Fluoxetine (oral)

Fluoxetine, more commonly known under its trade name of PROzac, is a doctor prescribed oral medication used to treat several mental disorders including depression.

Overview

Classified as an antidepressant medication, Fluoxetine will be familiar to many people when it is associated with its marketing name, PROzac. It may also be referred to as Rapiflux, Selfemara or Sarafem in the US and Phl-FLUoxetine in Canada.

Fluoxetine is available in an oral syrup or solution for those who have problems taking pills; otherwise it is available in capsule, time release capsule or tablet format.

Fluoxetine is known as an SSRI antidepressant. SSRI stands for selective serotonin-reuptake inhibitors. Neurotransmitters such as serotonin are produced by the nerve cells to send signals between each other, creating a communication network that affects everything from sleep patterns to moods to appetite and more. In the case of Fluoxetine, serotonin is the neurotransmitter directly improved by taking the drug.

A patient with deficient serotonin levels often has anxiety symptoms or mood disorders. Serotonin is known to normalize day-to-day bodily functions such as digestion of food, health of wounds, sleeping and appetite control. Balanced serotonin levels make patients more likely to have a calm demeanor and give them the ability to experience happiness while being more focused and relaxed.

Fluoxetine is a drug known as an SSRI type of medication that inhibits the body's re-absorption of serotonin, making sure that there is a normal level present in the body. Fluoxetine does not add serotonin in any way. By regulating the absorption pace of serotonin, the patient can experience a more normal lifestyle and healthy mood with Fluoxetine treatment.

Depression is a mental disorder that is common in adults, leading to feelings of guilt, low self-esteem and depressed mood. People who are diagnosed with depression typically have a low level of interest in activities, relationships or other people and do not experience any pleasure from everyday situations. This lack of interest can lead to a poor appetite, difficulty concentrating, low energy levels, insomnia and other symptoms that can affect their physical wellbeing. Described by patients as an intense sadness, depression is not soothed over time nor does it improve with positive life events. Depression can control every aspect of the patient's life and begin to affect their relationships and socialization.

Depression can happen at any age and to any one, no matter their status in life. In fact, there have been recent news headlines about celebrities and other successful people who have suffered from depression. Thankfully, there is help and depression can and will often be improved with therapy or drug treatment such as Fluoxetine. As depression is a condition that can recur in fifty percent of patients, many sufferers remain on a drug treatment regime of Fluoxetine for quite some time.

Conditions Treated

Type Of Medicine

  • Selective serotonin reuptake inhibitor (SSRI)
  • Antidepressant

Side Effects

As with any drug, not all side effects are experienced by all patients and some side effects are extremely mild. Your doctor has determined that use of Fluoxetine and the benefits it will have on your health outweigh any possible side effects you may experience. There are many patients using Fluoxetine successfully and only experiencing very mild to no side effects at all, which is encouraging for those about to start the treatment.

Informing your health care professional of any and all medications including herbal or holistic and other non-prescription medications not to mention pre-existing health conditions is critical to the success of Fluoxetine and other drugs used to treat depression and other mental disorders. Make sure you have informed your doctor of all medications and pre-existing health conditions prior to starting your Fluoxetine treatment.

Some patients may experience severe adverse health effects, which makes the continued use of the drug less beneficial to their overall health and wellbeing. A consultation with health care providers on use of this or any prescription drug will assist you with weighing the pros and cons of drug therapy treatment. Any symptoms that are severe or last for a prolonged period of time should be reported to your physician immediately.

If you experience any of the following unwanted health effects, let your physician know promptly:

