Medically reviewed by Drugs.com. Last updated on Nov 24, 2022.
Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder. Closely monitor patients of all ages for clinical worsening and emergence of suicidal thoughts and behaviors. When using fluoxetine hydrochloride and olanzapine in combination, also refer to the Boxed Warning section of the package insert for fluoxetine hydrochloride/olanzapine .Oral route(Solution)
Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder (MDD). Closely monitor patients of all ages for clinical worsening and emergence of suicidal thoughts and behaviors. Fluoxetine oral solution is approved for use in pediatric patients with MDD and obsessive compulsive disorder .Oral route(Tablet)
Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder. Closely monitor patients of all ages for clinical worsening and emergence of suicidal thoughts and behaviors. Fluoxetine hydrochloride oral tablets are not approved for use in pediatric patients .
The Sarafem brand name has been discontinued in the U.S. If generic versions of this product have been approved by the FDA, there may be generic equivalents available.
Commonly used brand name(s)
In the U.S.
- PROzac Weekly
Available Dosage Forms:
- Capsule, Delayed Release
Therapeutic Class: Antidepressant
Pharmacologic Class: Serotonin Reuptake Inhibitor
Uses for Sarafem
Fluoxetine is used to treat depression, obsessive-compulsive disorder (OCD), bulimia nervosa, premenstrual dysphoric disorder (PMDD), and panic disorder. It is also used together with olanzapine to treat depression that is part of bipolar disorder and treatment resistant depression in patients who have received at least 2 previous treatments but did not work well.
Fluoxetine is an antidepressant and belongs to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs). This medicine works by increasing the activity of a chemical called serotonin in the brain.
This medicine is available only with your doctor's prescription.
Before using Sarafem
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of fluoxetine in children. However, safety and efficacy have not been established to treat depression in children younger than 8 years of age, to treat obsessive-compulsive disorder in children younger than 7 years of age, and to treat depression that is part of bipolar disorder in children younger than 10 years of age.
Appropriate studies have not been performed on the relationship of age to the effects of fluoxetine in children with bulimia nervosa, panic disorder, or treatment resistant depression. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of fluoxetine in the elderly. However, elderly patients are more likely to have hyponatremia (low sodium in the blood) than younger adults, which may require caution and an adjustment in the dose for patients receiving fluoxetine.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Methylene Blue
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abiraterone Acetate
- Amtolmetin Guacil
- Antithrombin III Human
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Chloral Hydrate
- Choline Salicylate
- Dabigatran Etexilate
- Dermatan Sulfate
- Doxorubicin Hydrochloride Liposome
- Drotrecogin Alfa
- Flufenamic Acid
- Inotuzumab Ozogamicin
- Iobenguane I 123
- Iobenguane I 131
- Mefenamic Acid
- Morphine Sulfate Liposome
- Niflumic Acid
- Nimesulide Beta Cyclodextrin
- Pentosan Polysulfate Sodium
- Protein C
- Salicylic Acid
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Sodium Salicylate
- St John's Wort
- Tiaprofenic Acid
- Tolfenamic Acid
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Interactions with food/tobacco/alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other medical problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Bipolar disorder (mood disorder with mania and depression), or risk of or
- Bleeding problems or
- Diabetes or
- Glaucoma, angle-closure or
- Hyponatremia (low sodium in the blood) or
- Mania, history of or
- Seizures, history of—Use with caution. May make these conditions worse.
- Heart attack or stroke, recent or history of or
- Heart failure or
- Heart rhythm problems (eg, QT prolongation), or history of or
- Hypokalemia (low potassium in the blood) or
- Hypomagnesemia (low magnesium in the blood)—May cause side effects to become worse.
- Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
Proper use of Sarafem
This section provides information on the proper use of a number of products that contain fluoxetine. It may not be specific to Sarafem. Please read with care.
Take this medicine only as directed by your doctor, to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
This medicine should come with a Medication Guide. Follow the instructions carefully. Ask your doctor if you have any questions.
You may take the medicine with or without food.
You may have to take fluoxetine for a month or longer before you begin to feel better.
If you are using the oral liquid, shake the bottle well before measuring each dose. Measure the liquid with a marked measuring spoon, oral syringe, or medicine cup. A regular household teaspoon will not measure the proper amount of medicine.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage forms (capsules, delayed-release capsules, pulvules, or solution):
- For bulimia nervosa:
- Adults—60 milligrams (mg) once a day in the morning.
