Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking fluoxetine, it is especially important that your health care professional know if you are taking any of the following:

Alprazolam (e.g., Xanax)—Higher blood levels of alprazolam may occur and its effects may be increased

	Anticoagulants (blood thinners) or
	Digitalis glycosides (heart medicine)—Higher or lower blood levels of these medicines or fluoxetine may occur, increasing the chance of unwanted effects. Your doctor may need to see you more often, especially when you first start or when you stop taking fluoxetine. Your doctor also may need to change the dose of either medicine

Astemizole (e.g., Hismanal)—Higher blood levels of astemizole may occur, which increases the chance of having a very serious change in the rhythm of your heartbeat

	Buspirone (e.g., BuSpar) or
	Bromocriptine (e.g., Parlodel) or
	Dextromethorphan (cough medicine) or
	Levodopa (e.g., Sinemet) or
	Lithium (e.g., Eskalith) or
	Meperidine (e.g., Demerol) or
	Nefazodone (e.g., Serzone) or
	Pentazocine (e.g., Talwin) or
	Selective serotonin reuptake inhibitors, other (citalopram [Celexa], fluvoxamine [e.g., Luvox], paroxetine [e.g., Paxil], sertraline [e.g., Zoloft]) or
	Street drugs (LSD, MDMA [e.g., ecstasy], marijuana) or
	Sumatriptan (e.g., Imitrex) or
	Tramadol (e.g., Ultram) or
	Trazodone (e.g., Desyrel) or
	Tryptophan or
	Venlafaxine (e.g., Effexor)—Using these medicines with fluoxetine or within 5 weeks of stopping fluoxetine may increase the chance of developing a rare, but very serious, unwanted effect known as the serotonin syndrome. This syndrome may cause confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching. If you develop these symptoms contact your doctor as soon as possible. Taking tramadol with fluoxetine increases the chance of having convulsions (seizures). Also, taking tryptophan with fluoxetine may result in increased agitation or restlessness and intestinal or stomach problems

Moclobemide (e.g., Manerex)—The risk of developing serious unwanted effects, including the serotonin syndrome, is increased. Use of moclobemide with fluoxetine is not recommended. Also, it is recommended that 7 days be allowed between stopping treatment with moclobemide and starting treatment with fluoxetine, and it is recommended that 5 weeks be allowed between stopping treatment with fluoxetine and starting treatment with moclobemide

Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])— Do not take fluoxetine while you are taking or within 2 weeks of taking an MAO inhibitor. If you do, you may develop confusion, agitation, restlessness, stomach or intestinal problems, sudden high body temperature, extremely high blood pressure, and severe convulsions. At least 14 days should be allowed between stopping treatment with an MAO inhibitor and starting treatment with fluoxetine. If you have been taking fluoxetine, at least 5 weeks should be allowed between stopping treatment with fluoxetine and starting treatment with an MAO inhibitor

Phenytoin (e.g., Dilantin) or

Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])—Higher blood levels of these medicines may occur, which increases the chance of having serious side effects. Your doctor may want to see you more often and may need to change the doses of your medicines. Also, taking amitriptyline, clomipramine, or imipramine with fluoxetine may increase the chance of developing the serotonin syndrome

The number of capsules or teaspoonfuls of solution that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking fluoxetine.

For oral dosage forms (capsules or solution): For depression or obsessive-compulsive disorder: Adults—At first, usually 20 milligrams (mg) a day, taken as a single dose in the morning. Your doctor may increase the dose if needed. However, the dose usually is not more than 80 mg a day. Once your depression is under control, your doctor may wish to change you to a weekly dose. In this case, you will usually take a 90-mg capsule as a single dose one day per week. Children—Use and dose must be determined by your doctor. For bulimia nervosa: Adults—Usually 60 milligrams (mg) a day, taken as a single dose in the morning. Your doctor may start with a lower dose and increase it gradually. The dose usually is not more than 80 mg a day. Children—Use and dose must be determined by your doctor. For premenstrual dysphoric disorder: Adults—At first, usually 20 milligrams (mg) a day, taken as a single dose in the morning. Your doctor may increase the dose if needed. However, the dose usually is not more than 80 mg a day. Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, it is not necessary to make up the missed dose. Skip the missed dose and continue with your next scheduled dose. Do not double doses.

Storage—

To store this medicine:

	Keep out of the reach of children.
	Store away from heat and direct light.
	Keep the oral solution form of this medicine from freezing.
	Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
	Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

For diabetic patients:

This medicine may affect blood sugar levels. If you notice a change in the results of your blood or urine sugar tests or if you have any questions, check with your doctor.

This medicine may cause some people to become drowsy or less able to think clearly, or to have poor muscle control. Make sure you know how you react to fluoxetine before you drive, use machines, or do anything else that could be dangerous if you are not alert and well able to control your movements.