  • Skin rashes, itching or hives
  • Restlessness
  • Cold sweats
  • Anxiety
  • Confusion
  • Seizures
  • Pale skin, cool to the touch
  • Nervous demeanor
  • Fever
  • Chills
  • Pain in muscles or joints
  • Diarrhea
  • Concentrating is difficult or impossible
  • Drowsy, sleepy
  • Mouth dryness
  • Raging hunger or thirst
  • Rapid heart rhythm
  • Headache
  • Sweating
  • Lethargy
  • Changes in behavior
  • Moodiness
  • Reflexes are overactive
  • Tiny red or purple skin spots
  • Racing heart rhythm
  • Shaky
  • Unsteadiness
  • Shivering
  • Uncontrolled excitement
  • Difficulty breathing
  • Strange movements of the face or body
  • Fatigue
  • Weak muscles
  • Abdominal pain
  • Agitated mood
  • Pain in legs or back
  • Gums bleeding
  • Vision changes or loss
  • Skin peeling, loosening or blistering
  • Bloating
  • Signs of blood in stool or urine
  • Stool that is black or tar-like
  • Color blind to blue and yellow
  • Pain in chest
  • Stool that is the color of clay
  • Constipated
  • Vomiting
  • Unproductive cough
  • Urine that is dark in color
  • More urine or more frequent urination
  • Less urine or less frequent urination
  • Deepening depression
  • Difficulty breathing or swallowing
  • Lightheaded, dizzy or passing out
  • Ocular pain
  • Pounding or fast, irregular heart rhythm
  • Swelling of the body in general
  • Elevated temperature
  • Puffy, swollen eyelids or eyes, lips, tongue or face
  • Hives, itching
  • Hostile mood
  • Indigestion
  • Sluggish heart rhythm
  • Irritable mood
  • Swollen blotches on sex organs, legs, feet, arms, hands, throat, tongue, eyelids, or face
  • Stools are light in color
  • Little to no appetite
  • No control over bladder function
  • Twitching muscles
  • Nausea
  • Low to no pulse or blood pressure
  • Nightmares
  • Loud breathing
  • Knee or ankle pain
  • Nose bleeding
  • Red, painful lumps on legs
  • Side, abdominal or back pain
  • Tiny red dots on skin
  • Fast weight gain
  • Bloodshot eyes
  • Red skin sores with purple centers
  • Skin burns or itches, feels tender or peels
  • Stiff muscles
  • Drowsy to the extreme
  • Speech changes or slurring
  • Throat soreness
  • Ulcerated white stores in mouth or on lips
  • Heart stops
  • Short of breath for no reason
  • Weak legs or arms
  • Severe pain in chest
  • Swollen hands, face or ankles
  • Glands are painful or swollen
  • Suicidal tendencies
  • Chest constriction
  • Extreme fatigue
  • Movement that is uncontrolled of arms, face, tongue, legs or lips
  • Falling unconscious
  • Halitosis
  • Bruising or bleeding that is unusual or unexpected
  • Dull, tired, weak or sluggish demeanor
  • Extreme paleness
  • Use of force in emotional or physical ways to the extreme
  • Blood in vomit
  • Yellow tinge to skin or eyes

Temporary health effects may appear that will typically be short in duration, going away as your body becomes accustomed to treatment with Fluoxetine. If you have these symptoms, however, you should report them to your physician in case there are ways to ease them or eliminate them:

  • Loss of appetite
  • Strange dreams
  • Breasts are painful or enlarged
  • Taste sensation has changed
  • Vision has changed
  • Feeling warm or hot
  • Flushed neck or face
  • Urination frequency has increased
  • Hair is falling out
  • Appetite has increased
  • Skin is sensitive to sun
  • Menstrual pain
  • Cramps, pain or gas in the abdomen
  • Milk production in females that is unexpected
  • Loss of weight
  • Increased yawning
  • Skin is dry and cracked or scaly
  • Body does not retain heat
  • Erections are prolonged or painful
  • Male or female breast tenderness

Still other effects on your health may occur with use of Fluoxetine; if you experience any changes in your health, mood or wellbeing, notify your health care provider right away.

Dosage

It is important to follow the exact prescription your doctor has determined for you with regard to the amount of Fluoxetine your take, how often you take it and for how long. Each patient has different needs and symptoms, which will require specific dosage amounts depending on their overall health and body mass. The following is a generalized dosage that yours may vary from. Always follow your prescription that has been written especially for you and your condition.

Bulimia

Adult patients receiving Fluoxetine for treatment of bulimia nervosa will typically be prescribed 60 milligrams to be taken once daily in the morning. Children with this condition will have their dosage determined by their physician.

Depression

Adult patients will typically receive 20 milligrams as a once daily morning dose to begin with, which may be adjusted up to as much as 80 milligrams over a 24 hour period. Depending on how these patients respond, their dosage could change to a weekly dose of 90 milligrams. Children who are older than eight will have an initial dosage of 10 to 20 milligrams in the morning, adjusted as necessary. Children younger than eight will have a dosage specifically calculated for them, if required.