- Children—Use and dose must be determined by your doctor.
- For depression:
- Adults—At first, 20 milligrams (mg) once a day in the morning. Your doctor may adjust your dose as needed. If you are taking more than 20 mg per day, you may take the capsule once a day in the morning or 2 times a day (eg, morning and noon). However, the dose is usually not more than 80 mg per day.
- Children 8 years of age and older—At first, 10 or 20 mg once a day in the morning. Your doctor may adjust your dose as needed.
- Children younger than 8 years of age—Use and dose must be determined by your doctor.
- For depression associated with bipolar disorder (combination with olanzapine):
- Adults—At first, 20 milligrams (mg) of fluoxetine and 5 mg of olanzapine once a day, taken in the evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 50 mg of fluoxetine and 12 mg of olanzapine per day.
- Children 10 years of age and older—At first, 20 milligrams (mg) of fluoxetine and 2.5 mg of olanzapine once a day, taken in the evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 50 mg of fluoxetine and 12 mg of olanzapine per day.
- Children younger than 10 years of age—Use and dose must be determined by your doctor.
- For treatment resistant depression (combination with olanzapine):
- Adults—At first, 20 milligrams (mg) of fluoxetine and 5 mg of olanzapine once a day, taken in the evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 50 mg of fluoxetine and 20 mg of olanzapine per day.
- Children—Use and dose must be determined by your doctor.
- For obsessive-compulsive disorder:
- Adults—At first, 20 milligrams (mg) once a day in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 80 mg per day.
- Children 7 years of age and older—At first, 10 mg once a day in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.
- Children younger than 7 years of age—Use and dose must be determined by your doctor.
- For panic disorder:
- Adults—At first, 10 milligrams (mg) once a day in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.
- Children—Use and dose must be determined by your doctor.
- For premenstrual dysphoric disorder:
- Adults—At first, 20 milligrams (mg) once a day in the morning. Your doctor may have you take 20 mg every day of your menstrual cycle or for only 15 days of your cycle. Your doctor may adjust your dose as needed. However, the dose is usually not more than 80 mg per day.
- Children—Use and dose must be determined by your doctor.
- For bulimia nervosa:
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions while using Sarafem
It is important that your doctor check your progress at regular visits, to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.
Do not take fluoxetine with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], linezolid [Zyvox®], methylene blue injection, phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start taking fluoxetine during the 2 weeks after you stop a MAO inhibitor and wait 5 weeks after stopping fluoxetine before you start taking a MAO inhibitor. If you take them together or do not wait the proper amount of time, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions.
Do not take thioridazine (Mellaril®) with fluoxetine and wait 5 weeks after stopping fluoxetine before you start taking thioridazine. Do not use pimozide (Orap®) with fluoxetine. Using these medicines together can cause very serious heart problems.
Fluoxetine may cause a serious condition called serotonin syndrome if taken together with some medicines. Do not use fluoxetine with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John's wort, amphetamines, or some pain or migraine medicines (eg, rizatriptan, sumatriptan, tramadol, Frova®, Imitrex®, Maxalt®, Relpax®, Ultram®, Zomig®). Check with your doctor first before taking any other medicines with fluoxetine.
Fluoxetine may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.
Do not suddenly stop taking this medicine without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This will decrease the chance of having withdrawal symptoms such as agitation, breathing problems, chest pain, confusion, diarrhea, dizziness or lightheadedness, fast heartbeat, headache, increased sweating, muscle pain, nausea, restlessness, runny nose, trouble sleeping, trembling or shaking, unusual tiredness or weakness, vision changes, or vomiting.
Tell your doctor right away if you develop a rash or hives, swelling of the face, eyes, or mouth, or trouble breathing after taking this medicine.
This medicine may increase your risk for bleeding problems. Make sure your doctor knows if you are also taking other medicines that thin the blood, such as aspirin, nonsteroidal antiinflammatory agents, also called NSAIDs (eg, diclofenac, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, Voltaren®), or warfarin (Coumadin®, Jantoven®).
Hyponatremia (low sodium in the blood) may occur with this medicine. Check with your doctor right away if you have confusion, difficulty concentrating, headaches, memory problems, weakness, and unsteadiness.
