FLUOXETINE CINFA 20 mg HARD CAPSULES

2. What you need to know before you take fluoxetine cinfa

Do not take fluoxetine cinfa

• If you are allergic to fluoxetine or any of the other ingredients of this medicine (listed in section 6). If you experience a rash or other allergic reaction (such as itching, swelling of the face or lips or shortness of breath), stop taking the capsules immediately and contact your doctor as soon as possible.
• If you are taking other medicines, known as irreversible non-selective monoamine oxidase inhibitors (MAOIs), as a severe or life-threatening reaction may occur (e.g. iproniazid, which is used to treat depression).

Treatment with fluoxetine can only be started at least 2 weeks after stopping treatment with an irreversible non-selective MAOI.

Do not take any irreversible non-selective MAOI for at least 5 weeks after stopping fluoxetine. If you have been prescribed fluoxetine for a long time and/or at a high dose, your doctor may consider the need for a longer interval before taking an MAOI.

• If you are taking metoprolol (for heart failure) as it increases the risk of excessive slowing of heartbeats.

Warnings and precautions

Consult your doctor or pharmacist before starting treatment with fluoxetine cinfa.

• If you have heart disease.
• If you start to experience fever, muscle stiffness or tremors, changes in your mental state such as confusion, irritability and extreme agitation, you may be suffering from a condition called "serotonin syndrome" or "neuroleptic malignant syndrome". Although this syndrome is rare, it can be life-threatening, contact your doctor immediately, as you may need to stop treatment with fluoxetine.
• If you suffer from mania or have suffered from mania in the past; if you have a manic episode, contact your doctor immediately, as you may need to stop treatment with fluoxetine.
• If you have a history of bleeding disorders or if you develop bruising or unusual bleeding, or if you are pregnant (see "Pregnancy").
• If you are taking medicines that affect blood clotting (see "Other medicines and fluoxetine cinfa").
• If you have epilepsy or convulsions. If you have had convulsions or experience an increase in the frequency of them, contact your doctor immediately; you may need to stop treatment with fluoxetine.
• If you are receiving electroconvulsive therapy (ECT).
• If you are being treated with tamoxifen (used to treat breast cancer) (see "Other medicines and fluoxetine cinfa").
• If you start to feel restless and cannot sit or stand still (akathisia). Increasing your dose of fluoxetine may make it worse.
• If you have diabetes (your doctor may need to adjust your insulin or other antidiabetic treatment).
• If you have liver problems (your doctor may need to adjust your dose).
• If you have a low heart rate at rest and/or if you know you may have salt loss as a result of severe and prolonged diarrhea and vomiting or the use of diuretics (water pills).
• If you are taking diuretics (water pills), especially if you are an elderly patient.

• Glaucoma (increased eye pressure).

Suicidal thoughts and worsening of your depression or anxiety disorder

If you are depressed and/or suffer from an anxiety disorder, you may sometimes have thoughts of self-harm or suicide. This may increase when you first start taking antidepressants, as all these medicines need time to start working, usually around 2 weeks, although in some cases it may be longer.

You will be more likely to have these thoughts:

• If you have had thoughts of self-harm or suicide before.
• If you are a young adult. Information from clinical trials has shown an increased risk of suicidal behavior in adults under 25 years with psychiatric disorders who were treated with antidepressants.

If you have thoughts of self-harm or suicide at any time, contact your doctor or go to hospital straight away.

It may be helpful for you to tell a relative or close friend that you are depressed or have an anxiety disorder, and ask them to read this leaflet. You might ask them to tell you if they think your depression or anxiety has got worse, or if they are worried about changes in your behaviour.

Children and adolescents

Patients under 18 years have an increased risk of side effects such as suicidal attempts, suicidal thoughts and hostility (mainly aggression, confrontational behaviour and irritability) when taking this type of medicine. Fluoxetine should only be used in children and adolescents aged 8 to 18 years for the treatment of moderate to severe depressive episodes (in combination with psychological therapy), and should not be used for other indications in this age group.

