Patient/caregiver was educated on contraindications for using Prozac as follows:
- Prozac use, especially along with a few other antidepressants, such as, imipramine, citalopram, and sertraline, can significantly increase the serotonin levels in the body and lead to development of serotonin syndrome. Caution must be exercised even when discontinuing on any of the above mentioned antidepressant medications with potential to increase serotonin levels and starting on Prozac, by observing a window period of atleast 2 weeks, before the transition to Prozac is made. Using Prozac with these medications closely can result in dangerously elevated serotonin in the blood, leading to development of serotonin syndrome, which can contribute to nausea, vomiting, diarrhea, rapid heart rate and dangerous arrhythmias, mania, agitation, and hallucinations.
- Prozac is mainly excreted by kidneys in the urine. Individuals with renal disease cannot excrete Prozac metabolites normally. The medication and metabolites can stay in blood circulation for longer time, resulting in increased risk for side-effects and consequent toxicity. So, Prozac could be avoided in individuals with renal dysfunction and an alternative medication considered or used with caution, with periodical monitoring for renal function and development of any toxic symptoms.
