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Prozac

(fluoxetine)

In this factsheet:
• How does Prozac work? What will it do for me?
• How should I use Prozac?
• What form(s) does Prozac come in?
• Who should NOT take Prozac?
• What side effects are possible with Prozac?
• Are there any other precautions or warnings for Prozac?
• What other drugs could interact with Prozac?

DIN (Drug Identification Number)

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 or nervousness
• decreased appetite
• decreased sexual drive
• diarrhea
• dizziness or lightheadedness
• drowsiness
• dry mouth
• headache
• heartburn
• increased sweating
• nausea
• tiredness or weakness
• trembling or shaking
• trouble sleeping

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

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

• breast enlargement or pain
• chills or fever
• fast or irregular heartbeat
• inability to sit still, or restlessness
• joint or muscle pain
• purple or red spots on skin
• skin rash, hives, or itching
• talking, feeling, and acting with excitement and activity you cannot control
• unusual secretion of milk (women)

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

convulsions (seizures) 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 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 trouble breathing unusual or incomplete body or facial movements

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.

Diabetes: If you have diabetes, your doctor should closely monitor your condition while you are taking fluoxetine, as it may affect blood sugar control.

Drowsiness/reduced alertness: People taking fluoxetine should avoid driving a car or performing hazardous tasks until they determine that this medication does not affect them adversely.

Medical conditions: If you have epilepsy, liver disease, kidney disease, or a history of mania, 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.

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.

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:

alcohol antipsychotics (e.g., haloperidol, risperidone, clozapine) benzodiazepines (e.g., diazepam, lorazepam) buspirone carbamazepine clarithromycin clopidrogrel dextromethorphan digoxin divalproex dronedarone levodopa lithium MAO inhibitors (e.g., phenelzine, tranylcypromine) meperidine metoprolol nifedipine

nilotinib other SSRIs (e.g., paroxetine, fluvoxamine) phenobarbital phenytoin pimozide propranolol quinine St. John's wort sumatriptan tamoxifen tetrabenazine tricyclic antidepressants (e.g., desipramine, imipramine) tryptophan valproic acid verapamil warfarin ziprasidone

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.

I feel a sense of sadness and/or hopelessness

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I feel restless and/or irritable

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have lost interest in hobbies and activities I once enjoyed

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have thoughts of self-harm, death, or suicide (if you have these thoughts, please seek medical help immediately)

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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2. Fatigue

Serious depression affects about 11% of Canadians at some time in their lives, and about 4% during any given year

I do not have the energy to do the things I need or want to do

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I think the lack of energy could be related to depression instead of another health issue

Yes Possibly No

Yes Possibly No

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3. Sleep

During depression treatment, sleep and appetite often improve before your mood improves.(

I am sleeping too much

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I am having trouble getting enough sleep

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have other sleep problems that are impacting my life

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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4. Weight

Weight loss is considered significant if you gain or lose more than 5% of your body weight within a month.

I have been losing weight recently without trying

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have been gaining weight recently without trying

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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5. Thinking and concentrating

Having a close relative with depression, experiencing childhood trauma or the death of a loved one, or worrying a lot about problems may increase the likelihood of experiencing an episode of depression

I have difficulty concentrating

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have difficulty thinking clearly

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

I have trouble making decisions

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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6. Unexplained Aches and Pains

Up to 76% of people with depression also experience physical symptoms, such as headache, stomach pain, and back pain

I am bothered by unexplained aches and pains (headache, stomach pain, other pains)

No Impact Mild Moderate Severe Debilitating

0 1 2 3 4

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