OCD

Obsessive-compulsive disorder sufferers will, at first, generally be prescribed 20 milligrams daily to be taken in the morning, adjusted up to 80 milligrams daily depending on patient need and symptoms. Children who are seven years old and up will first be prescribed anywhere between 10 and 20 milligrams every morning, adjusted as required but not more than 60 milligrams over a 24 hour period. Children who are not yet seven years old will have the appropriate dose calculated for them specifically.

Panic disorder

Patients with this condition will generally receive 10 milligrams to be taken each morning as their initial dosage, with adjustments as required but not exceeding 60 milligrams daily. Children with this disorder will have their dosage calculated specifically based on their needs.

Premenstrual dysphoric disorder

Females with this condition will be prescribed a 20 milligram dose each daily to be taken in the morning, continued through the menstrual cycle or for only half their cycle, depending on what their doctor feels is necessary. This dosage amount may increase but typically will not exceed 80 milligrams daily. Children who have not yet reached puberty do not typically suffer from this condition.

Missing a dose of Fluoxetine should not cause you to double dose; skip the missing dose and resume your regular schedule as soon as possible unless you are considerable hours away from your next dose.

Interactions

As with all medications, Fluoxetine may interact with certain medications, health conditions and other impacts on your daily life or health conditions. If you have, in the past, experienced a hyperactive response to another medication, animals, dyes or preservatives, this should be communicated to your health care professional. Your full medical history along with any prescriptions you are on, non-prescription drugs you take, vitamins, herbs or supplements you use should be disclosed to your doctor prior to taking Fluoxetine.

Pediatric patients have not been studied for use of Fluoxetine in children with regard to those who are not yet age 7 years and diagnosed with OCD or those younger than 8 years of age and diagnosed with depression. Safety and effectiveness of Fluoxetine can be assumed to be the same as for an adult in children older than specified, with the exception being children with bulimia or panic disorder, who have not been studied at all.

Geriatric patients can expect the same health risks and effectiveness as adult patients, with the exception of those with age-related conditions such as low blood sodium, which may require dosage adjustment.

No data has been provided on the safety of Fluoxetine on women who are pregnant or on nursing mothers. Safety and usefulness should be considered prior to taking this medication if you are pregnant. If you become pregnant while on this medication, consult your physician on whether you should continue this drug therapy.

The following medicines are known to adversely interact with Fluoxetine and may negate your doctor's prescription of the drug. Make sure you let your physician know if you are taking:

  • Amifampridine
  • Bromopride
  • Bepridil
  • Clorgyline
  • Cisapride
  • Furazolidone
  • Dronedarone
  • Isocarboxazid
  • Iproniazid
  • Linezolid
  • Levomethadyl
  • Methylene Blue
  • Mesoridazine
  • Moclobemide
  • Metoclopramide
  • Pargyline
  • Nialamide
  • Pimozide
  • Phenelzine
  • Procarbazine
  • Piperaquine
  • Safinamide
  • Rasagiline
  • Selegiline
  • Saquinavir
  • Terfenadine
  • Sparfloxacin
  • Toloxatone
  • Thioridazine
  • Ziprasidone
  • Tranylcypromine

The following medications react adversely with Fluoxetine, but may be adjusted in dosage so that the two can be taken together, if necessary. Inform your doctor if you are currently taking:

  • Abciximab
  • Acecainide
  • Abiraterone
  • Acemetacin
  • Aceclofenac
  • Ajmaline
  • Acenocoumarol
  • Almotriptan
  • Alfuzosin
  • Amiodarone
  • Amineptine
  • Amitriptyline
  • Amisulpride
  • Amoxapine
  • Amitriptylinoxide
  • Anagrelide
  • Amtolmetin Guacil
  • Anisindione
  • Ancrod
  • Apixaban
  • Antithrombin III Human
  • Aprindine
  • Apomorphine
  • Argatroban
  • Ardeparin
  • Arsenic Trioxide
  • Aripiprazole
  • Aspirin
  • Asenapine
  • Atazanavir
  • Astemizole
  • Azithromycin
  • Azimilide
  • Bemiparin
  • Bedaquiline
  • Bretylium
  • Bivalirudin
  • Bromfenac
  • Brexpiprazole
  • Bufexamac
  • Brompheniramine
  • Bupropion
  • Buprenorphine
  • Cangrelor
  • Buserelin
  • Celecoxib
  • Carbamazepine
  • Chloral Hydrate
  • Certoparin
  • Chlorpheniramine
  • Chloroquine
  • Choline Salicylate
  • Chlorpromazine
  • Cinacalcet
  • Cilostazol
  • Citalopram
  • Ciprofloxacin
  • Clomipramine
  • Clarithromycin
  • Clopidogrel
  • Clonixin
  • Cobicistat
  • Clozapine
  • Crizotinib
  • Cocaine
  • Dabigatran Etexilate
  • Cyclobenzaprine
  • Dalteparin
  • Dabrafenib
  • Dasatinib
  • Danaparoid
  • Degarelix
  • Defibrotide
  • Dermatan Sulfate
  • Delamanid
  • Desirudin
  • Desipramine
  • Desvenlafaxine
  • Deslorelin
  • Dexibuprofen
  • Dexfenfluramine
  • Dextromethorphan
  • Dexketoprofen
  • Diclofenac
  • Dibenzepin
  • Diflunisal
  • Dicumarol
  • Dipyrone
  • Dipyridamole
  • Dofetilide
  • Disopyramide
  • Domperidone
  • Dolasetron
  • Doxepin
  • Donepezil
  • Doxorubicin Hydrochloride Liposome
  • Doxorubicin
  • Drotrecogin Alfa
  • Droperidol
  • Duloxetine
  • Droxicam
  • Edoxaban
  • Ebastine
  • Eletriptan
  • Efavirenz
  • Enflurane
  • Eliglustat
  • Epoprostenol
  • Enoxaparin
  • Eribulin
  • Eptifibatide
  • Escitalopram
  • Erythromycin
  • Etofenamate
  • Etodolac
  • Famotidine
  • Etoricoxib
  • Felbinac
  • Felbamate
  • Fenoprofen
  • Fenfluramine
  • Fepradinol
  • Fentanyl
  • Fingolimod
  • Feprazone
  • Floctafenine
  • Flecainide
  • Flufenamic Acid
  • Fluconazole
  • Flurbiprofen
  • Fluphenazine
  • Fondaparinux
  • Fluvoxamine
  • Foscarnet
  • Formoterol
  • Frovatriptan
  • Fosphenytoin
  • Gatifloxacin
  • Galantamine
  • Gonadorelin
  • Gemifloxacin
  • Granisetron
  • Goserelin
  • Haloperidol
  • Halofantrine
  • Heparin
  • Halothane
  • Hydroquinidine
  • Histrelin
  • Hydroxytryptophan
  • Hydroxychloroquine
  • Ibuprofen
  • Hydroxyzine
  • Ibutilide
  • Ibuprofen Lysine
  • Iloprost
  • Iloperidone
  • Indomethacin
  • Imipramine
  • Isoflurane
  • Iobenguane I 123
  • Itraconazole
  • Isradipine
  • Ketoconazole
  • Ivabradine
  • Ketorolac
  • Ketoprofen
  • Lepirudin
  • Lapatinib
  • Levofloxacin
  • Leuprolide
  • Lidoflazine
  • Levomilnacipran
  • Lorcaserin
  • Lofepramine
  • Loxoprofen
  • Lornoxicam
  • Lumiracoxib
  • Lumefantrine
  • Mefenamic Acid
  • Meclofenamate
  • Melitracen
  • Mefloquine
  • Meperidine
  • Meloxicam
  • Metronidazole
  • Methadone
  • Milnacipran
  • Mifepristone
  • Mizolastine
  • Mirtazapine
  • Moxifloxacin
  • Morniflumate
  • Nadroparin
  • Nabumetone
  • Naproxen
  • Nafarelin
  • Nebivolol
  • Naratriptan
  • Nepafenac
  • Nefazodone
  • Nilotinib
  • Niflumic Acid
  • Nimesulide Beta Cyclodextrin
  • Nimesulide
  • Nortriptyline
  • Norfloxacin
  • Olanzapine
  • Octreotide
  • Opipramol
  • Ondansetron
  • Oxycodone
  • Oxaprozin
  • Paliperidone
  • Oxyphenbutazone
  • Panobinostat
  • Palonosetron
  • Parnaparin
  • Parecoxib
  • Pasireotide
  • Paroxetine
  • Pentamidine
  • Pazopanib
  • Pentosan Polysulfate Sodium
  • Pentazocine
  • Perphenazine
  • Perflutren Lipid Microsphere
  • Phenprocoumon
  • Phenindione
  • Piketoprofen
  • Phenylbutazone
  • Pirmenol
  • Pimavanserin
  • Pitolisant
  • Piroxicam
  • Prajmaline
  • Posaconazole
  • Prasugrel
  • Pranoprofen
  • Procainamide
  • Probucol
  • Proglumetacin
  • Prochlorperazine
  • Propafenone
  • Promethazine
  • Propranolol
  • Propionic Acid
  • Proquazone
  • Propyphenazone
  • Protriptyline
  • Protein C
  • Quinine
  • Quetiapine
  • Reviparin
  • Ranolazine
  • Risperidone
  • Rilpivirine
  • Rivaroxaban
  • Ritonavir
  • Rofecoxib
  • Rizatriptan
  • Salsalate
  • Salicylic Acid
  • Sematilide
  • Selexipag
  • Sertraline
  • Sertindole
  • Sodium Phosphate
  • Sevoflurane
  • Sodium Salicylate
  • Sibutramine
  • Sodium Phosphate, Dibasic
  • Sorafenib
  • Sodium Phosphate, Monobasic
  • Solifenacin
  • Spiramycin
  • Sotalol
  • Sulfamethoxazole
  • St John's Wort
  • Sulindac
  • Sulfinpyrazone
  • Sultopride
  • Sulpiride
  • Sunitinib
  • Sumatriptan
  • Tamoxifen
  • Tacrolimus
  • Tedisamil
  • Tapentadol
  • Telithromycin
  • Telavancin
  • Terbinafine
  • Tenoxicam
  • Tianeptine
  • Tetrabenazine
  • Ticagrelor
  • Tiaprofenic Acid
  • Tinzaparin
  • Ticlopidine
  • Tizanidine
  • Tirofiban
  • Tolmetin
  • Tolfenamic Acid
  • Toremifene
  • Tolterodine
  • Trazodone
  • Tramadol
  • Trifluoperazine
  • Treprostinil
  • Trimipramine
  • Trimethoprim
  • Tryptophan
  • Triptorelin
  • Vandetanib
  • Valdecoxib
  • Vasopressin
  • Vardenafil
  • Venlafaxine
  • Vemurafenib
  • Vinflunine
  • Vilazodone
  • Voriconazole
  • Vorapaxar
  • Vortioxetine
  • Vorinostat
  • Zolmitriptan
  • Warfarin
  • Zuclopenthixol
  • Zotepine

The following medications may increase the risk of certain adverse health effects if taken simultaneously as Fluoxetine, so be sure to alert your doctor if you take:

  • Buspirone
  • Alprazolam
  • Delavirdine
  • Cyproheptadine
  • Ginkgo
  • Digoxin
  • Phenytoin
  • Lithium

Other substances such as alcoholic beverages, tobacco products and illegal drugs can adversely interact with Fluoxetine as well, so discuss the use of these substances with your physician prior to taking Fluoxetine.

Even certain health conditions, whether in the past, newly diagnosed or suspected, can have an effect on the safety and effectiveness of Fluoxetine. Make sure you have your medical information available to disclose to your physician and alert them of the following conditions, if applicable:

Warnings

Your physician will most likely prescribe, in addition to Fluoxetine treatment, a series of counseling sessions for your condition, depending on the severity. You will also need to visit your doctor for regular progress updates which may include blood sample testing to make sure you aren't suffering from any ill effects of this medication.

MAO inhibitors such as Zyvox, Marplan, Nardil, Eldepryl or Parnate should not be taken if you are on a course of treatment with Fluoxetine. Avoid these medications for 14 days prior to and for at least five weeks after you have taken Fluoxetine for maximum safety or you will risk developing symptoms of stomach or intestinal upset, elevated temperature, hypertension, convulsions, confused mood, agitation or severe restlessness associated with this combination of drugs.

Mellaril and/or Orap should never be taken with Fluoxetine and should be discontinued prior to starting treatment with this drug. Avoid this drug for five weeks after ceasing your dosage of Fluoxetine. The use of these drugs together can put you at risk for severe cardiac issues.

You are at risk for serotonin syndrome if you combine Fluoxetine with Buspar, Abstral, Duragesic, Eskalith, Lithobid, St. John's wort or some migraine medications and pain relievers such as Zomig, Ultram, Frova, Imitrex, Maxalt and Relpax. Your doctor should be consulted prior to you combining these drugs.

