Prozac (Fluoxetine)

Prozac, or fluoxetine, is a Selective Serotonin Reuptake Inhibitor, also known as an SSRI. Prozac and other SSRIs are not considered narcotics (controlled substances), and the U.S. Drug Enforcement Administration doesn’t consider it to have a high risk of addiction or abuse.

It’s one of the most prescribed antidepressants in the United States, with more than 28 million Americans reportedly using it. Prozac stimulates certain chemical messengers (neurotransmitters) that communicate between brain cells. It was the first SSRI that the U.S. Food and Drug Administration (FDA) approved to treat depression in adults, children and adolescents.

Fluoxetine may improve mood and energy levels, but it may also result in common fluoxetine side effects including agitation, abnormal heartbeat and confusion. Serious side effects include suicidal thoughts, insomnia and anorexia. Some studies also link Prozac to birth defects in children. However, as of March 2017, the FDA has not added new warnings to Prozac’s label.

People sometimes wonder if Prozac is the same as Xanax (alprazolam). Although they’re both prescribed for similar conditions, including anxiety and panic disorders, Xanax is not an SSRI. Xanax is a benzodiazepine. The two drugs are not interchangeable, but some people take Prozac for anxiety, an off-label use the FDA has not approved.

Prozac is used to treat major depressive disorder, obsessive-compulsive disorder, panic disorder, bulimia, premenstrual dysphoric disorder, binge eating disorder and bipolar depression. Doctors also prescribe it for treatment-resistant depression in combination with olanzapine (Zyprexa).

Prozac can make you feel more optimistic, improving mood, appetite, sleep, focus and energy levels. It may also decrease anxiety, fear, unwanted thoughts and panic attacks.

Manufacturer Eli Lilly has not put off-label uses of Prozac through clinical trial testing and the FDA has not approved these uses.

New research in 2022 calls into question the effectiveness of SSRIs for depression. A study from the University College of London suggests a serotonin chemical imbalance may not be correlated with depression, which is what SSRIs address.

Before taking Prozac, you should know that drug interactions are possible. It’s important to tell your doctors about any current medications, herbs and supplements you’re already taking and if you’re allergic to any drugs. This is especially important if you are taking, or recently stopped taking, a monoamine oxidase inhibitor (MAOI) such as Zyvox, Nardil, Parnate, Zelapar or Emsam.

Also let your doctors know if you’re pregnant, trying to get pregnant or if you’re nursing an infant.

Drug Interactions

Prozac may interact with a variety of drugs, including MAOIs, certain antipsychotics and some antidepressants (TCAs), potentially causing fatal complications.

Side effects of Prozac drug interactions can include internal bleeding, seizures and abnormal heart rhythms. Patients should always check with their doctors before taking any medication with Prozac.

Serious drug interactions include:

Prozac can also have negative effects for those who use opioid pain relievers (such as codeine) or muscle relaxers, marijuana (cannabis) or alcohol.

It also interferes with the accuracy of certain medical and lab tests, including brain scans for Parkinson’s disease.

Prozac is available in a variety of dosages. Your dosage, frequency and duration of use depends on the condition that needs treating and your age. A typical dose is 20 mg a day, taken in the morning.

If you miss a dose of Prozac, take it as soon as possible. If you miss a dose and it’s nearly time for your next one, take the next dose but don’t double-up on two doses.

Fluoxetine is rarely lethal from an overdose. But if you faint, have a fast or irregular heartbeat, experience trouble breathing and feel severe dizziness, seek medical attention immediately.

Clinical trials reported that Prozac can trigger one or more negative side effects. While not life-threatening, speak with your doctor if you experience this side effects.

Patients taking Prozac may also experience rare but serious side effects including suicidal thoughts and behaviors, seizures and bleeding issues.

Although some people may experience some negative fluoxetine side effects such anxiety, agitation, nausea and drowsiness, most people who take it don’t experience serious side effects.

Prozac, Pregnancy and Birth Defects

Prozac’s product label advises those who are pregnant to use the drug only if benefits to the mother outweigh risks to the fetus. It warns against breastfeeding while taking Prozac. The FDA warned in 2006 that SSRIs including Prozac can increase the risk of fetal heart complications when taken during the last half of pregnancy. People have filed Prozac lawsuits because of birth defects, violent behavior and suicidal tendencies.

A CDC study published in 2015 linked Prozac to an increased risk of heart wall defects, craniosynostosis and heart defects, risks, which were also found in a larger, more recent study in BioMed Central. Mothers who took SSRIs while pregnant have less than a 1% chance of their infants developing a lung condition called persistent pulmonary hypertension of the newborn (PPHN), a potentially fatal condition.

Prozac Black Box Suicide Warning

The FDA issued a black box warning in October 2004 about prescribing Prozac for children, and two years later extended the warning to include people as old as 24. In 2007, the FDA began requiring manufacturers of antidepressants to update warnings about the increased risks of suicidal thoughts and behaviors during the first two months of treatment.

An International Journal of Risk and Safety in Medicine study in 2022 questioned whether the clinical trial results used to gain FDA approval of fluoxetine use in children and adolescents were accurately reported and suggested the drug is unsafe and ineffective.