September 20, 2014
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Drug Factsheets

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Prozac

(fluoxetine)

DIN (Drug Identification Number)

02018985 PROZAC 10MG CAPSULE
00636622 PROZAC 20MG CAPSULE

What side effects are possible with Prozac?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • anxiety
  • decreased appetite
  • decreased sexual ability
  • decreased sexual drive
  • diarrhea
  • dizziness
  • drowsiness
  • dry mouth
  • headache
  • increased sweating
  • nausea
  • nervousness
  • symptoms of hypoglycemia (low blood sugar), including:
    • anxiety or nervousness
    • chills
    • cold sweats
    • confusion
    • cool pale skin
    • difficulty concentrating
    • drowsiness
    • excessive hunger
    • fast heartbeat
    • headache
    • shakiness or unsteady walk
    • unusual tiredness or weakness
  • tiredness
  • trouble sleeping
  • upset stomach
  • weakness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • breast enlargement or pain
  • difficulty urinating
  • fast or irregular heartbeat
  • hallucinations (hearing or seeing things that aren't there)
  • inability to sit still, or restlessness
  • missed menstrual periods
  • signs of an allergic reaction (e.g., skin rash, hives, or itching)
  • signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • symptoms of mania (e.g., decreased need for sleep, elevated or irritable mood, racing thoughts)
  • symptoms of increased pressure in the eyes (e.g., decreased or blurred vision, eye pain, red eye, swelling of the eye)
  • talking, feeling, and acting with excitement and activity you cannot control
  • unusual or incomplete body or facial movements
  • unusual secretion of milk (women)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • convulsions (seizures)
  • signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
  • signs of bleeding in the stomach (e.g., bloody, black, or tarry stools, spitting up of blood, vomiting blood or material that looks like coffee grounds)
  • symptoms of hyponatremia (low blood sodium), including:
    • confusion
    • convulsions (seizures)
    • drowsiness
    • dryness of mouth
    • increased thirst
    • lack of energy
  • symptoms of serotonin syndrome, including:
    • diarrhea
    • fever
    • increased sweating
    • mood or behaviour changes
    • overactive reflexes
    • racing heartbeat
    • restlessness
    • shivering or shaking

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.





Are there any other precautions or warnings for Prozac?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Allergy: Approximately 7% of people who take fluoxetine develop a rash or hives. Almost one-third of these people need to stop treatment because of the rash. If you get a skin rash while taking this medication, consult your doctor as soon as possible.

Bleeding: Fluoxetine may cause a reduced number of platelets in the blood, which can make it difficult to stop cuts from bleeding. If you notice any signs of bleeding, such as frequent nosebleeds, unexplained bruising, or black and tarry stools, notify your doctor as soon as possible. Your doctor will order routine blood tests to make sure potential problems are caught early.

Diabetes: Fluoxetine may cause changes in blood glucose control. If you have diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Your doctor may want you to monitor your blood sugar more carefully while you are taking fluoxetine.

Drowsiness/reduced alertness: Fluoxetine may cause drowsiness or dizziness, affecting your ability to drive or operate machinery. Avoid these and other hazardous tasks until you have determined how this medication affects you.

Heart rhythm: Fluoxetine can cause changes to the normal rhythm of the heart, including an irregular heartbeat called QT prolongation. QT prolongation is a serious life-threatening condition that can cause fainting, seizures, and sudden death. If you are at risk for heart rhythm problems (e.g., people with heart failure, angina, low potassium or magnesium levels), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: Severe kidney disease may affect how fluoxetine is removed from the body and contribute to side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Psychiatric Conditions: Fluoxetine has been reported to cause manic episodes, particularly for people who have bipolar disorder. Signs of mania include extreme levels of energy, hallucinations, suspiciousness, aggression or difficulty focusing your thoughts. If you experience any of these, or if you notice these signs in a family member who is taking fluoxetine, contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking this medication.

Seizures: There have been occasional reports of seizures occurring with fluoxetine. Seizures are more likely to occur when higher doses of this medication are taken. If you have a history of epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Serotonin Syndrome: Severe reactions are possible when fluoxetine is combined with other medications that act on serotonin, such as tricyclic antidepressants and certain medications for migraine headache. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. Coma and death are possible.

If you are taking other medications, discuss with your doctor how these medications may affect your medical condition, how your medical condition may affect the dosing and effectiveness of these medications, and whether any special monitoring is needed.

Stopping the medication: Some people experience withdrawal effects if fluoxetine is suddenly stopped. Withdrawal symptoms may include headache, difficulty sleeping, numbness, tingling burning or prickling sensations, nervousness, anxiety, nausea, sweating or weakness. Before stopping the medication, talk to your doctor.

Suicidal or agitated behaviour: People taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking this medication.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. Some babies whose mothers took fluoxetine during pregnancy have had withdrawal effects.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking fluoxetine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with Prozac?

