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" What is it used for? In adults fluoxetine is used to treat:  major depression obsessive-compulsive disorder (a psychiatric disorder in which tasks are excessively repeated)  bulimia nervosa.  In children and adolescents aged eight years and over fluoxetine is used to treat:  moderate to severe major depressive episodes, if the depression is unresponsive to psychological therapy after four to six sessions. (Fluoxetine should only be prescribed by a specialist for children and should be used in combination with psychological therapy.)    How does it work? Prozac capsules and liquid contain the active ingredient fluoxetine, which is a type of medicine called an antidepressant. It is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). (NB. Fluoxetine is also available without a brand name, ie as the generic medicine.)  Antidepressant medicines act on nerve cells in the brain. In the brain there are numerous different chemical compounds called neurotransmitters. These act as chemical messengers between the nerve cells. Serotonin is one such neurotransmitter and has various functions that we know of.  When serotonin is released from nerve cells in the brain it acts to lighten mood. When it is reabsorbed into the nerve cells, it no longer has an effect on mood. It is thought that when depression occurs, there may be a decreased amount of serotonin released from nerve cells in the brain.  SSRIs work by preventing serotonin from being reabsorbed back into the nerve cells in the brain. This helps prolong the mood lightening effect of any released serotonin. In this way, fluoxetine helps relieve depression. Fluoxetine may also be used in the treatment of bulimia nervosa and obsessive compulsive disorder in adults. It is not fully understood how fluoxetine works in these illnesses. It may take between two to four weeks for the benefits of this medicine to appear, so it is very important that you keep taking it, even if it doesn&amp;#039;t seem to make much difference at first. If you feel your depression has got worse, or if you have any distressing thoughts or feelings in these first few weeks, then you should talk to your doctor.    How do I take it?  Fluoxetine is usually taken once a day, however the total daily dose can be split into two or more doses. Follow the instructions given by your doctor.  You should try to take your dose at the same times each day. The medicine can have a slightly alerting effect, so some people find it is best to take it in the morning so that it doesn&amp;#039;t stop you getting to sleep at bedtime. The capsules and liquid can be taken either with or without food. If you forget to take a dose at your usual time take it as soon as you remember, unless it is nearly time for you next dose. In this case just leave out the forgotten dose(s) and take your next scheduled dose as usual. Don&amp;#039;t take a double dose to make up for a missed dose. You should keep taking this medicine regularly until your doctor tells you to stop. When treating depression, current recommendations are that antidepressants are continued for at least six months after recovery to help prevent the depression coming back after the medicine is stopped. You should avoid suddenly stopping this medicine, as suddenly stopping SSRIs can cause symptoms such as headache, nausea, pins and needles, tremor, difficulty sleeping, intense dreams, dizziness, agitation and anxiety. Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They are less likely with fluoxetine than with other SSRIs, because it remains in your blood for a few weeks after you stop taking it, and its blood level naturally decreases slowly over time. However, you should follow the instructions given by your doctor or pharmacist when it is time to stop treatment. Your dose should normally be reduced gradually over at least one to two weeks.   Warning!  Depression and other psychiatric illnesses are associated with an increased risk of suicidal thoughts, self-harm, and suicide. You should be aware that this medicine may not start to make you feel better for at least two to four weeks. However, it is important that you keep taking it in order for it to work properly and for you to feel better. If you feel your depression or anxiety has got worse, or if you have any distressing thoughts, or feelings about suicide or harming yourself in these first few weeks, or indeed at any point during treatment or after stopping treatment, then it is very important to talk to your doctor.  In children, fluoxetine is not licensed or recommended for uses other than moderate to severe depression. Children and adolescents may be more susceptible to hostility and suicidal thoughts or behaviour when starting treatment with antidepressants. They should be carefully monitored and encouraged to report any distressing feelings, thoughts about suicide or self-harm, irritability, mood changes or other unusual change in behaviour that they may experience while taking the medicine. If you are worried about your child at any point it is important to talk to your doctor immediately.   