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fluoxetine
Prozac · Sarafem · Symbyax (with olanzapine)
SSRI⚠ Unverified beta content
At a glance
- Class
- Selective serotonin reuptake inhibitor (long half-life)
- Black box
- ⚠ Suicidal thoughts and behaviors
- Key monitoring
- Suicidality / mood / behavior
- Usual adult dose
- Depression: 20–60 mg/day
- Call provider / escalate if
- Thoughts of suicide or self-harm, or sudden worsening of mood • Serotonin syndrome signs: agitation, fever, sweating, tremor, muscle stiffness, diarrhea, fast heartbeat • Fainting, racing/irregular heartbeat
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- fluoxetine (Prozac, Sarafem, Symbyax (with olanzapine)) — selective serotonin reuptake inhibitor (long half-life).
- Used for: Major depressive disorder; OCD; Bulimia nervosa; Panic disorder.
Usual adult dosing
- Depression: 20–60 mg/day (Typical start 20 mg every morning.)
- OCD: 20–60 mg/day
- Bulimia nervosa: 60 mg every morning
- Max: 80 mg/day
Boxed warning
- Suicidal thoughts and behaviors: antidepressants increase the risk in children, adolescents and young adults (to age 24) with major depression and other psychiatric disorders. Monitor closely, especially at start and with dose changes.
Monitor
- Suicidality / mood / behavior [Every contact; closely early & after dose changes]
Nursing priorities
- Baseline mood, suicidal ideation (ask directly), anxiety, sleep, appetite, activity level.
- Screen for history of mania/hypomania or bipolar disorder before/early in treatment.
- Assess suicidal ideation each shift/visit, especially first weeks and after dose changes; follow facility safety protocols.
- Full effect often takes 4–6 weeks; reinforce that early side effects often ease but benefit is delayed.
- Do not stop abruptly; support adherence and report missed doses/side effects.
Major interactions
- MAOIs / linezolid / methylene blue: Serotonin syndrome – contraindicated; allow washout per label (typically 14 days after MAOI).
- Other serotonergic drugs (triptans, tramadol, fentanyl, St John’s wort, other antidepressants, lithium): Increased risk of serotonin syndrome.
- CYP2D6 substrates (TCAs, thioridazine – contraindicated, pimozide – contraindicated, metoprolol, codeine/tramadol): Increased levels of the other drug; reduced activation of prodrugs.
Key teaching
- Take it every day, even when you feel better. It can take 4–6 weeks to feel the full effect.
- Do not stop suddenly – talk to your provider first; stopping fast can cause dizziness, “brain zaps,” nausea, and irritability.
- Tell your care team right away about new or worse thoughts of hurting yourself, agitation, or unusual changes in mood or behavior.
Optional: AI explanation
Off by default. To enable, add your own API key in Settings (stored only on this device).
Boxed warning
- Suicidal thoughts and behaviors: antidepressants increase the risk in children, adolescents and young adults (to age 24) with major depression and other psychiatric disorders. Monitor closely, especially at start and with dose changes.
Other serious warnings
- Serotonin syndrome
- Bleeding risk
- Hyponatremia/SIADH
- Activation of mania
- QT prolongation / torsades (use caution with risk factors)
- Seizures
- Strong CYP2D6 inhibitor – raises levels of many drugs
Sources: FDA label (DailyMed): PROZAC (FLUOXETINE HYDROCHLORIDE) CAPSULE [DISTA
- Suicidality / mood / behaviorWhen: Every contact; closely early & after dose changes
- SodiumWhen: If at risk or symptomatic
- ECG / QTcConsider with cardiac disease, electrolyte abnormalities or other QT-prolonging drugs
- Weight / appetite
Sources: FDA label (DailyMed): PROZAC (FLUOXETINE HYDROCHLORIDE) CAPSULE [DISTA
Assessment
- Baseline mood, suicidal ideation (ask directly), anxiety, sleep, appetite, activity level.
- Screen for history of mania/hypomania or bipolar disorder before/early in treatment.
- Medication/supplement list for serotonergic drugs, anticoagulants, NSAIDs.
- Baseline sodium if older adult, on diuretics, or history of hyponatremia.
