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Hypersensitivity to fluoxetine or to any of its excipients.
Monoamine oxidase inhibitors: Cases of serious and sometimes fatal reactions have been reported in patients receiving an SSRI in combination with a monoamine oxidase inhibitor (MAOI), and in patients who have recently discontinued an SSRI and have been started on a MAOI. Treatment of fluoxetine should only be started 2 weeks after discontinuation of an irreversible MAOI.
Some cases presented with features resembling serotonin syndrome (which may resemble, and be diagnosed as, neuroleptic malignant syndrome). Cyproheptadine or dantrolene may benefit patients experiencing such reactions.
Symptoms of a drug interaction with a MAOI include: hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, mental status changes that include confusion, irritability, and extreme agitation, progressing to delirium and coma. Therefore, fluoxetine is contra-indicated in combination with a non-selective MAOI. Similarly, at least 5 weeks should elapse after discontinuing fluoxetine treatment before starting a MAOI. If fluoxetine has been prescribed chronically and/or at a high dose, a longer interval should be considered.
The combination is not recommended. Treatment with fluoxetine can be initiated the following day after discontinuation of a reversible MAOI (eg, moclobemide).
