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Fluoxetine (Prozac) is an antidepressant medication, commonly prescribed to treat depression and other mental health conditions. It is generally safe to use and does not often lead to serious adverse effects or addiction. However, side effects can occur, and it is important to use Prozac as instructed.
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What is fluoxetine (Prozac)?
Fluoxetine is an antidepressant medication classed as a selective serotonin reuptake inhibitor (SSRI). Fluoxetine is available as a generic medication and as a branded medication, Prozac. [1] Fluoxetine is available as an oral liquid, tablets, and capsules ranging from 10 mg to 60 mg, and delayed-release capsules of 90 mg. [2]
Symbyax is a combination medication containing olanzapine and fluoxetine, available in strengths 3 mg/25 mg, 6 mg/25 mg, 6 mg/50 mg, 12 mg/25 mg, and 12 mg/50 mg (olanzapine/fluoxetine). [3]
How fluoxetine works in the brain
Fluoxetine works by impacting the levels and activity of serotonin. Serotonin is a neurotransmitter that helps regulate various functions, including mood, sleep, and appetite. Fluoxetine blocks the reuptake of serotonin, resulting in higher serotonin levels in the brain. This can help contribute to improvements in mental health symptoms. [2]
Approved uses and off-label applications
Prozac (fluoxetine) is approved by the US Food and Drug Administration (FDA) for the following uses: [2][4]
- Major depressive disorder (MDD)
- Obsessive-compulsive disorder (OCD)
- Bulimia nervosa
- Acute treatment of panic disorder (PD), with or without agoraphobia
Prozac is approved by the FDA for use in combination with olanzapine for: [2][4]
- Treatment of acute depressive episodes associated with bipolar disorder
- Treatment-resistant depression
Off-label use
Fluoxetine is sometimes prescribed off-label (for purposes that are not FDA-approved), such as: [2]
- Binge eating disorder
- Social anxiety disorder
- Borderline personality disorder (BPD)
- Premenstrual dysphoric disorder (PMDD)
- Raynaud phenomenon
- Selective mutism
- Post-traumatic stress disorder (PTSD)
Dosage and administration guide
Prozac treatment should commence with a low dose, which can be gradually increased to find the most effective therapeutic dose. Gradual increases help to reduce side effects when starting treatment. [4]
- Major depressive disorder: Initial dose of 20 mg per day, which can be increased up to a maximum dose of 80 mg. Delayed-release Prozac can be started 7 days after the last 20 mg dose and is taken once per week.
- Obsessive-compulsive disorder: Initial dose of 20 mg per day, which can be increased up to a maximum of 80 mg per day. Typically, 20 mg to 60 mg is an effective maintenance dose.
- Bulimia nervosa: Administer 60 mg per day. Some people may need to start with a lower dose and be gradually increased to a 60 mg maintenance dose.
- Panic disorder: The initial dose is 10 mg per day, which can be increased up to a maximum daily dose of 60 mg.
- Depressive episodes in bipolar I disorder: Start fluoxetine at 20 mg per day with a low dose of an atypical antipsychotic medication, like 5 mg olanzapine. Doses can be increased to 50 mg (fluoxetine) and 12 mg (olanzapine).
- Treatment-resistant depression: Start with 20 mg (fluoxetine) and 5 mg (olanzapine) per day. Doses can be increased to 50 mg (fluoxetine) and 18 mg (olanzapine) if required.
Before use: Is Prozac right for you?
Before starting Prozac treatment, the prescribing physician will ensure that the medication is suitable. They will ask about the individual’s history of mental and physical health conditions and any current or recent medications. In some cases, Prozac is not an appropriate medication or may need to be used in reduced doses and with closer monitoring. For example: [1][4]
- Pregnancy and breastfeeding: Prozac may cause some risk to the fetus or the breastfeeding infant, so it is used only when it is deemed that the benefits may outweigh the risks during pregnancy and breastfeeding. Careful monitoring is imperative throughout treatment.
- Children: Prozac can be used to treat children, although it is not recommended for people under the age of 7 for OCD and 8 for MDD.