- Review CYP2D6 substrates (e.g., TCAs, some antipsychotics, metoprolol, codeine/tramadol).
Interventions
- Assess suicidal ideation each shift/visit, especially first weeks and after dose changes; follow facility safety protocols.
- Full effect often takes 4–6 weeks; reinforce that early side effects often ease but benefit is delayed.
- Do not stop abruptly; support adherence and report missed doses/side effects.
- Monitor for activation (agitation, insomnia, restlessness/akathisia, new mania).
- Give in the morning (activating). Very long half-life (norfluoxetine ~4–16 days): drug effects, interactions and withdrawal timing are prolonged; tapering is usually self-limiting.
- Allow ≥5 weeks after stopping before starting an MAOI (per label).
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Thoughts of suicide or self-harm, or sudden worsening of mood
- Serotonin syndrome signs: agitation, fever, sweating, tremor, muscle stiffness, diarrhea, fast heartbeat
- Fainting, racing/irregular heartbeat
- Unusual bleeding
- Confusion/unsteadiness (low sodium)
- Seizure
- Manic symptoms
- Severe rash, hives, swelling
Sources: FDA label (DailyMed): PROZAC (FLUOXETINE HYDROCHLORIDE) CAPSULE [DISTA · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Nausea
- Headache
- Insomnia, nervousness / anxiety, restlessness
- Diarrhea
- Sexual dysfunction
- Decreased appetite / weight change
- Sweating, tremor
Sources: FDA label (DailyMed): PROZAC (FLUOXETINE HYDROCHLORIDE) CAPSULE [DISTA
- MAOIs / linezolid / methylene blue MajorSerotonin syndrome – contraindicated; allow washout per label (typically 14 days after MAOI).
- Other serotonergic drugs (triptans, tramadol, fentanyl, St John’s wort, other antidepressants, lithium) MajorIncreased risk of serotonin syndrome.
- NSAIDs, aspirin, anticoagulants, antiplateletsIncreased bleeding risk (GI bleed).
- Diuretics, other hyponatremia-causing drugsAdded risk of hyponatremia/SIADH, especially in older adults.
- CYP2D6 substrates (TCAs, thioridazine – contraindicated, pimozide – contraindicated, metoprolol, codeine/tramadol) MajorIncreased levels of the other drug; reduced activation of prodrugs.
- Warfarin, phenytoinLevels/INR may change – monitor.
Sources: FDA label (DailyMed): PROZAC (FLUOXETINE HYDROCHLORIDE) CAPSULE [DISTA
- Take it every day, even when you feel better. It can take 4–6 weeks to feel the full effect.
- Do not stop suddenly – talk to your provider first; stopping fast can cause dizziness, “brain zaps,” nausea, and irritability.
- Tell your care team right away about new or worse thoughts of hurting yourself, agitation, or unusual changes in mood or behavior.
- Check with a pharmacist/provider before taking other medicines, herbal products (like St John’s wort), or NSAIDs such as ibuprofen.
- Avoid alcohol or limit it; it can make side effects and depression worse.
- Take it in the morning; it can cause trouble sleeping if taken late.
- Because it stays in your body a long time, side effects or interactions can last weeks after you stop it.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Major depressive disorder
- OCD
- Bulimia nervosa
- Panic disorder
- PMDD
- Bipolar depression (with olanzapine as Symbyax)
Dosing
- Depression: 20–60 mg/dayTypical start 20 mg every morning.
- OCD: 20–60 mg/day
- Bulimia nervosa: 60 mg every morning
- Max: 80 mg/day
Sources: FDA label (DailyMed): PROZAC (FLUOXETINE HYDROCHLORIDE) CAPSULE [DISTA
Prescriber-oriented details; limited in this beta.
cyp Notes
- Potent CYP2D6 inhibitor; moderate CYP2C19 inhibitor; effect persists weeks after discontinuation.
Sources: FDA label (DailyMed): PROZAC (FLUOXETINE HYDROCHLORIDE) CAPSULE [DISTA
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): PROZAC (FLUOXETINE HYDROCHLORIDE) CAPSULE [DISTA PRODUCTS COMPANY]
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified