Contraindicated in:

• Hypersensitivity;

• Concurrent use or use within 14 days of discontinuing MAO inhibitors (fluoxetine should be discontinued at least 5 wk before MAO therapy is initiated);

• Concurrent use of pimozide;

• Concurrent use of thioridazine (fluoxetine should be discontinued at least 5 wk before thioridazine therapy is initiated).

• History of seizures;

• Debilitated patients (↑ risk of seizures);

• Diabetes mellitus;

• Patients with concurrent chronic illness or multiple drug therapy (dose adjustments may be necessary);

• Hepatic impairment (↓ doses/↑ dosing interval may be necessary);

• May ↑ risk of suicide attempt/ideation especially during early treatment or dose adjustment;

• Patients with ↑ intraocular pressure or at risk for acute narrow-angle glaucoma;

• OB: Use during first trimester may ↑ risk of cardiovascular malformations in infant. Use during third trimester may result in neonatal serotonin syndrome requiring prolonged hospitalization, respiratory and nutritional support. May cause sedation in infant. Use only if potential benefit justifies potential risk to fetus;

• Lactation: May cause sedation in infant; discontinue drug or bottle-feed;

• Pedi: Risk of suicide ideation or attempt may be greater in children or adolescents (safe use in children <8 yr not established);

• Geri: Appears on Beers list. Geriatric patients are at ↑ risk for excessive CNS stimulation, sleep disturbances, and agitation.