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Drug Interactions When you are taking Prozac, it is especially important that your health care professional know if you are taking any of the following:

- Astemizole (e.g., Hismanal)—Higher blood levels of a temizole 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
- Dextro methorphan (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

How should you take this medication? Prozac comes as a capsule, tablet, and liquid to take by mouth. It is usually taken once or twice a day and may be taken with or without food. Follow the directions on your prescription label carefull y, and ask your doctor or pharmacist to explain any part you do not understand. Take Prozac exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Continue to take Prozac even if you feel well. Do not stop taking Prozac without talking to your doctor, especially if you have taken large doses for a long time. Your doctor probably will want to decrease your dose gradually. This drug must be taken regularly for a few weeks before its full effect is felt.

What side effects may occur? In children and adolescents, less common side effects may also include:
- Agitation, excessive menstrual bleeding, frequent urination, hyperactivity, mania or hypomania (inappropriate feelings of elation and/or rapid thoughts), nosebleeds, personality changes, and thirst

A wide variety of other very rare reactions have been reported during Prozac therapy. If you develop any new or un explained symptoms, tell your doctor without delay.

Precautions Before Using This Medicine Older adults—Many medicines have not been tested in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effec s or problems in older people. In studies done to date that included elderly people, Prozac did not cause different side effects or problems in older people than it did in younger adults.

Possible food and drug interactions when taking this medication P450 isozyme (IID6): - Like other selective serotonin reuptake inhibitors, fluoxetine inhibits the specific hepatic cytochrome P450 isozyme (IID6) which is responsible for the metabolism of debrisoqui ne and sparteine. Although the clinical significance of this effect has not been established, inhibition of IID6 may lead to elevated plasma levels of co-administered drugs which are metabolized by th is isozyme. Drugs metabolized by cytochrome P450IID6 include the tricyclic antidepressants (e.g., nortriptyline, amitriptyline, imipramine, and desipramine), phenothiazine neuroleptics (e.g., perphena zine and thioridazine), and Type 1C antiarrhythmics (e.g., propafenone and flecainide).

Symptoms of overdose Nausea and vomiting were prominent in overdoses involving higher fluoxetine doses. Other prominent symptoms of overdose included agitation, restlessness, hypomania, and other signs of CNS excitation, including seizures.

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