It is preferable not to use this treatment during pregnancy unless the potential benefit outweighs the potential risk. Thus, you and your doctor may decide to gradually stop taking Prozac while you are pregnant or before being pregnant. However, depending on your circumstances, your doctor may suggest that it is better for you to keep taking Prozac. Caution should be exercised when used during pregnancy, especially during late pregnancy or just before giving birth since the following effects have been reported in new born children: Make sure you do not run out of medicine.

You may notice the following effects withdrawal effects when you stop taking Prozac: Most people find that any symptoms on stopping Prozac are mild and disappear within a few weeks. If you experience symptoms when you stop treatment, contact your doctor. How to take Prozac When stopping Prozac, your doctor will help you to reduce your dose slowly over one or two weeks - this should help reduce the chance of withdrawal effects. Always take this medicine exactly as your doctor or pharmacist has told you.

Check with your doctor or pharmacist if you are not sure. Do not take more medicine than your doctor tells you. Do not take extra medicine to make up the missed dose.

If you miss a dose of Prozac Weekly, take the missed dose as soon as you remember and take the next dose 7 days later. However, if it is almost time for the next regularly scheduled weekly dose, skip the missed dose and take the next one as directed.

What happens if I overdose? Seek emergency medical attention or call the Poison Help line at What should I avoid while taking Prozac? Drinking alcohol can increase certain side effects of Prozac.

Prozac and alcohol in more detail Ask your doctor before taking a nonsteroidal anti-inflammatory drug NSAID for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen Advil, Motrin , naproxen Aleve , celecoxib Celebrex , diclofenac, indomethacin, meloxicam, and others. This medication may impair your thinking or reactions.

Be careful if you drive or do anything that requires you to be alert. Prozac side effects Get emergency medical help if you have signs of an allergic reaction to Prozac: Report any new or worsening symptoms to your doctor, such as: Call your doctor at once if you have: Common Prozac side effects may include: This is not a complete list of side effects and others may occur.

Call your doctor for medical advice about side effects. Side effects in more detail What other drugs will affect Prozac? Dosage adjustments should be made carefully on an individual patient basis, to maintain the patients at the lowest effective dose. Patients with depression should be treated for a sufficient period of at least 6 months to ensure that they are free from symptoms. Obsessive-compulsive disorder Adults and the elderly: Although there may be an increased potential for undesirable effects at higher doses, in some patients, if after two weeks there is insufficient response to 20mg, the dose may be increased gradually up to a maximum of 60mg.

If no improvement is observed within 10 weeks, treatment with fluoxetine should be reconsidered. If a good therapeutic response has been obtained, treatment can be continued at a dosage adjusted on an individual basis.

While there are no systematic studies to answer the question of how long to continue fluoxetine treatment, OCD is a chronic condition and it is reasonable to consider continuation beyond 10 weeks in responding patients. Dosage adjustments should be made carefully on an individual patient basis, to maintain the patient at the lowest effective dose. The need for treatment should be reassessed periodically.

Some clinicians advocate concomitant behavioural psychotherapy for patients who have done well on pharmacotherapy. Long-term efficacy more than 24 weeks has not been demonstrated in OCD. Adults and the elderly: Long-term efficacy more than 3 months has not been demonstrated in bulimia nervosa. The recommended dose may be increased or decreased. Paediatric population - Children and adolescents aged 8 years and above Moderate to severe major depressive episode Treatment should be initiated and monitored under specialist supervision.

Dose adjustments should be made carefully, on an individual basis, to maintain the patient at the lowest effective dose. Clinical trial experience with daily doses greater than 20mg is minimal. There is only limited data on treatment beyond 9 weeks.

Due to higher plasma levels in lower-weight children, the therapeutic effect may be achieved with lower doses see section 5. For paediatric patients who respond to treatment, the need for continued treatment after 6 months should be reviewed. If no clinical benefit is achieved within 9 weeks, treatment should be reconsidered. Elderly patients Caution is recommended when increasing the dose, and the daily dose should generally not exceed 40mg.

Hepatic impairment A lower or less frequent dose e. Abrupt discontinuation should be avoided. When stopping treatment with PROZAC the dose should be gradually reduced over a period of at least one to two weeks in order to reduce the risk of withdrawal reactions see sections 4.

If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose, but at a more gradual rate. Method of administration For oral administration. Fluoxetine may be administered as a single or divided dose, during or between meals.

When dosing is stopped, active drug substances will persist in the body for weeks. This should be borne in mind when starting or stopping treatment. The capsule and oral solution forms are bioequivalent. Fluoxetine is contra-indicated in combination with irreversible, non-selective monoamine oxidase inhibitors e. Fluoxetine is contra-indicated in combination with metoprolol used in cardiac failure see section 4.

PROZAC should only be used in children and adolescents aged 8 to 18 years for the treatment of moderate to severe major depressive episodes and it should not be used in other indications.

If, based on clinical need, a decision to treat is nevertheless taken, the patient should be carefully monitored for the appearance of suicidal symptoms. In addition, only limited evidence is available concerning long-term effect on safety in children and adolescents, including effects on growth, sexual maturation and cognitive, emotional and behavioural developments see section 5.

In a week clinical trial, decreased height and weight gain was observed in children and adolescents treated with fluoxetine see section 5. It has not been established whether there is an effect on achieving normal adult height. The possibility of a delay in puberty cannot be ruled out see sections 5. Growth and pubertal development height, weight, and TANNER staging should therefore be monitored during and after treatment with fluoxetine. If either is slowed, referral to a paediatrician should be considered.

In paediatric trials, mania and hypomania were commonly reported see section 4. Fluoxetine should be discontinued in any patient entering a manic phase. This risk persists until significant remission occurs. As improvement may not occur during the first few weeks or more of treatment, patients should be closely monitored until such improvement occurs. It is general clinical experience that the risk of suicide may increase in the early stages of recovery.

Other psychiatric conditions for which PROZAC is prescribed can also be associated with an increased risk of suicide-related events.

In addition, these conditions may be co-morbid with major depressive disorder. The same precautions observed when treating patients with major depressive disorder should therefore be observed when treating patients with other psychiatric disorders. Patients with a history of suicide-related events, those exhibiting a significant degree of suicidal ideation prior to commencement of treatment are known to be at greater risk of suicidal thoughts or suicide attempts, and should receive careful monitoring during treatment.

A meta-analysis of placebo-controlled clinical trials of antidepressants drugs in adult patients with psychiatric disorders showed an increased risk of suicidal behaviour with antidepressants compared to placebo in patients less than 25 years old.

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