RiteMED Fluoxetine Special Precautions

Because of their epileptogenic effect, SSRIs should be used with caution in patients with epilepsy or a history of such disorders (and should be avoided if the epilepsy is poorly controlled). Treatment should be stopped if seizures develop or when there is an increase in seizure frequency.
Care is advised in patients receiving ECT as prolonged seizures have occurred rarely. SSRIs should also be used with caution in patients with cardiac disease or a history of bleeding disorders. Although SSRIs are preferred to tricyclics for the treatment of depression in patients with diabetes, they may alter glycemic control and therefore caution is also warranted in diabetic subjects. SSRIs should be used with caution in patients with angle-closure glaucoma.
Fluoxetine should be stopped in patients who develop a rash since systemic effects, possibly related to vasculitis, have occurred in such patients. Fluoxetine undergoes hepatic metabolism and should be used with caution and in reduced doses in patients with impaired hepatic functions.
Patients should be closely monitored during early therapy until significant improvement in depression is observed because suicide is an inherent risk in depressed patients. Suicidal thoughts and behavior may also develop during early treatment with antidepressants for other disorders; the same precautions observed when treating patients with depression should therefore be observed when treating patients with other disorders. If SSRIs are given for the depressive component of bipolar disorder, mania may be precipitated. Symptoms may also worsen during the initial treatment of panic disorder with SSRIs. SSRIs should generally be withdrawn gradually to reduce the risk of withdrawal symptoms although this may be unnecessary for Fluoxetine because of its long half-life.
Effects in ability to drive and use machines: While affective disorders probably adversely affect driving skill, treatment with anti-depressants can also be hazardous, although patients may be safer drivers with medication than without. Impairment of performance is largely related to sedative and antimuscarinic effects.