There is only limited evidence available concerning the long-term safety of fluoxetine in children and adolescents, in terms of its effect on growth (height and weight) and sexual, cognitive, emotional and behavioural development. Your doctor should carefully discuss the risks and benefits of the medicine with you and your child before treatment is started. The child&amp;#039;s growth and development should be monitored during and after treatment. If there is no obvious benefit on the child&amp;#039;s depression after nine weeks of treatment, use of the medicine should be reconsidered. This medicine may reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won&amp;#039;t affect your performance. It is recommended that you avoid drinking alcohol while taking this medicine.  SSRI antidepressants have been associated with the development of unpleasant or distressing restlessness and the need to move, often accompanied by an inability to sit or stand still. This is most likely to occur within the first few weeks of treatment. If you experience these symptoms you should consult your doctor.  Antidepressants may cause the amount of sodium in the blood to drop - a condition called hyponatraemia. This can cause symptoms such as drowsiness, confusion, muscle twitching or convulsions. Elderly people may be particularly susceptible to this effect. You should consult your doctor if you develop any of these symptoms while taking this medicine, so that your blood sodium level can be checked if necessary. If you experience seizures (convulsions or fits) while taking this medicine, consult your doctor immediately, as you will need to stop treatment with this medicine. This also applies if you suffer from epilepsy and experience more seizures than normal after starting this medicine. Consult your doctor if you develop a skin rash or other unexplained allergic reaction while taking this medicine.   Use with caution in  Elderly people. Children and adolescents. Young adults. People with a history of suicidal behaviour or thoughts.  People with a history of mania, hypomania or manic depression (bipolar affective disorder). People also receiving electroconvulsive therapy (ECT).  People taking antipsychotic medicines.  People with decreased liver function. Heart disease. People with a personal or family history of an abnormal heart rhythm, seen on a heart monitoring trace (ECG) as a &amp;#039;prolonged QT interval&amp;#039;. People with a slow heart beat (bradycardia). People with low levels of potassium or magnesium in their blood. Diabetes. People with epilepsy or a history of seizures. People with a history of bleeding disorders. People taking medicines that affect blood clotting (eg anticoagulants such as warfarin - see end of factsheet for more information).  People with raised pressure in the eye(s) or a risk of closed angle glaucoma.   Not to be used in  People who have taken a monoamine-oxidase inhibitor antidepressant (MAOI) in the last 14 days. People who are in a manic episode.  Uncontrolled epilepsy. Uncontrolled seizure disorders, eg due to brain injury. Prozac liquid contains sucrose and should not be used by people with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency.   This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.   Pregnancy and breastfeeding Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.  This medicine can be used during pregnancy, but only with caution and if the benefits to the mother outweigh any risks to the developing baby. This is particularly important in the first and third trimester and prior to and during labour. The medicine may cause fluoxetine-type side effects or withdrawal symptoms in the newborn baby if used in late pregnancy. It is important to seek medical advice from your doctor if you get pregnant or plan to have a baby while taking this medicine, so that you can discuss the potential risks to the baby if you keep taking the medicine, compared with the risks of stopping treatment.  This medicine passes into breast milk and may have adverse effects on a nursing infant. Mothers who need to take this medicine should discuss the risks and benefits of breastfeeding with their doctor.   Side effects Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.  Very common (affect more than 1 in 10 people)  Difficulty sleeping (insomnia). Headache. Feeling sick (nausea). Diarrhoea. Fatigue.   Common (affect between 1 in 10 and 1 in 100 people)  Decreased appetite and weight loss. Dry mouth. Anxiety, nervousness and restlessness. Feeling jittery. Sexual problems such as decreased sex drive or problems with getting an erection or ejaculation. Abnormal dreams. Dizziness. Change in taste. Feeling sleepy or lethargic. Blurred vision. Awareness of your heart beat (palpitations). Flushing. Yawning. Indigestion. Vomiting. Increased sweating. Rash or itching. Frequent urination. Aching joints.   Uncommon (affect between 1 in 100 and 1 in 1000 people)  Problems with orgasm. Problems with co-ordination or balance. Tremor or twitching. Dilated pupils. Low blood pressure. Hair loss. Increased tendency to bruise. Feeling hot, cold or generally unwell.   