There may be an interaction between fluoxetine and any of the following:

  • abiraterone
  • acetylsalicylic acid (ASA)
  • alcohol
  • alfuzosin
  • amantadine
  • amiodarone
  • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
  • antihistamines (e.g,. cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
  • antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzepine, quetiapine, risperidone)
  • aprepitant
  • aripiprazole
  • atomoxetine
  • baclofen
  • barbiturates (e.g., phenobarbital, secobarbital)
  • benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
  • beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
  • bosentan
  • bromocriptine
  • bupropion
  • buspirone
  • cabergoline
  • captopril
  • carbamazepine
  • carvedilol
  • celecoxib
  • chloral hydrate
  • chloroquine
  • cinacalcet
  • cisapride
  • clopidrogrel
  • cocaine
  • crizotinib
  • dabigatran
  • dasatinib
  • degarelix
  • delavirdine
  • desmopressin
  • dextromethorphan
  • diabetes medications (e.g., chlorpropamide, glipizide, glyburide, insulin, nateglinide, rosiglitazone)
  • digoxin
  • disopyramide
  • divalproex
  • dofetilide
  • domperidone
  • doxorubicin
  • dronedarone
  • efavirenz;
  • escitalopram
  • etravirine
  • fenofibric acid
  • fingolimod
  • flecainide
  • fluconazole
  • fluorouracil
  • fluvastatin
  • gabapentin
  • galantamine
  • gemfibrozil
  • glucosamine
  • ifosfamide
  • imatinib
  • imipramine
  • irbesartan
  • isoniazid
  • ketoconazole
  • lamotrigine
  • lapatinib
  • linezolid
  • leflunomide
  • levetiracetam
  • levodopa
  • lithium
  • lopinavir
  • losartan
  • macrolide antibiotics (e.g., clarithromycin, erythromycin)
  • maprotiline
  • mefloquine
  • meperidine
  • metoprolol
  • methadone
  • methamphetamine
  • methotrimeprazine
  • methoclopramide
  • mexiletine
  • mifepristone
  • milk thistle
  • mirtazapine
  • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
  • multivitamins with minerals
  • muscle relaxants (e.g., cyclobenzaprine, methocarbamol, orphenadrine)
  • narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
  • nefazodone
  • nicardipine
  • nifedipine
  • nilotinib
  • non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
  • olopatadine
  • omega-3 fatty acids
  • omeprazole
  • paliperidone
  • pazopanib
  • peginterferon alfa-2b
  • pentamidine
  • pentoxifylline
  • phenytoin
  • pimozide
  • prasugrel
  • primidone
  • procainamide
  • propafenone
  • quinidine
  • quinine
  • quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
  • rifampin
  • ritonavir
  • rivaroxaban
  • romidepsin
  • St. John's wort
  • other selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
  • saquinivir
  • scopolamine
  • serotonin antagonists (e.g., granisetron, ondansetron)
  • sotalol
  • sulfadiazine
  • sulfisoxazole
  • sumatriptan
  • sunitinib
  • tamoxifen
  • terbinafine
  • tetrabenazine
  • thioridazine
  • ticagrelor
  • ticlopidine
  • timolol
  • tipranavir
  • tolterodine
  • topiramate
  • tramadol
  • trazodone
  • tricyclic antidepressants (e.g., amitriptyline, desipramine, imipramine, trimipramine)
  • trimethoprim
  • "triptan" migraine medications (e.g., eletriptan, sumatriptan)
  • tryptophan
  • valproic acid
  • vandetanib
  • vemurafenib
  • venlafaxine
  • verapamil
  • vitamin E
  • voriconazole
  • warfarin
  • zafirlukast
  • zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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Depression Symptom Checker Tool

The Depression Symptom Checker tool can help you learn about depression. Use this tool to create a list of your symptoms and rate how much the symptoms impact your life on a daily basis. The checklist is divided into 6 symptom categories that are associated with depression. You can also learn more about symptoms of depression here.

For each statement choose a number from 0 to 4 that describes the impact on your daily life, where 4 has the highest impact and 0 has no impact:

  • 0 = no impact on daily life/no symptoms
  • 1 = mild impact on daily life
  • 2 = moderate impact on daily life
  • 3 = severe impact on daily life
  • 4 = debilitating impact on daily life

It is important to remember that this is not a “score” but a way to help you communicate how much you feel the symptom impacts your daily life. When you finish you will be able to print out your symptoms and share this information with your doctor. Use the Doctor Discussion Guide to prepare for your doctor’s visit.

Rate how much the following symptoms apply to you.

1. Emotions

Depression can affect anyone at any age, although it most commonly appears between 15 and 45 years of age.

0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4

Visit your doctor with these results, when booking your appointment inform your doctor that you may need extra time to discuss these matters. Getting help for your depression can change your life. Don’t wait- depression is an illness that can, and should be treated.

Thoughts about death or suicide are common in depression, and it’s important to take such thoughts seriously. If you feel like giving up or as if you might hurt yourself, get help immediately: call your doctor, go to the emergency room or call 911.

This tool is adapted with permission from similar content found on www.depressionhurts.ca.


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