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Consideration should be given to changing the therapeutic regimenincluding possibly discontinuing the medicationin patients whose depression is persistently worseor who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidalityespecially if these symptoms are severeabrupt in onsetor were not part of the patient’s presenting symptoms.

The effect of fluoxetine on labor and delivery in humans is unknownHoweverbecause fluoxetine crosses the placenta and because of the possibility that fluoxetine may have adverse effects on the newbornfluoxetine should be used during labor and delivery only if the potential benefit justifies the potential risk to the fetus.

SNRIs and SSRIsincluding fluoxetinemay increase the risk of bleeding reactionsConcomitant use of aspirinnonsteroidal anti-inflammatory drugswarfarinand other anti-coagulants may add to this riskCase reports and epidemiological studiescase-control and cohort designhave demonstrated an association between use of drugs that interfere with serotonin reuptake and the occurrence of gastrointestinal bleedingBleeding reactions related to SNRIs and SSRIs use have ranged from ecchymoseshematomasepistaxisand petechiae to life-threatening hemorrhages.

Preferred drug of choice in elderly over tricyclic antidepressants because of fewer side effects.

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