Furthermore, there is only limited information on the long-term safety of fluoxetine in relation to growth, puberty and cognitive, emotional and behavioural development in this age group. However, if you are a patient under 18 years, your doctor may prescribe fluoxetine for the treatment of moderate to severe depressive episodes in combination with psychological therapy when they decide that it is the most suitable treatment for you. If your doctor prescribes fluoxetine to a patient under 18 years and you wish to discuss this decision, please go back to your doctor. You should inform your doctor if any of the symptoms mentioned above appear or worsen when patients under 18 years are taking fluoxetine.

Fluoxetine should not be used in the treatment of children under 8 years of age.

Sexual dysfunction

Some medicines of the group to which fluoxetine belongs (called SSRIs) may cause symptoms of sexual dysfunction (see section 4). In some cases, these symptoms persist after stopping treatment.

Other medicines and fluoxetine cinfa

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Do not take fluoxetine with:

• Irreversible non-selective monoamine oxidase inhibitors (MAOIs,some of which are used to treat depression. Irreversible non-selective MAOIs should not be used with fluoxetine as they may cause serious or even life-threatening reactions (serotonin syndrome), (see section "Do not take fluoxetine cinfa"). Treatment with fluoxetine should only be started at least 2 weeks after stopping treatment with an irreversible MAOI (e.g. tranilcipromine). Do not take any irreversible non-selective MAOI for at least 5 weeks after stopping fluoxetine. If you have been prescribed fluoxetine for a long time and/or at a high dose, your doctor may consider the need for a longer interval before taking an MAOI.

• Metoprololwhen used for heart failure; as it increases the risk of excessive slowing of heartbeats.

Fluoxetine may affect the action of other medicines (interaction):

• Tamoxifen(used to treat breast cancer); your doctor may consider a different antidepressant treatment because fluoxetine may change the blood levels of this medicine and it cannot be ruled out that the effect of tamoxifen may be reduced.

• Monoamine oxidase A inhibitors (MAO-A)including moclobemide, linezolid (an antibiotic) and methylthioninium chloride (also known as methylthioninium chloride, used to treat mild eye irritation): due to the risk of serious or even life-threatening reactions (called serotonin syndrome). Treatment with fluoxetine can be started the day after stopping treatment with a reversible MAOI, but your doctor may monitor you closely and use a lower dose of the MAOI medicine.
• Mequitazine(used to treat allergies); as taking this medicine with fluoxetine may increase the risk of changes in heart activity.
• Phenytoin(a medicine used for epilepsy): fluoxetine may increase the blood levels of this medicine, so your doctor will need to monitor you more closely when administering phenytoin with fluoxetine and will need to do more frequent check-ups.
• Lithium, selegiline, St. John's Wort, tramadol(for pain relief), triptans(for migraine treatment) andtryptophan: there is an increased risk of mild serotonin syndrome if these medicines are given with fluoxetine. Your doctor will monitor you more closely.
• Medicines that may affect heart rhythm, such as Class IA and III antiarrhythmicsand antipsychotics(e.g. phenothiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, some antimicrobial agents(e.g. sparfloxacin, moxifloxacin, intravenous erythromycin, pentamidine), treatment for malaria, particularly halofantrine, or some antihistamines(astemizole, mizolastine), as taking one or more of these medicines with fluoxetine may increase the risk of changes in heart activity.
• Anticoagulants(such as warfarin), NSAIDs(such as ibuprofen, diclofenac), aspirinand other medicines that affect blood clotting(including clozapine, used to treat some mental disorders). Fluoxetine may alter the effect of these medicines in the blood. Your doctor will need to do certain tests, adjust your dose and monitor you more closely if you start or stop treatment with fluoxetine while taking warfarin.
• Cyproheptadine(used to treat allergies); as it may reduce the effect of fluoxetine.
• Medicines that lower blood sodium levels(including, medicines that increase urine production, desmopressin, carbamazepine and oxcarbazepine); as the use of fluoxetine with these medicines may increase the risk of excessively low blood sodium levels.
• Antidepressantssuch as tricyclic antidepressants, other selective serotonin reuptake inhibitors (SSRIs) or bupropion, mefloquine or chloroquine(used to treat malaria), tramadol(for pain relief) or antipsychoticssuch as phenothiazines or butyrophenones; as the use of fluoxetine with these medicines may increase the risk of convulsions.
• Flecainide, propafenone, nebivolol or encainide(for heart problems), carbamazepine(for epilepsy treatment), atomoxetine or tricyclic antidepressants(e.g. imipramine, desipramine and amitriptyline)or risperidone(for schizophrenia treatment); as fluoxetine may change the blood levels of these medicines, it is possible that your doctor will need to reduce your dose when administering them with fluoxetine.

