Prozac Warnings and Precautions (Cont.)

• Antidepressants (including Prozac) may increase the risk of suicidal thinking or behavior in children, teenagers, and adults (see Depression and Suicide for more information). Therefore, if you notice any changes in symptoms or new symptoms, talk to your healthcare provider immediately. Some of these symptoms may include anxiety, hostility, agitation, panic, restlessness, hallucinations, extreme hyperactivity, and suicidal thinking or behavior (see Prozac and Suicide for more information).
   
• Before prescribing Prozac for depression, your healthcare provider should make sure that you do not have bipolar disorder (instead of depression). Sometimes, the symptoms of bipolar disorder and depression are very similar, and Prozac can cause problems in people with bipolar disorder.
   
• Prozac can cause rashes or other allergic reactions. If you develop an unexplained rash or hives, talk to your healthcare provider.
   
• Taking Prozac with other medications that affect serotonin can increase your risk of a developing a dangerous group of symptoms called serotonin syndrome. These other medications include other antidepressants, triptans (migraine medications), and several other medications (see Prozac Drug Interactions for more information). Contact your healthcare provider immediately if you have any possible symptoms of serotonin syndrome, including:

o Confusion

o Seeing or hearing things that are not really there (hallucinations)

o Fast heartbeat (tachycardia)

o Feeling faint

o Fever

o Sweating

o Muscle spasms

o Difficulty walking

o Diarrhea.

• Prozac can cause insomnia and anxiety. Talk to your healthcare provider if you are experiencing anxiety or problems sleeping while taking Prozac.
   
• There is a possibility that Prozac may cause unwanted weight loss (see Prozac and Weight Loss).
   
• If you have a seizure disorder, there is a possibility that taking Prozac may cause seizures. Talk to your healthcare professional before taking Prozac if you have seizures.
   
• If you are stopping Prozac, you should be monitored by a healthcare professional for Prozac withdrawal symptoms. If you do develop any withdrawal symptoms, such as irritability, anxiety, confusion, headache, lethargy, or insomnia, your healthcare provider may slow down the rate at which the Prozac is stopped. However, the antidepressant may be less likely than other medications to cause withdrawal symptoms because it stays in your system for such a long time (see Prozac Withdrawal).
   
• Prozac may cause bleeding in the stomach or intestines. This risk is increased in those taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen. Symptoms of gastrointestinal bleeding may include:

o Bright red blood coating the stool

o Dark blood mixed with the stool

o Black or tarry stool

o Bright red blood in vomit

o Vomit that has the appearance of coffee grounds.

If you experience any of these symptoms, call your healthcare provider.

• If you are elderly or taking a diuretic, Prozac could cause low salt levels in the blood (hyponatremia). This generally returns to "normal" when Prozac is discontinued.
   
• If you have liver problems, you may need a lower Prozac dose, since the liver helps to remove Prozac from the blood.
   
• Prozac stays in your system for a long time. This means that you may not see the effects of a change in dose for several weeks.
   
• Prozac may affect your ability to perform complex tasks requiring mental and motor skills. Therefore, it is recommended that you become accustomed to its effect on you before becoming involved in activities requiring mental or motor concentration (such as driving a car or operating machinery).
   
• Prozac can interact with certain medications (see Prozac Drug Interactions).
   
• Prozac is considered a pregnancy Category C medication. This means that it may not be safe to use during pregnancy. Talk to your healthcare provider about the risks and benefits of using Prozac during pregnancy (see Prozac and Pregnancy for more information).
   
• Prozac passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about using Prozac (see Fluoxetine and Breastfeeding).