Some young adults and teenagers may exhibit behavioral changes such as agitation, irritability or they may have thoughts of suicide or become more depressed. Other patients may experience insomnia, become irritable or get upset more easily. Still others may experience a huge boost of energy or act in a reckless way. If you or your close family and friends notice these mood changes, alert your health care provider immediately.

Do not stop taking your Fluoxetine without the express consent of your medical doctor, as this drug can cause withdrawal symptoms if stopped suddenly. A gradual slow-down of medication with a program that will avoid withdrawal symptoms will be prescribed for you if it has been determined that you should quit taking Fluoxetine.

Hives, rashes or swelling in your facial area such as around your mouth or eyes and any trouble breathing should be reported to your physician, as they could be the sign of a hypersensitive reaction to this drug.

You may be at an increased risk for unwanted bleeding; patients who currently take blood thinner medications such as diclofenac, ibuprofen, naproxen, Advil, Aleve, Celebrix, Voltaren or warfarin, Coumadin, Jantoven should alert their physicians to this fact.

Low blood sodium levels, known as the condition hyponatremia, is another risk associated with taking Fluoxetine. Your doctor should be alerted if you have difficulty concentrating or get headaches, unsteadiness or weakness or experience confusion and memory problems.

Dizziness and an uneven, rapid heart rhythm should be symptoms to alert your physician of as they could be related to a syndrome known as long QT. Hereditary heart conditions of your close family members could indicate that you are at a higher risk for this complication.

Do not consume alcoholic beverages while you are taking Fluoxetine.

Diabetic patients should monitor their glucose levels closely, as Fluoxetine can have an effect on these levels in some patients.

Before you operate heavy equipment or power tools or even drive a motor vehicle, be aware of how Fluoxetine affects your alertness, as some patients experience excessive drowsiness and loss of muscle control while on this medication.

Do not take other medicines, vitamins or supplements of any kind without the express permission of your physician.

Storage

Fluoxetine is available through prescription only and should be taken only as directed. Keep this and other medicines out of sight and reach of children as a precaution. Fluoxetine should be kept in its original, labeled container at room temperature and not exposed to heat, moisture or direct light. Do not allow Fluoxetine to freeze. Outdated or unused Fluoxetine should be disposed of, with proper disposal at the advice of your health care professional.

Summary

Fluoxetine is a medication classed as a selective serotonin reuptake inhibitors or SSRIs. The drug operates by preventing the body from eliminating serotonin. Serotonin is used by the body for many every day functions such as appetite control, sleep, digestion and more. In the case of patients with depression, low serotonin levels may be the cause of the disease and, therefore, a prescription of Fluoxetine makes sense to normalize these levels as a form of treatment. Fluoxetine is also used in patients who have been diagnosed with other mental disorders including bulimia, panic disorder and OCD, among others.

Adverse drug interactions while on a treatment course with Fluoxetine are quite common and it is recommended that you avoid taking any other drugs while you are on this medication. This includes any over-the-counter drugs, vitamin therapies or herbal and holistic treatments you may be taking. If taking other medications is unavoidable, make sure all your treatments are made known to your physician in case dose adjustment is required.

Pre-existing health conditions such as cardiac history or hereditary history, blood or bleeding diseases, mental health issues such as mania or bipolar disorder, should be fully disclosed to your health care professional prior to being prescribed Fluoxetine. This drug could worsen these conditions or cause them to re-occur if in remission or appear if they are hereditary and not exhibited prior to taking Fluoxetine.

Do not use Fluoxetine if you drink alcoholic beverages. If you are diabetic, check your blood sugar levels as this medication may alter them. You may become drowsy or lose muscle control while taking Fluoxetine, so it is wise to use extreme caution for yourself and others with regard to driving or operating power tools or heavy equipment.

Regular monitoring of your condition as well as mental health counseling may be required with use of Fluoxetine, so be sure to keep all appointments and remain under the advice of your health care professional for the duration of your drug therapy.

Store this drug and others safely away from children and pets and dispose of it correctly if it is unused or expired, according to the instructions from your physician or your pharmacist. Always take your prescribed dosage in the morning, as instructed by your physician. Do not suddenly discontinue your dose of this medication as you can run the risk of withdrawal symptoms without your doctor's guidance.