Rare (affect between 1 in 1000 and 1 in 10,000 people)  Unpleasant sensation of restlessness that causes an inability to sit still (akathisia - see warning section above). Convulsions. Mania. Hallucinations. Panic attacks. Abnormal reaction of the skin to light (photosensitivity). Milky secretion from the breasts (galactorrhoea). Difficulty passing urine.  The side effects listed above may not include all of the side effects reported by the medicine&amp;#039;s manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.   How can this medicine affect other medicines? It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.  Fluoxetine must not be taken at the same time as monoamine oxidase inhibitor antidepressants (MAOIs) such as phenelzine, isocarboxazid or tranylcypromine, or with selegiline or rasagiline, which are also MAOIs and are used to treat Parkinson&amp;#039;s disease. If you have been taking one of these MAOIs you should not start treatment with fluoxetine until at least 14 days after stopping the MAOI. Treatment with these MAOIs, or with the related antidepressant moclobemide, should not be started until at least five weeks after fluoxetine has been stopped. Linezolid is an antibiotic that is also an MAOI. This medicine can be given in combination with fluoxetine, provided that there are facilities for close observation of symptoms of serotonin syndrome and monitoring of blood pressure.  Fluoxetine can reduce the effectiveness of tamoxifen and it should be avoided wherever possible in people taking tamoxifen. Fluoxetine may increase the blood levels of the following medicines, and for this reason your doctor may prescribe a lower dose of these if you are taking them with fluoxetine, or if you have taken fluoxetine in the previous five weeks:  aripiprazole atomoxetine benzodiazepines such as diazepam or alprazolam (if these are taken with fluoxetine there may be an increased chance of drowsiness) carbamazepine clozapine flecainide haloperidol phenytoin tricyclic antidepressants such as imipramine, amitriptyline, clomipramine, desipramine.  If fluoxetine is taken with lithium it may cause the blood level of lithium to rise, or there may be an increased risk of side effects. The combination should only be used with caution. There may be an increased risk of side effects if fluoxetine is taken with the following, which also enhance the activity of serotonin in the brain:  duloxetine metoclopramide sibutramine the herbal remedy St John&amp;#039;s wort (Hypericum perforatum) - \u2013 this should not be taken in combination with fluoxetine triptans for migraine, eg sumatriptan  tramadol tryptophan.  Fluoxetine may increase the effect of anti-blood-clotting medicines (anticoagulants) such as warfarin, and this may increase the risk of bleeding. If you are taking an anticoagulant with this medicine, your blood clotting time (INR) should be regularly monitored. As SSRIs have been associated with bleeding abnormalities, the following medicines, which are known to affect the ability of the blood to clot, should be used with caution in people taking fluoxetine because the combination may carry an increased risk of causing bleeding:  antiplatelet (&amp;#039;blood thinning&amp;#039;) medicines such as aspirin, clopidogrel or dipyridamole some antipsychotic medicines, eg clozapine some antisickness medicines, eg prochlorperazine dabigatran non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or diclofenac tricyclic antidepressants, eg amitriptyline.  Treatment with this medicine may alter control of blood sugar in people with diabetes, who may need an adjustment in their dose of insulin or antidiabetic tablets. People with diabetes should discuss this with their doctor. Treatment with this medicine may oppose the anticonvulsant effects of medicines used to treat epilepsy. There may be an increased risk of side effects if fluoxetine is taken with antipsychotic medicines such as haloperidol. There may be an increased risk of an abnormal heart rhythm if fluoxetine is used in combination with other medicines that can cause this problem, such as the following:  antiarrhythmics (medicines to treat abnormal heart beats), eg amiodarone, procainamide, disopyramide, sotalol  the antihistamines astemizole, mizolastine or terfenadine arsenic trioxide  atomoxetine  certain antidepressants, eg amitriptyline, imipramine, maprotiline  certain antimalarials, eg halofantrine, chloroquine, quinine, mefloquine, Riamet  certain antipsychotics, eg thioridazine, haloperidol, sertindole, pimozide cisapride  dronedarone  droperidol  intravenous erythromycin or pentamidine  methadone  moxifloxacin.    Other medicines containing the same active ingredient  Olena. Oxactin. Prozep. Prozit.  Fluoxetine capsules and oral solutions are also available without a brand name, ie as the generic medicine.   Last updated 07.05.2013 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/medicines/depression/a7424/prozac-fluoxetine/>