Prozac Interactions: Alcohol, Medications, and Others

Does Prozac interact with other drugs?

Before you start taking Prozac, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Prozac interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Prozac?” section below.)

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The table below lists drugs that may interact with Prozac. Keep in mind that this table doesn’t include all drugs that may interact with Prozac. For more information about some of these interactions, see the “Drug interactions explained” section below.

When should I avoid Prozac?

Certain health conditions or other factors could raise your risk of harm if you take Prozac. In such cases, your doctor may not prescribe Prozac for you. These are known as contraindications. The list below includes contraindications of Prozac.

• a blood disorder treatment called methylene blue (ProvayBlue)
• the antibiotic linezolid (Zyvox)
• MAOI antidepressants such as:
  • isocarboxazid (Marplan)
  • phenelzine (Nardil)
  • selegiline (Emsam)
  • tranylcypromine (Parnate)

If you take an MAOI drug. If you take a monoamine oxidase inhibitor (MAOI) drug, your doctor will likely not prescribe Prozac. This is because taking Prozac with this type of drug has a high risk of causing a serious side effect called serotonin syndrome. Examples of MAOI drugs include:

Your doctor will likely not prescribe Prozac if you’ve taken an MAOI drug in the past 14 days. And they’ll likely not prescribe an MAOI drug until at least 5 weeks after you’ve stopped taking Prozac. You can ask your doctor about other treatments that may be better options for you.

If you take pimozide or thioridazine. If you take pimozide or thioridazine, which are antipsychotic drugs, your doctor will likely not prescribe Prozac. This is because taking Prozac with these drugs could cause a life threatening irregular heartbeat. You can ask your doctor about other treatments that may be better options for you.

If you’ve had an allergic reaction. If you’ve had an allergic reaction to Prozac or any of its ingredients, your doctor likely won’t prescribe Prozac. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.

Before you start taking Prozac, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Prozac is safe for you to take.

Does Prozac interact with alcohol?

Prozac is not known to interact with alcohol. But Prozac and alcohol can cause some similar side effects, such as sleepiness, dizziness, nausea, and diarrhea. So you may be more likely to experience these side effects if you drink alcohol during your Prozac treatment.

It’s important to note that alcohol can also worsen symptoms of mental health conditions such as depression. Your doctor may recommend that you avoid or limit your alcohol consumption while taking an antidepressant.

If you drink alcohol and have questions about consuming it while taking Prozac, talk with your doctor or pharmacist.

Drug interactions explained

Learn more below about certain drug interactions that can occur with Prozac.

Interaction with nonsteroidal anti-inflammatory drugs (NSAIDs)

Prozac can interact with NSAIDs, which are used to treat swelling and pain. NSAIDs are commonly taken with Prozac.

Examples of NSAID medications include:

• aspirin
• diclofenac (Zipsor)
• ibuprofen (Advil, Motrin)
• ketoprofen
• naproxen (Naprosyn, Aleve)

What could happen

Prozac and NSAIDs can both increase the risk of bleeding, especially bleeding in your digestive system, such as in your stomach. So taking these drugs together can raise your risk of this side effect.

If you have problems with blood clotting, you may have a higher risk of bleeding if you take Prozac with an NSAID. If you’re older than 65 years or have had ulcers (sores) in your stomach or intestines, you may have a higher risk of bleeding in your digestive system if you take Prozac with an NSAID.

What you can do

Before taking Prozac with an NSAID, ask your doctor whether it’s safe for you to do so.

If you do take these drugs together, your doctor will prescribe the lowest possible dose of the NSAID for the shortest possible time. You should not take a higher dose of either medication than your doctor prescribes.

If you take Prozac and an NSAID together, tell your doctor right away if you have unusual bleeding, such as nosebleeds, bleeding gums, or bruising more easily than usual.

Also tell your doctor right away if you have symptoms of bleeding in your digestive system. These may include vomiting blood or a substance that looks like coffee grounds and passing black or tar-like stools. Your doctor may have you stop taking the NSAID if you have any of these symptoms.

If you have questions about taking Prozac with NSAIDs, talk with your doctor or pharmacist.

