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Whether Byetta (Exenatide Injection)- Multum systemic events and rash have a common underlying cause or Byetta (Exenatide Injection)- Multum due to different aetiologies or pathogenic processes is not known.

Upon the appearance of rash or of other possibly allergic phenomena for which an Byetta (Exenatide Injection)- Multum aetiology cannot be identified, Prozac should be discontinued. Altered appetite and weight. Significant weight loss, especially in underweight depressed patients, may be an undesirable result of treatment with fluoxetine hydrochloride.

This incidence is approximately 6-fold that seen in placebo controls. However, only rarely have fluoxetine hydrochloride patients been discontinued for weight loss. Screening for bipolar disorder. A major depressive episode may be the initial presentation of bipolar disorder. Twelve patients among more than 6,000 evaluated worldwide in the course of premarketing development of fluoxetine experienced convulsions (or events described as possibly having been seizures), a rate of 0.

Prozac should be introduced with care in patients with a history of seizures. The long elimination half-lives of fluoxetine and its metabolites. Discontinuation symptoms have been reported in association with SSRIs. Because of the long elimination half-life of fluoxetine, and its active metabolite norfluoxetine, plasma fluoxetine and norfluoxetine concentrations Byetta (Exenatide Injection)- Multum gradually at the conclusion of therapy, which reduces greatly the likelihood of developing discontinuation symptoms and makes dosage tapering unnecessary in most patients.

Common symptoms associated with withdrawal of SSRIs include dizziness, paraesthesia, headache, anxiety and nausea. Onset of symptoms can occur within Byetta (Exenatide Injection)- Multum day of discontinuation but may be delayed, particularly in the case of fluoxetine, due to its long half-life. The majority of symptoms experienced on withdrawal of SSRIs are nonserious, self limiting behavior topic have varying durations.

Fluoxetine has been only rarely associated with such symptoms. Some studies have shown that the efficacy of tamoxifen, Byetta (Exenatide Injection)- Multum measured by the risk of breast cancer relapse, may be reduced when coprescribed with fluoxetine as a result of inhibition of CYP2D6 (see Section 4.

This risk may increase with longer duration of coadministration. When tamoxifen is used for the treatment or prevention of breast cancer, prescribers should consider using an alternative antidepressant with little or no CYP2D6 inhibition. Use in patients with concomitant illness. Clinical trial experience with fluoxetine hydrochloride in patients with concomitant systemic illness is limited.

Caution is advisable in using Prozac in patients with diseases or conditions that could affect metabolism or haemodynamic responses. Prozac has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease.

Patients with these diagnoses were systematically excluded from clinical studies during the product's premarket testing. In subjects with cirrhosis of the liver, the clearances of fluoxetine and its active metabolite, norfluoxetine, were decreased, thus increasing the elimination half-lives of these substances. A lower or less frequent dose should be used in patients with cirrhosis. Since fluoxetine is extensively metabolised, excretion of unchanged drug in urine is a minor route of elimination.

However, until adequate numbers of patients with severe renal impairment have been evaluated during chronic treatment with fluoxetine, it should be used with caution in such patients. In patients with diabetes, fluoxetine hydrochloride may alter glycaemic control. Hypoglycaemia has occurred during therapy with fluoxetine hydrochloride and hyperglycaemia has developed following discontinuation of the drug. SSRIs and SNRIs, including fluoxetine, may increase the risk of bleeding events, including gastrointestinal bleeding (see Section 4.

Other haemorrhagic manifestations (e. NSAIDs, aspirin) and in patients with known bleeding tendencies. Drug abuse and dependence. Physical and psychological dependence. Fluoxetine hydrochloride has not been systematically studied, in animals or humans, for its potential for abuse, tolerance, or physical dependence. Consequently, physicians should carefully evaluate patients for history of drug abuse and follow such patients closely, observing them for signs of Prozac misuse or abuse (e.

The hyponatraemia appeared to be reversible when Prozac was discontinued. Although these cases were complex with varying possible aetiologies, some were possibly due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The majority of these occurrences have been in older patients and in patients taking diuretics or who were otherwise volume depleted. The observed decreases were not clinically significant in this trial.

Hyponatraemia in the elderly. In five, hyponatraemia occurred within 19 days of commencement of fluoxetine, however fluoxetine withdrawal was associated with recovery in all cases. Hence, it may be advisable to monitor electrolytes in geriatric patients during the first weeks of therapy. While there have been reports of abnormal bleeding in several patients taking fluoxetine, it is unclear whether fluoxetine had a causative role. There are gynecology exam clinical studies establishing the benefit of the combined use of ECT and Prozac.

There have been some reports of prolonged Naltrexone Hydrochloride Tablets (naltrexone hydrochloride)- Multum in patients on Prozac receiving ECT treatment. Phospholipids are increased in some tissues of mice, rats, and dogs given fluoxetine chronically. This effect is reversible after cessation Bupropion Hydrochloride Extended-Release Tablets (Budeprion XL)- FDA fluoxetine treatment.

Phospholipid accumulation in animals has been observed with many cationic amphiphilic drugs, including fenfluramine, imipramine, and ranitidine. The significance of this effect in humans is unknown. Administration of fluoxetine to juvenile rats from weaning to young adulthood was associated with growth retardation, skeletal muscle Byetta (Exenatide Injection)- Multum and adverse effects on Byetta (Exenatide Injection)- Multum and female reproductive systems (see Section 4.

Psychosexual the no effect level for these changes, exposure to fluoxetine and norfluoxetine was less than clinical exposure to 8-fold higher than clinical exposure. The significance of these findings for human risk is unknown. Evaluation of patients over the age of 60 who receive fluoxetine 20 mg daily revealed no unusual pattern of adverse events relative to the clinical experience in Byetta (Exenatide Injection)- Multum patients.

However, these data are insufficient to rule out possible age related differences during chronic use, particularly in elderly patients who have concomitant systemic illnesses or who are Byetta (Exenatide Injection)- Multum concomitant drugs (see Section 4.

While clinical studies have been conducted in children and adolescents, the use of Prozac is not recommended in this population Byetta (Exenatide Injection)- Multum Section 4. No specific Calcipotriene Ointment (Dovonex Ointment)- Multum laboratory interactions involving cross-reactivity of fluoxetine with assays for other substances (i.



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