Contact your doctor right away if you have dizziness, fainting, or a fast, pounding, or uneven heartbeat. Make sure your doctor knows if you have ever had a heart rhythm problem, such as QT prolongation, or if you or a family member has had a heart attack, heart failure, low blood pressure, or a stroke.
The use of alcohol is not recommended in patients who are taking fluoxetine.
This medicine may affect blood sugar levels. If you are diabetic and notice a change in the results of your blood or urine sugar tests, check with your doctor.
This medicine may cause some people to become drowsy or less able to think clearly, or to have poor muscle control. Make sure you know how you react to fluoxetine before you drive, use machines, or do anything else that could be dangerous if you are not alert and well able to control your movements.
Check with your doctor right away if you have decreased interest in sexual intercourse, delayed or inability to have an orgasm in women, inability to have or keep an erection in men, or loss in sexual ability, desire, drive, or performance. These could be symptoms of sexual dysfunction.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.
Sarafem side effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
- Hives, itching, skin rash
- inability to sit still
- Chills or fever
- joint or muscle pain
- cold sweats
- cool pale skin
- difficulty with concentration
- dryness of the mouth
- excessive hunger
- fast or irregular heartbeat
- increased sweating
- increased thirst
- lack of energy
- mood or behavior changes
- overactive reflexes
- purple or red spots on the skin
- racing heartbeat
- shakiness or unsteady walk
- shivering or shaking
- talking, feeling, and acting with excitement and activity you cannot control
- trouble with breathing
- unusual or incomplete body or facial movements
- unusual tiredness or weakness
Incidence not known
- back or leg pains
- bleeding gums
- blistering, peeling, or loosening of the skin
- blood in the urine or stools
- bloody, black or tarry stools
- blue-yellow color blindness
- blurred vision
- chest pain, discomfort, or tightness
- clay-colored stools
- continuing vomiting
- cough or dry cough
- dark urine
- decreased interest in sexual intercourse
- decreased urine output
- decreased vision
- delayed or inability to have an orgasm
- difficulty with breathing
- difficulty with swallowing
- dizziness or lightheadedness
- eye pain
- fast, pounding, or irregular heartbeat or pulse
- general body swelling
- high fever
- inability to have or keep an erection
- irregular or slow heart rate
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- light-colored stools
- loss in sexual ability, desire, drive, or performance
- loss of appetite
- loss of bladder control
- muscle twitching
- no blood pressure or pulse
- noisy breathing
- pain in the ankles or knees
- painful, red lumps under the skin, mostly on the legs
- painful or prolonged erection of the penis
- pains in the stomach, side, or abdomen, possibly radiating to the back
- pinpoint red spots on the skin
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- rapid weight gain
- red or irritated eyes
- red skin lesions, often with a purple center
- redness, tenderness, itching, burning, or peeling of the skin
- severe muscle stiffness
- severe sleepiness
- slurred speech
- sore throat
- sores, ulcers, or white spots on the lips or in the mouth
- stomach pain
- stopping of heart
- sudden weakness in the arms or legs
- sudden, severe chest pain
- swelling of the face, ankles, or hands
- swollen or painful glands
- thoughts of killing oneself
- twitching, twisting, or uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
- unpleasant breath odor
- unusual bleeding or bruising
- unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
- unusually pale skin
- use of extreme physical or emotional force
- vomiting of blood
- yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- Decreased appetite
Less common or rare
- Abnormal dreams
- breast enlargement or pain
- change in sense of taste
- changes in vision
- feeling of warmth or heat
- flushing or redness of the skin, especially on face and neck
- frequent urination
- hair loss
- increased appetite
- increased sensitivity of the skin to sunlight
- menstrual pain
- stomach cramps, gas, or pain
- unusual secretion of milk, in females
- weight loss
Incidence not known
- Cracks in the skin
- loss of heat from the body
- painful or prolonged erections of the penis
- scaly skin
- swelling of the breasts or breast soreness in both females and males
- unusual milk production
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Frequently asked questions
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More about Sarafem (fluoxetine)
- Check interactions
- Reviews (22)
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- Side effects
- Dosage information
- During pregnancy
- Drug class: selective serotonin reuptake inhibitors
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