Monitor mood changes. Inform health care professional if patient demonstrates significant increase in anxiety, nervousness, or insomnia.
» Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient. Risk may be increased in children, adolescents, and adults ≤24 yr. After starting therapy, children, adolescents, and young adults should be seen by health care professional at least weekly for 4 wk, every 3 wk for next 4 wk, and on advice of health care professional thereafter.
» Monitor appetite and nutritional intake. Weigh weekly. Notify health care professional of continued weight loss. Adjust diet as tolerated to support nutritional status.
» Assess for sensitivity reaction (urticaria, fever, arthralgia, edema, carpal tunnel syndrome, rash, hives, lymphadenopathy, respiratory distress) and notify health care professional if present; symptoms usually resolve by stopping fluoxetine but may require administration of antihistamines or corticosteroids.
Assess for sexual side effects (erectile dysfunction; decreased libido).
Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, arrhythmias, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Report immediately.
Assess for serotonin syndrome (mental changes [agitation, hallucinations, coma], autonomic instability [tachycardia, labile BP, hyperthermia], neuromuscular aberrations [hyperreflexia, incoordination], and/or GI symptoms [nausea, vomiting, diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, triptans).OCD
Assess for frequency of obsessive-compulsive behaviors. Note degree to which these thoughts and behaviors interfere with daily functioning.Bulimia Nervosa
Assess frequency of binge eating and vomiting during therapy.PMDD
Monitor mood prior to and periodically during therapy.Lab Test Considerations
Monitor CBC and differential periodically during therapy. Notify health care professional if leukopenia, anemia, thrombocytopenia, or increased bleeding time occurs.
» Proteinuria and mild ↑ in AST may occur during sensitivity reactions.
» May cause ↑ in serum alkaline phosphatase, ALT, BUN, creatine phosphokinase; hypouricemia, hypocalcemia, hypoglycemia or hyperglycemia, and hyponatremia.