Interaction with opioid pain relievers

Prozac can interact with opioids, which are used to treat moderate to severe pain. These drugs are often prescribed with Prozac. But they may increase the risk of certain side effects. Some opioids may also be less effective when taken with Prozac.

Examples of opioids include:

• codeine
• fentanyl (Actiq, Fentora)
• hydrocodone (Hysingla ER)
• tramadol (ConZip)

What could happen

Prozac and opioids can both cause a serious side effect called serotonin syndrome. So taking these drugs together can raise your risk of this side effect. With serotonin syndrome, you have a buildup in your body of a chemical called serotonin. Symptoms of serotonin syndrome include:

• fast heart rate
• increased sweating
• tremor
• twitching
• stiff muscles
• nausea or vomiting
• agitation
• seizures

Prozac can also make certain opioids less effective at relieving pain. Opioids that interact with Prozac in this way include codeine, oxycodone, hydrocodone, and tramadol.

What you can do

If you take Prozac with an opioid pain reliever, your doctor will prescribe the lowest possible dose of opioid for the shortest possible time. You should not take a higher dose of either medication than your doctor prescribes.

If the opioid isn’t effective in relieving your pain, talk with your doctor. They may have you try a different pain reliever.

If you take Prozac and an opioid together, tell your doctor right away if you develop symptoms of serotonin syndrome. They may have you stop taking Prozac, the opioid, or both.

There are other types of pain relievers that don’t interact with Prozac. For example, it’s usually safe to take acetaminophen (Tylenol) with Prozac.

If you have questions about taking Prozac with opioids or other pain relievers, talk with your doctor or pharmacist.

Interaction with certain other antidepressants

Prozac can interact with certain other antidepressants. These may be used to treat depression, anxiety disorders, or nerve pain. Prozac is sometimes used with other antidepressants, especially for treatment-resistant depression.

Examples of other antidepressants that can interact with Prozac include:

• tricyclic antidepressants (TCAs) such as amitriptyline
• selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft)
• serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor XR)

What could happen

Prozac, TCAs, SSRIs, and SNRIs can all cause a serious side effect called serotonin syndrome. So taking Prozac with one of these other antidepressants can raise your risk of this side effect. With serotonin syndrome, you have a buildup of a chemical called serotonin in your body.

Symptoms of serotonin syndrome include:

• fast heart rate
• increased sweating
• tremors
• twitching
• stiff muscles
• nausea or vomiting
• agitation
• seizures

Taking Prozac with a TCA can also cause the TCA levels to build up in your body. This can raise your risk of side effects from the drug.

What you can do

If you take Prozac with another antidepressant, your doctor may prescribe a lower dose for you of one or both drugs. You should not take a higher dose of either medication than your doctor prescribes.

If you take Prozac with another antidepressant, tell your doctor right away if you develop symptoms of serotonin syndrome. They may have you stop taking one or both antidepressants.

If you have questions about taking Prozac with other antidepressants, talk with your doctor or pharmacist.

Are there other interactions with Prozac?

Prozac may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Prozac.

Does Prozac interact with supplements?

Before you start taking Prozac, talk with your doctor or pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

Prozac can interact with tryptophan, a supplement used to ease symptoms of depression, anxiety, and sleep problems. Taking Prozac with tryptophan can raise your risk of a serious side effect called serotonin syndrome.

With serotonin syndrome, you have a buildup of a chemical called serotonin in your body. Symptoms of serotonin syndrome include:

• fast heart rate
• increased sweating
• tremors
• twitching
• stiff muscles
• nausea or vomiting
• agitation
• seizures

Due to this risk, your doctor will likely recommend that you do not take Prozac with tryptophan.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Prozac interactions with herbs

Prozac can interact with St. John’s wort, an herbal supplement used to ease symptoms of depression and other conditions. Taking Prozac with St. John’s wort can raise your risk of a serious side effect called serotonin syndrome. (See the section directly above to learn more.)

Due to this risk, your doctor will likely recommend that you do not take Prozac with St. John’s wort.

Prozac and vitamins

There are currently no reports of Prozac interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Prozac.

Does Prozac interact with food?

There are currently no reports of Prozac interacting with food. If you have questions about eating certain foods during your treatment with Prozac, talk with your doctor.

Does Prozac interact with vaccines?

