Med of the Month: Prozac

As a dental professional, you're likely to encounter patients taking a range of medications beyond the usual, and one name that often appears is Prozac (fluoxetine). This antidepressant is frequently prescribed for depression, anxiety, and other mental health conditions. But do you know how fluoxetine might affect your dental care plan? From potential drug interactions to side effects like dry mouth or bruxism, understanding this medication is essential for providing safe, informed treatment. Here's what every dental provider should know about fluoxetine:

Generic Name: Fluoxetine

Brand Name(s): Prozac

Pronunciation: floo OX e teen

About this drug:

• Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used to treat:

  • Acute and maintenance treatment of Major Depressive Disorder (MDD) 

  • Acute and maintenance treatment of Obsessive Compulsive Disorder (OCD) 

  • Acute and maintenance treatment of Bulimia Nervosa

  • Acute treatment of Panic Disorder (with or without agoraphobia)

• It may be used together with olanzapine (Zyprexa) to treat manic depression caused by bipolar disorder and to treat depression after at least 2 other medications have not been successful.

Dentistry-related tidbits:

• This medication may cause xerostomia. Prescribe a fluoride supplement if a patient has a high rate of caries and increase the frequency of dental exams.

• Fluoxetine may cause bruxism. Consider evaluating the patient for a nightguard.

• This medication may cause gingivitis and abnormal tastes.

• Do not prescribe quinolone antibiotics (e.g. ciprofloxacin) and macrolide antibiotics (e.g. azithromycin) in combination with Fluoxetine to avoid the risk of cardiac arrhythmias and QT prolongation.

• Exercise caution when prescribing narcotics, benzodiazepines, muscle relaxants, anticonvulsants (e.g. gabapentin), or any other sedating medication in combination with this medication to avoid an increased risk of CNS and respiratory depression, severe hypotension, syncope, or diminished psychomotor function.

• Avoid prescribing NSAIDs, the steroid Hydrocortisone, and Penicillin G in combination with this medication to avoid an increased risk for GI bleeding and other bleeding issues. Prescribe the lowest dose possible for the shortest duration needed to manage pain, or prescribe Acetaminophen or Acetaminophen-based pain medications.

• Fluoxetine should not be taken if an MAO inhibitor (e.g. linezolid) has been used in the past 14 days to avoid the risk of serotonin syndrome, hyponatremia, and other dangerous side effects. If needed, take fluoxetine 24 hours after the last dose of linezolid.

• Before prescribing any medication, use the Rx Check tool to prevent potential drug interactions or adverse effects.

Fun facts:

• Fluoxetine helps keep more serotonin available in your brain by blocking its reabsorption too quickly. More serotonin means improved mood, less anxiety, and a better ability to manage stress. 

• Advise the patient to limit drinking alcohol as this combination may increase the risk of CNS and respiratory depression, diminished psychomotor function, and hypotension, including orthostasis and syncope.

• This medication may slow thinking or reactions and cause dizziness and drowsiness. Advise the patient to be careful if they drive, operate machinery, or engage in other activities until they know how this medication affects them.

• The following are the medication’s Black Box Warnings:

  • This medication may increase the risk of suicidal thinking and behavior in children, adolescents, and young adults. Caregivers and family should observe closely and communicate with the doctor if changes are noticed.

  • Patients of all ages taking antidepressants should be closely monitored for worsening symptoms, changes in behavior, or suicidal thoughts or actions.

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