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Concomitant use of SARAFEMfluoxetinein patients taking MAOIs is contraindicatedThere have been reports of serioussometimes fatalreactionsincluding hyperthermiarigiditymyoclonusautonomic instability with possible rapid fluctuations of vital signsand mental status changes that include extreme agitation progressing to delirium and comain patients receiving fluoxetine in combination with a monoamine oxidase inhibitorMAOIand in patients who have recently discontinued fluoxetine and are then started on an MAOISome cases presented with features resembling neuroleptic malignant syndromeThereforefluoxetineincluding SARAFEMshould not be used in combination with an MAOIor within a minimum of 14 days of discontinuing therapy with an MAOIsee CONTRAINDICATIONSSince fluoxetine and its major metabolite have very long elimination half-livesat least 5 weeksperhaps longerespecially if fluoxetine has been prescribed chronically and/or at higher dosesshould be allowed after stopping fluoxetine before starting an MAOIsee DOSAGE AND ADMINISTRATIONCONTRAINDICATIONSWARNINGS AND PRECAUTIONSand CLINICAL PHARMACOLOGY

Headacheastheniapainaccidental injuryinfectionflu syndromenauseadiarrheainsomniadizzinessnervousnessabnormal thinkingdecreased libidorhinitispharyngitisrashmay be serioushyponatremiaespelderly

During marketing of SARAFEMSNRIsand SSRIsthere have been spontaneous reports of adverse reactions occurring upon discontinuation of these drugsparticularly when abruptincluding the followingdysphoric moodirritabilityagitationdizzinesssensory disturbancesfor exampleparesthesias such as electric shock sensationsanxietyconfusionheadachelethargyemotional labilityinsomniaand hypomaniaWhile these reactions are generally self-limitingthere have been reports of serious discontinuation symptoms.

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