- Older adults: People over the age of 65 might be at increased risk of adverse effects and may need reduced doses and careful monitoring.
- Impaired liver function: People with cirrhosis or other liver conditions may require reduced doses, and caution is advised.
- History of mania: Prozac may cause the onset of a manic episode, particularly in those with a history of bipolar disorder or mania.
- History of angle-closure glaucoma: Prozac may critically increase this severity.
- Heart conditions: Prozac can cause QT prolongation or ventricular arrhythmia, particularly in those with a history of heart issues.
Interactions
Prozac can interact with other medications and substances, which can impact the effectiveness of the medication and increase the risk of adverse effects. Prozac should not be taken alongside monoamine oxidase inhibitors (MAOIs), as this can cause serious or even fatal interactions and increase the risk of serotonin syndrome. [4]
Other potential interactions include other antidepressants, benzodiazepines, antipsychotics, anticonvulsants, opioids, St John’s wort, tryptophan, and alcohol. [1][4]
Side effects and risks
Side effects are common when initiating a medication. Typically, these will only last a couple of weeks and will go away on their own. Common side effects of fluoxetine include: [1][4]
- Nausea
- Diarrhea
- Dry mouth
- Anxiety
- Insomnia
- Weakness
- Shaking
- Changes in appetite and weight
- Unusual dreams
- Sexual dysfunction
- Headaches
- Trouble concentrating
If any of these side effects persist, contact a doctor.
Severe side effects
If severe side effects occur, report to the prescribing doctor immediately. This includes: [1][4]
- Rash, hives, or blisters
- Fever
- Joint pain
- Swelling of the mouth or throat
- Swollen hands, feet, arms, or legs
- Trouble breathing or swallowing
- Extreme changes in heartbeat
- Extreme confusion
- Sweating and shivering
- Severe muscle stiffness or twitching
- Hallucinations
- Persistent vomiting or diarrhea
- Abnormal or unexplained bleeding or bruising
Other risks
Risks of fluoxetine use include: [2][4]
- Suicidal ideation: SSRIs, such as fluoxetine, can cause suicidal ideation, particularly at the start of treatment and in people under the age of 24. People should be made aware of this risk and advised to contact a medical professional if concerning signs emerge.
- Serotonin syndrome: Serotonin syndrome is a potentially fatal condition that occurs when serotonin levels are too high. The risk of serotonin syndrome is increased if fluoxetine is used alongside other serotonergic medications.
- Abnormal bleeding: Prozac can increase the risk of unusual bleeding, particularly if used alongside blood-thinning medications.
- Cognitive and motor impairment: Use caution when driving or operating machinery, as judgment and motor skills may be impaired.
Is Prozac addictive?
Prozac is not considered to be an addictive substance. It does not cause euphoric effects (or a “high”) and does not impact dopamine, as do many addictive substances. It is unlikely to be used as a drug of abuse, although people with a history of substance abuse should be observed closely during treatment to monitor for signs of misuse, changes in drug-seeking behavior, and use not as prescribed. [4]
Withdrawal and management
Prolonged Prozac use can result in the development of physical dependence. This can result in discontinuation syndrome (or withdrawal symptoms) when treatment is stopped, particularly if it is stopped abruptly. This can cause symptoms such as “brain zaps” (electric shock sensations in the brain), low mood, anxiety, agitation, insomnia, headaches, lethargy, and confusion. [4]
It is recommended to gradually reduce the dosage of Prozac when stopping treatment to help prevent or reduce the severity of discontinuation symptoms. [4]
Tips for safe and supported use
When starting Prozac treatment, the prescribing doctor should make the individual aware of any potential side effects and risks. Regular reviews should be conducted to monitor the safety and effectiveness of the medication, allowing the individual to report any concerning side effects.
If serious side effects occur or the individual experiences thoughts of wanting to harm themselves, contact the prescribing doctor immediately. When it is deemed appropriate to discontinue Prozac treatment, discuss with the healthcare provider how to safely taper off the medication.
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