fluoxetine, Prozac, Sarafem, Prozac Weekly (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
Fluoxetine may increase the effect of warfarin (Coumadin), leading to excessive bleeding. Warfarin therapy should be monitored more frequently in patients who also are taking fluoxetine. Combining SSRIs with aspirin, nonsteroidal anti-inflammatory drugs (for example ibuprofen [Motrin, Advil)]) or other drugs that affect bleeding may increase the likelihood of upper gastrointestinal bleeding.
Combining pimozide (Orap) and fluoxetine may result in abnormal heart beats. Thioridazine should not be administered with fluoxetine or within 5 weeks after fluoxetine has been discontinued. Fluoxetine increases blood levels of thioridazine and increases the side effects of thioridazine such as abnormal heart beats. Combining fluoxetine with tricyclic antidepressants, antipsychotic drugs, and drugs used for treating abnormal heart beats may result in increased side effects.
PREGNANCY: Use of fluoxetine during the third trimester of pregnancy may lead to adverse effects in the newborn.
NURSING MOTHERS: Fluoxetine is excreted in breast milk. Therefore, use of fluoxetine while nursing is not recommended.
SIDE EFFECTS: Fluoxetine, as with most antidepressants, can cause nausea, headaches, anxiety, insomnia, drowsiness, and loss of appetite. Fluoxetine has been implicated in serious skin rashes and vasculitis (inflammation of small blood vessels). Increased blood pressure can occur, and blood pressure should be monitored. Seizures have been reported as has sexual dysfunction. Some patients may experience withdrawal reactions upon stopping fluoxetine. Symptoms of withdrawal include anxiety, nausea, nervousness, and insomnia. The dose of fluoxetine should be gradually reduced when therapy is discontinued.
Antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of fluoxetine or any other antidepressant in a child or adolescent must balance this risk of suicide with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.
Reference: FDA Prescribing Information
Last Editorial Review: 4/1/2013
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