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In patients with diabetesfluoxetine may alter glycemic controlHypoglycemia has occurred during therapy with fluoxetineand hyperglycemia has developed following discontinuation of the drugAs is true with many other types of medication when taken concurrently by patients with diabetesinsulin and/or oral hypoglycemicdosage may need to be adjusted when therapy with fluoxetine is instituted or discontinued.

Patients should be advised of the signs and symptoms associated with serotonin syndrome that may include mental status changesfor exampleagitationhallucinationsdeliriumand comaautonomic instabilityfor exampletachycardialabile blood pressuredizzinessdiaphoresisflushinghyperthermianeuromuscular changesfor exampletremorrigiditymyoclonushyperreflexiaincoordinationseizuresand/or gastrointestinal symptomsfor examplenauseavomitingdiarrheaPatients should be cautioned to seek medical care immediately if they experience these symptoms.

Table 2Altered Appetite and Weight Treatment Emergent Adverse ReactionsIncidence in PMDD Placebo-Controlled Clinical Trials.

The following adverse reactions have been identified during post approval use of fluoxetineBecause these reactions are reported voluntarily from a population of uncertain sizeit is difficult to reliably estimate their frequency or evaluate a causal relationship to drug exposure.

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