QTc interval. Avoid or Use Alternate Drug.sodium sulfate/?magnesium sulfate/potassium chlorideMonitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases effects of fluoxetine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycolMonitor Closely (1)fluoxetine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.sodium sulfate/potassium sulfate/magnesium sulfateMonitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases effects of fluoxetine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.solifenacinMonitor Closely (1)solifenacin and fluoxetine both increase QTc interval. Use Caution/Monitor.sorafenibMonitor Closely (1)sorafenib and fluoxetine both increase QTc interval. Use Caution/Monitor.sotalolSerious - Use Alternative (1)fluoxetine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.sparsentanMonitor Closely (1)sparsentan will decrease the level or effect of fluoxetine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C9 inducer) decreases exposure of CYP2C9 substrates and reduces efficacy related to these substrates. St John's WortSerious - Use Alternative (1)fluoxetine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.sufentanil SLMonitor Closely (1)sufentanil SL, fluoxetine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.sulfamethoxazoleMonitor Closely (1)fluoxetine will increase the level or effect of sulfamethoxazole by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.sulfasalazineMonitor Closely (1)fluoxetine, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.sulindacMonitor Closely (1)fluoxetine, sulindac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.sumatriptanMonitor Closely (1)sumatriptan and fluoxetine both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)fluoxetine, sumatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.sumatriptan intranasalMonitor Closely (1)sumatriptan intranasal and fluoxetine both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)fluoxetine, sumatriptan intranasal. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.sunitinibMonitor Closely (1)sunitinib and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.tacrolimusMonitor Closely (1)tacrolimus and fluoxetine both increase QTc interval. Use Caution/Monitor.tamoxifenMonitor Closely (1)fluoxetine will decrease the level or effect of tamoxifen by decreasing metabolism. Use Caution/Monitor. Inhibition of CYP2D6 metabolism to tamoxifen's active metabolite, endoxifen.tamsulosinMonitor Closely (1)fluoxetine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tapentadolMonitor Closely (1)fluoxetine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.tazemetostatMonitor Closely (1)fluoxetine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tedizolidSerious - Use Alternative (1)tedizolid, fluoxetine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.telavancinMonitor Closely (1)fluoxetine and telavancin both increase QTc interval. Use Caution/Monitor.terbinafineMonitor Closely (1)terbinafine will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.terbutalineMonitor Closely (1)fluoxetine and terbutaline both increase QTc interval. Modify Therapy/Monitor Closely. Fluoxetine prolongs the QT interval; the prescribing information for fluoxetine recommends avoiding concurrent use of other drugs that may prolong the QT interval; risk may be increased with higher doses and/or when associated with hypokalemia; drugs that prolong the QTc interval may potentiate the effects of beta2 agonists on the cardiovascular systemtetrabenazineMonitor Closely (1)fluoxetine increases effects of tetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decrease tetrabenazine dose by 50% when coadministered with strong CYP2D6 inhibitors.Serious - Use Alternative (1)tetrabenazine and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.thioridazineContraindicated (3)thioridazine will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. thioridazine and fluoxetine both increase QTc interval. Contraindicated. fluoxetine increases levels of thioridazine by decreasing metabolism. Contraindicated. Risk of long QT syndrome.Serious - Use Alternative (1)fluoxetine will increase the level or effect of thioridazine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.thiothixeneMonitor Closely (1)thiothixene and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.timololSerious - Use Alternative (1)fluoxetine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.tinidazoleMonitor Closely (1)fluoxetine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tipranavirSerious - Use Alternative (1)tipranavir will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.tolazamideMonitor Closely (1)fluoxetine increases effects of tolazamide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.tolbutamideMonitor Closely (2)fluoxetine will increase the level or effect of tolbutamide by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. fluoxetine increases effects of tolbutamide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.tolfenamic acidMonitor Closely (1)fluoxetine, tolfenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.tolmetinMonitor Closely (1)fluoxetine, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.tolterodineSerious - Use Alternative (1)fluoxetine will increase the level or effect of tolterodine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.toremifeneMonitor Closely (1)toremifene and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.torsemideMinor (1)torsemide, fluoxetine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.tramadolMonitor Closely (1)fluoxetine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.tranylcypromineContraindicated (1)tranylcypromine and fluoxetine both increase serotonin levels. Contraindicated.trazodoneMonitor Closely (1)trazodone and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)fluoxetine and trazodone both increase serotonin levels. Avoid or Use Alternate Drug.triclabendazoleMonitor Closely (1)triclabendazole and fluoxetine both increase QTc interval. Use Caution/Monitor.trifluoperazineMonitor Closely (2)trifluoperazine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely. fluoxetine will increase the level or effect of trifluoperazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.trimethoprimMonitor Closely (1)fluoxetine and trimethoprim both increase QTc interval. Use Caution/Monitor.trimipramineMonitor Closely (1)trimipramine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)fluoxetine and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.triptorelinSerious - Use Alternative (1)triptorelin increases toxicity of fluoxetine by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.tropisetronMonitor Closely (2)fluoxetine will increase the level or effect of tropisetron by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. fluoxetine and tropisetron both increase QTc interval. Use Caution/Monitor.umeclidinium bromide/vilanterol inhaledMonitor Closely (1)fluoxetine and umeclidinium bromide/vilanterol inhaled both increase QTc interval. Modify Therapy/Monitor Closely. Fluoxetine prolongs the QT interval; the prescribing information for fluoxetine recommends avoiding concurrent use of other drugs that may prolong the QT interval; risk may be increased with higher doses and/or when associated with hypokalemia; drugs that prolong the QTc interval may potentiate the effects of beta2 agonists on the cardiovascular systemvalbenazineMonitor Closely (2)valbenazine and fluoxetine both increase QTc interval. Use Caution/Monitor. fluoxetine will increase the level or effect of valbenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Consider reducing valbenazine dose based on tolerability if coadministered with a strong CYP2D6 inhibitor.valerianMonitor Closely (1)valerian and fluoxetine both increase sedation. Use Caution/Monitor.vandetanibSerious - Use Alternative (1)fluoxetine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.vardenafilMonitor Closely (1)vardenafil and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.vemurafenibSerious - Use Alternative (1)vemurafenib and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.venlafaxineMonitor Closely (1)fluoxetine and venlafaxine both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)fluoxetine and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.Minor (1)venlafaxine will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.vilanterol/fluticasone furoate inhaledMonitor Closely (1)fluoxetine and vilanterol/fluticasone furoate inhaled both increase QTc interval. Modify Therapy/Monitor Closely. Fluoxetine prolongs the QT interval; the prescribing information for fluoxetine recommends avoiding concurrent use of other drugs that may prolong the QT interval; risk may be increased with higher doses and/or when associated with hypokalemia; drugs that prolong the QTc interval may potentiate the effects of beta2 agonists on the cardiovascular systemvilazodoneSerious - Use Alternative (1)fluoxetine, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .voclosporinMonitor Closely (1)voclosporin, fluoxetine. Either increases effects of the other by QTc interval. Use Caution/Monitor.vorapaxarMonitor Closely (1)fluoxetine, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur; SSRIs and SNRIs may cause platelet serotonin depletion .voriconazoleMonitor Closely (2)fluoxetine will increase the level or effect of voriconazole by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. fluoxetine and voriconazole both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)fluoxetine will increase the level or effect of voriconazole by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.vorinostatMonitor Closely (1)vorinostat and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.vortioxetineSerious - Use Alternative (1)fluoxetine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.warfarinMonitor Closely (1)fluoxetine, warfarin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Serotonin release by platelets plays an important role in hemostasis. SSRIs and SNRIs may increase anticoagulation effect of warfarin. .zanubrutinibMonitor Closely (1)fluoxetine, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.ziprasidoneMonitor Closely (1)fluoxetine and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.zolmitriptanMonitor Closely (1)zolmitriptan and fluoxetine both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)fluoxetine, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.zotepineMonitor Closely (1)fluoxetine increases levels of zotepine by decreasing metabolism. Use Caution/Monitor. >10% Insomnia (10-33%) Nausea (12-29%) Headache (20-25%) Weakness (7-21%) Diarrhea (8-18%) Somnolence (5-17%) Anorexia (4-17%) Asthenia (10-15%) Anxiety (6-15%) Nervousness (8-14%) Tremor (3-13%) 1-10% Dry mouth (6-10%) Dyspepsia (6-10%) Chills (1-10%) Flu syndrome (1-10%) Palpitation (1-10%) Dizziness (9%) Sweating (2-8%) Impotence (2-7%) Rash (4-6%) Constipation (5%) Abnormal dreams (1-5%) Decreased libido (1-5%) Flatulence (3%) Vomiting (3%) Abnormal vision (2%) Fever (2%) Urinary frequency (2%) Frequency Not Defined Dysglycemia in patients with DM Risk of seizure with concomitant electroconvulsive therapy (rare) Hypertension Postmarketing Reports Galactorrhea Black Box Warnings In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses This increase was not seen in patients >24 years; a slight decrease in suicidal thinking was seen in adults >65 years In children and young adults, the risks must be weighed against the benefits of taking antidepressants Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during the initial 1-2 months of therapy and dosage adjustments The patient’s family should communicate any abrupt changes in behavior to the health-care provider Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy Not FDA approved for treatment of bipolar depression or children < 7 yearsContraindications Hypersensitivity Concomitant pimozide or thioridazine (within 5 weeks of administering fluoxetine) Breastfeeding Coadministration with MAOIs Coadministration may cause serotonin syndrome Coadministration of MAOIs with fluoxetine or within 5 weeks of discontinuing fluoxetine Initiating fluoxetine within 14 days of administering an MAOI Starting fluoxetine in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome If linezolid or IV methylene blue must be administered, discontinue fluoxetine immediately and monitor for CNS toxicity; may resume fluoxetine 24 hr after last linezolid or methylene blue dose or after 5 weeks of monitoring, whichever comes first Cautions Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (aged 18-24 years) Development of potentially life-threatening serotonin syndrome reported with SNRIs and SSRIs alone but particularly with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. Johns Wart) if concomitant use with