Taking fluoxetine cinfa with food, drinks and alcohol

• Fluoxetine can be taken with or without food, as you prefer.
• It is not recommended to drink alcohol while taking this medicine.

Pregnancy, breastfeeding and fertility

If you are pregnant or breastfeeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Pregnancy

In babies whose mothers took fluoxetine during the first months of pregnancy, there are studies that describe a higher risk of congenital defects affecting the heart. In the general population, approximately 1 in 100 babies are born with a heart defect. This probability increased to about 2 in 100 in babies whose mothers took fluoxetine.

When taken during pregnancy, particularly in the last 3 months of pregnancy, medicines like fluoxetine may increase the risk of a serious disease in babies called persistent pulmonary hypertension of the newborn (PPHN), which makes the baby breathe faster and turn blue. These symptoms usually start during the first 24 hours after the baby is born. If this happens to your baby, contact your midwife and/or doctor immediately.

If you take fluoxetine in the final stages of pregnancy, there may be an increased risk of heavy vaginal bleeding shortly after delivery, especially if you have a history of bleeding disorders. Your doctor or midwife should know that you are taking fluoxetine so they can advise you.

It is preferable not to use this treatment during pregnancy unless the potential benefit outweighs the potential risk. Therefore, you and your doctor may decide to stop taking fluoxetine gradually during pregnancy or before becoming pregnant. However, depending on your circumstances, your doctor may suggest that it is better for you to continue taking fluoxetine.

Caution should be exercised when using during pregnancy, especially during the last stage of pregnancy or just before delivery, as the following effects have been reported in newborn babies: irritability, tremors, muscle weakness, persistent crying, and difficulty sleeping or feeding.

Breastfeeding

Fluoxetine is excreted in breast milk and may cause side effects in children. Breastfeeding should only be continued if it is absolutely necessary. If breastfeeding continues, your doctor may prescribe a lower dose of fluoxetine.

Fertility

Animal studies have shown that fluoxetine reduces sperm quality.

Theoretically, this could affect fertility, but the impact on human fertility has not been observed yet.

Driving and using machines

During treatment with fluoxetine, you may feel drowsy or dizzy. Do not drive or use tools or machines until you know how the treatment with fluoxetine affects you.

3. How to take fluoxetine cinfa

Follow exactly the administration instructions of this medication indicated by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist again.

Do not take more capsules than indicated by your doctor.

Form of administration

Swallow the capsules with water. Do not chew the capsules.

Adults

The recommended dose is:

• Depression:the recommended dose is 1 capsule (20 mg) per day. Your doctor may review and adjust your dose if necessary within 3 to 4 weeks after starting treatment. When necessary, the dose can be gradually increased up to a maximum of 3 capsules (60 mg) per day.

The dose should be carefully increased to ensure that you receive the lowest effective dose. You may not feel better immediately after starting to take your medication for depression. This is common because there is no improvement in depressive symptoms until after the first few weeks of treatment. Patients with depression should be treated for a period of at least 6 months.

• Bulimia nervosa:the recommended dose is 3 capsules (60 mg) per day.
• Obsessive-compulsive disorder:the recommended dose is 1 capsule (20 mg) per day. Your doctor may review and adjust the dose after two weeks of treatment. When necessary, the dose can be gradually increased up to a maximum of 3 capsules (60 mg) per day. If no improvement is observed within ten weeks, your doctor will reconsider your treatment.

Use in children and adolescents

Treatment in children and adolescents from 8 to 18 years with depression should be initiated and supervised by a specialist. The initial dose is 10 mg per day. After one or two weeks, your doctor may increase the dose to 20 mg per day. The dose should be carefully increased to ensure that the patient maintains the lowest effective dose. Children with low weight may need lower doses. If there is a satisfactory response to treatment, your doctor should reassess the need to continue treatment after 6 months. If no improvement is observed within 9 weeks, treatment should be reconsidered.

