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Before having surgerytell your doctor or dentist about all the products you useincluding prescription drugsnonprescription drugsand herbal products

Hepatic impairmentcirrhosisDecreased clearance of parent drug and active metabolitenorfluoxetinelower or less frequent dose recommended.

The dosage is based on your medical condition and response to treatmentTo reduce your risk of side effectsyour doctor may direct you to start this medication at a low dose and gradually increase your doseFollow your doctor’s instructions carefullyTake this medication regularly to get the most benefit from itTo help you remembertake it at the same time each day.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotoninExamples include street drugs such as MDMAecstasyStJohn’s wortcertain antidepressantsincluding other SSRIs such as citalopram/paroxetineSNRIs such as duloxetine/venlafaxinetryptophanamong othersThe risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Tell your doctor right away if any of these unlikely but serious side effects occurunusual or severe mental/mood changessuch as agitationunusual high energy/excitementthoughts of suicideeasy bruising/bleedingmuscle weakness/spasmshakinesstremordecreased interest in sexchanges in sexual abilityunusual weight loss.

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