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Serotonin release by platelets plays an important role in hemostasisEpidemiological studies of the case-control and cohort design that have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding have also shown that concurrent use of an NSAID or aspirin may potentiate this risk of bleedingAltered anticoagulant effectsincluding increased bleedinghave been reported when SNRIs or SSRIs are coadministered with warfarinPatients receiving warfarin therapy should be carefully monitored when fluoxetine is initiated or discontinuedsee WARNINGS AND PRECAUTIONS

Patients with concurrent disease or on multiple concomitant medications may require dosage adjustmentssee WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY

Fluoxetine may cause a condition that affects the heart rhythmQT prolongationQT prolongation can rarely cause seriousrarely fatalfast/irregular heartbeat and other symptomssuch as severe dizzinessfaintingthat need medical attention right away.

Tell your doctor right away if any of these unlikely but serious side effects occurunusual or severe mental/mood changessuch as agitationunusual high energy/excitementthoughts of suicideeasy bruising/bleedingmuscle weakness/spasmshakinesstremordecreased interest in sexchanges in sexual abilityunusual weight loss.

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