Use in elderly patients

Dose increases by your doctor should be carried out more carefully, and the daily dose should not generally exceed 2 capsules (40 mg). The maximum dose is 3 capsules (60 mg) per day.

Hepatic impairment

If you have a liver problem or are using other medication that may interact with fluoxetine, your doctor will decide whether to prescribe a lower dose or instruct you on how to use fluoxetine on alternate days.

If you take more fluoxetine cinfa than you should

If you take too many capsules, go to the emergency department of the nearest hospital or consult your doctor immediately. If possible, take the fluoxetine packaging with you.

The symptoms of overdose include: nausea, vomiting, seizures, heart problems (such as irregular heartbeats or cardiac arrest), lung problems, and changes in mental state ranging from excitement to coma.

In case of overdose or accidental ingestion, consult your doctor or pharmacist immediately or call the Toxicology Information Service, phone 91 562 04 20, indicating the medication and the amount ingested.

If you forget to take fluoxetine cinfa

Do not worry if you forget to take a dose. Take the next dose the following day at the usual time. Do not take a double dose to make up for missed doses.

Taking your medication at the same time every day can help you remember to take it regularly.

If you interrupt treatment with fluoxetine cinfa

Do not stop taking fluoxetine unless your doctor has indicated it, even if you start feeling better. It is essential that you continue taking your medication.

Make sure you do not run out of medication.

You may experience the following effects (withdrawal effects) when interrupting treatment with fluoxetine: dizziness, tingling sensation similar to pinpricks or needles, sleep disturbances (intense dreams, nightmares, insomnia), feeling of restlessness or agitation, unusual fatigue or weakness, anxiety, nausea and/or vomiting (feeling sick or being sick), tremors (instability), and headache.

Most people find that the symptoms that occur when interrupting treatment with fluoxetine are moderate and disappear within a few weeks. If you experience these symptoms when interrupting your treatment, consult your doctor.

When interrupting treatment with fluoxetine, your doctor will help you gradually reduce the dose over one to two weeks. This will help reduce the possibility of withdrawal effects.

If you have any other questions about the use of this medication, ask your doctor or pharmacist.

4. Possible adverse effects

Like all medications, this medication can cause adverse effects, although not all people experience them.

• If you have suicidal thoughts or self-harm at any time, contact your doctor or go directly to the hospital(see section 2).
• If you have a skin rash or allergic reactions such as itching, swelling of the lips/tongue, or wheezing/shortness of breath, stop taking the capsules and inform your doctor immediately.
• If you feel restless and feel like you cannot sit still or stay quiet, you may be suffering from something called akathisia, and increasing your fluoxetine dose could make you feel worse. If you feel this way, consult your doctor.
• Talk to your doctor immediatelyif your skin starts to redden or shows any reaction or blisters, or if your skin begins to peel. This happens very rarely.

The most frequent adverse effects (very common adverse effects that may affect more than 1 in 10 people) are insomnia, headache, diarrhea, discomfort (nausea), and fatigue.

Some patients have experienced:

• A combination of symptoms (known as serotonin syndrome) that include unexplained fever with increased breathing or heart rate, sweating, muscle stiffness or tremors, confusion, extreme agitation or drowsiness (rarely).
• Feeling of weakness, drowsiness, or confusion, mainly in elderly patients and in people treated with diuretics.
• Prolonged and painful erection.
• Irritability and extreme agitation.
• Heart problems, such as rapid or irregular heartbeat, fainting, collapse, or dizziness when standing up, which may indicate abnormal heart rhythm.

If you experience any of the above adverse effects, inform your doctor immediately.

The following adverse effects have also been reported in patients taking fluoxetine:

Frequent(may affect up to 1 in 10 people)

• Lack of appetite, weight loss.
• Nervousness, anxiety.
• Restlessness, lack of concentration.
• Feeling of nervous tension.
• Decreased sexual desire or sexual problems (including difficulty maintaining an erection during sexual activity).
• Sleep disturbances, abnormal dreams, fatigue, drowsiness.
• Dizziness.
• Alteration of taste.
• Uncontrolled tremor movements.
• Blurred vision.
• Feeling of rapid and irregular heartbeats.
• Flushing.
• Indigestion, vomiting.
• Dry mouth.
• Skin rash, hives, itching.
• Excessive sweating.
• Joint pain.
• Increased frequency of urination.
• Unexplained vaginal bleeding.
• Feeling of weakness or chills.

