to make sure you are safe. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant. It works by increasing the levels of serotonin, a chemical messenger in the brain. This improves mood and physical symptoms of depression and also relieves symptoms of panic and obsessive disorders.

• Depression • Panic disorder • Obsessive-compulsive disorder • Bulimia nervosa

Fluoxetine is a potent and highly selective inhibitor of serotonin (5-HT) re-uptake. No affinity for adrenoceptors or histamine, GABA-B, or muscarinic receptors.

Adult Dose: Oral Depression Adult: Initially, 20 mg once daily. May gradually increase up to max 80 mg daily in 2 divided doses, if no clinical response after several wk. Bulimia nervosa Adult: 60 mg daily as a single or in divided doses. Hepatic impairment: Reduce dose and/or dosing frequency. Obsessive compulsive disorder Adult: Initially, 20 mg once daily, increased up to 60 mg daily if no clinical response after several wk. Max: 80 mg daily in 2 divided doses. Premenstrual dysphoric disorder Adult: 20 mg daily continuously. Alternatively, 20 mg daily to be started 14 days before menstruation and continued until 1st day of menses; repeat w/ each cycle. Panic disorder Adult: Initially, 10 mg once daily, increase to 20 mg daily after a wk. May further increase to 60 mg daily, if no clinical response after several wk. Elderly: Max: 60 mg daily. Hepatic impairment: Reduce dose and/or dosing frequency. Child Dose: Oral Depression Child: >8 yr Initially, 10 mg daily, may increase to 20 mg daily after 1-2 wk. Low wt childn: Initially, 10 mg daily, may increase to 20 mg daily after several wk, only if clinical response is insufficient. Obsessive compulsive disorder Child: >7 yr Initially, 10 mg daily, may increase to 20 mg daily after 2 wk; increase further up to 60 mg daily after several wk as necessary. Low-wt childn: Initially, 10 mg daily, may increase to 20-30 mg daily after several wk, if required. Renal Dose: Renal impairment: Use caution; drug accumulation may occur with severe renal impairment

Take this medicine in the dose and duration as advised by your doctor. Do not chew, crush or break it. Fluoxetine may be taken with or without food, but it is better to take it at a fixed time.

Common: • Erectile dysfunction • Indigestion • Influenza like syndrome • Loss of appetite • Low sexual desire • Nausea • Sore throat • Sweating • Tremor • Weakness • Yawning • Abnormal dreams • Delayed ejaculation • Dryness in mouth • Insomnia (difficulty in sleeping) • Nervousness • Sleepiness • Sinus infection

[UNSAFE] Fluoxetine may cause side effects which could affect your ability to drive. Take Fluoxetine in the morning since it can keep you awake if taken late at night. It may cause anxiety and agitation when you first start taking it. It may cause weight loss and decreased appetite. Don't drive or do anything requiring concentration until you know how Fluoxetine affects you. Talk to your doctor if you notice sudden mood changes or develop suicidal thoughts. Inform your doctor if you experience difficulty having an orgasm or have decreased sex drive. The addiction/dependence potential of Fluoxetine is very less. Do not stop taking medication suddenly without doctor consultation as that may lead to agitation, anxiety, and dysphoria.

Severe renal or hepatic failure; hypersensitivity; lactation; concomitant MAOIs or within 2 wk of MAOI withdrawal.

May cause transient shift in plasma conc of tightly protein bound drugs e.g. warfarin and digoxin, resulting in adverse effects. T1/2 of diazepam is prolonged. Avoid concurrent use with clopidogrel. Potentially Fatal: Serious reactions when combined with MAOIs; at least 14 days should elapse after MAOIs withdrawal before starting fluoxetine treatment or at least 5 wk should elapse after fluoxetine treatment before starting MAOIs therapy. Two-fold increase in plasma levels of other antidepressants when combined with fluoxetine. Monitor lithium levels when combined.

[UNSAFE] It is unsafe to consume alcohol with Fluoxetine.

[CONSULT YOUR DOCTOR] Fluoxetine may be unsafe to use during pregnancy. Although there are limited studies in humans, animal studies have shown harmful effects on the developing baby. Your doctor will weigh the benefits and any potential risks before prescribing it to you. Please consult your doctor.

[CONSULT YOUR DOCTOR] Fluoxetine is probably unsafe to use during breastfeeding. Limited human data suggests that the drug may pass into the breastmilk and harm the baby.

[SAFE IF PRESCRIBED] Fluoxetine is probably safe to use in patients with kidney disease. Limited data available suggests that dose adjustment of Fluoxetine may not be needed in these patients. Please consult your doctor. [CAUTION] Fluoxetine should be used with caution in patients with liver disease. Dose adjustment of Fluoxetine may be needed. Please consult your doctor.

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