Uncommon(may affect up to 1 in 100 people)

• Feeling detached, distant from oneself.
• Strange thoughts.
• Sexual problems, including orgasm problems, occasionally persisting after treatment discontinuation.
• Suicidal thoughts or self-harm.
• Teeth grinding.
• Muscle spasms, involuntary movements, or balance and coordination problems.
• Memory disturbances.
• Dilated pupils.
• Noise in the ears.
• Low blood pressure.
• Breathing difficulties.
• Nosebleeds.
• Difficulty swallowing.
• Hair loss.
• Increased tendency to bruise.
• Unexplained bruising or bleeding.
• Cold sweats.
• Difficulty urinating.
• Feeling of cold or heat.
• Liver test abnormalities.

Rare(may affect up to 1 in 1,000 people)

• Low sodium levels in the blood.
• Decreased platelet count in the blood, which increases the risk of bleeding or bruising.
• Decreased white blood cell count.
• Atypically reckless behavior.
• Hallucinations.
• Agitation.
• Panic attacks.
• Confusion.
• Stuttering.
• Aggressiveness.
• Seizures.
• Vasculitis (inflammation of a blood vessel).
• Rapid swelling of tissues around the neck, face, mouth, and/or throat.
• Pain in the esophagus (the tube that connects the mouth to the stomach).
• Hepatitis.
• Lung problems.
• Sensitivity to sunlight.
• Muscle pain.
• Urination problems.
• Milk production.

Frequency not known(cannot be estimated from available data)

• Abundant vaginal bleeding shortly after childbirth (postpartum hemorrhage), see "Pregnancy" in section 2 for more information.

Bone fractures: In patients taking this type of medication, an increased risk of bone fractures has been observed.

Most of these adverse effects tend to disappear with continued treatment.

Other adverse effects in children and adolescents (8 to 18 years)

In addition to the possible adverse effects mentioned above, fluoxetine may decrease growth or delay sexual maturation. Suicidal behavior (suicide attempts and suicidal thoughts), hostility, mania, and nosebleeds have also been frequently reported in children.

Reporting adverse effects

If you experience any type of adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect that does not appear in this leaflet. You can also report them directly through the Spanish Medicines and Health Products Agency: https://www.notificaram.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medication.

5. Conservation of fluoxetine cinfa

Keep this medication out of sight and reach of children.

This medication does not require special storage conditions.

Do not use this medication after the expiration date shown on the packaging after CAD. The expiration date is the last day of the month indicated.

Medications should not be disposed of through wastewater or household waste. Deposit the packaging and medications you no longer need at the SIGRE point in the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medications you no longer need. This will help protect the environment.

6. Package contents and additional information

Composition of fluoxetine cinfa

• The active ingredient is fluoxetine. Each capsule contains 20 mg of fluoxetine (in the form of fluoxetine hydrochloride).
• The other components are:

Capsule content: pregelatinized cornstarch.

Capsule components: gelatin, titanium dioxide (E-171), quinoline yellow (E-104), and erythrosine (E-127).

Appearance of the product and package contents

Hard gelatin capsules with an orange cap and white body.

Available in PVC/ALU blisters. Each package contains blisters of 14, 28, 56, or 60 hard capsules.

Marketing authorization holder and manufacturer:

Laboratorios Cinfa, S.A.

Carretera Olaz-Chipi, 10. Polígono Industrial Areta

31620 Huarte (Navarra) - Spain

Date of the last revision of this leaflet:May 2021

Detailed information about this medication is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/

You can access detailed and updated information about this medication by scanning the QR code included in the leaflet and packaging with your smartphone. You can also access this information at the following internet address: https://cima.aemps.es/cima/dochtml/p/63499/P_63499.html

QR code to: https://cima.aemps.es/cima/dochtml/p/63499/P_63499.html