There are currently no reports of Prozac interacting with vaccines. If you have questions about getting certain vaccines during your Prozac treatment, talk with your doctor.

Does Prozac interact with lab tests?

There are currently no reports of Prozac interacting with lab tests. If you have questions about having certain lab tests during your treatment with Prozac, talk with the healthcare professional ordering the test.

Does Prozac interact with cannabis or CBD?

Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Prozac. Taking Prozac with cannabis or cannabis products may increase the risk of side effects with cannabis.

Before you start treatment with Prozac, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Does my health history affect whether I should take Prozac?

Certain medical conditions or other health factors may raise the risk of interactions with Prozac. Before taking Prozac, talk with your doctor about your health history. They’ll determine whether Prozac is right for you.

Health conditions or other factors that might interact with Prozac include:

Bipolar disorder, mania, or hypomania. If you have depression, tell your doctor if you or a family member has ever had bipolar disorder or a manic or hypomanic episode. These factors may suggest that your depression is related to bipolar disorder.

If your depression is related to bipolar disorder, your doctor will likely prescribe Prozac with olanzapine (Zyprexa, Zyprexa Zydis). If you have bipolar disorder, taking Prozac on its own to treat depression could raise your risk of having a manic episode.

Electroconvulsive therapy (ECT). Doctors sometimes useECT for treatment-resistant depression. But in people taking Prozac, receiving ECT may raise the risk of seizures. If your doctor prescribes Prozac with ECT, ask them if this combination is safe for you.

Seizure disorders. Prozac may cause seizures in some people.If you already have a condition that causes seizures, such as epilepsy, you may have a higher risk of seizures with Prozac. Talk with your doctor about whether Prozac is safe for you.

Bleeding problems. Taking Prozac may increase your risk of bleeding. If you already have bleeding problems, such as hemophilia or a bleeding stomach ulcer, talk with your doctor about whether Prozac is safe for you. If you take blood thinners, ask your doctor if Prozac is safe for you.

Heart problems. Prozac may cause an abnormal heart rhythm called long QT syndrome in some people. This side effect can cause life threatening irregular heartbeats. You may have a higher risk of long QT syndrome if you have certain heart problems. These include heart failure, a recent heart attack, or a slow or irregular heartbeat. If you have a heart problem, talk with your doctor about whether Prozac is safe for you.

Low sodium, potassium, or magnesium levels. If you have a low level of potassium or magnesium, you may have a higher risk of long QT syndrome with Prozac. (To learn more about long QT syndrome, see the paragraph above.) Or if you have a low sodium level, taking Prozac could make your condition worse.

Your doctor may prescribe treatment to correct these imbalances before you start taking Prozac. If you take a diuretic medication (water pills) with Prozac, your doctor may regularly check your levels of sodium, potassium, and magnesium during your treatment.

Diabetes. If you have diabetes, taking Prozac may affect your blood sugar levels. Talk with your doctor about whether you should check your blood sugar more often during and after your Prozac treatment.

Liver problems. If you have liver problems, Prozac could build up in your body. This could raise your risk of side effects. If you have liver problems, your doctor may prescribe a lower dosage of Prozac for you.

Older age. If you’re age 65 years or older, you may have a higher risk of developing low sodium levels with Prozac. Your doctor may prescribe a lower dosage of Prozac for you.

Pregnancy. It’s not known whether Prozac is safe to take during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before taking Prozac.

If you do take Prozac while pregnant, consider enrolling in the National Pregnancy Registry for Antidepressants. This registry collects details about pregnancy issues reported with Prozac. To learn more, call 866-961-2388 or talk with your doctor.

Breastfeeding. It’s not known whether it’s safe to take Prozac while breastfeeding. The drug passes into breast milk and may cause certain side effects in a child who is breastfed. If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.

Allergic reaction. If you’ve had an allergic reaction to Prozac or any of its ingredients, your doctor will likely not prescribe Prozac. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

How can I prevent interactions?

Taking certain steps can help you avoid interactions with Prozac. Before starting treatment, talk with your doctor or pharmacist. Things to discuss with them include:

• Whether you drink alcohol or use cannabis.
• Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
• What to do if you’re prescribed a new drug during your Prozac treatment.

It’s also important to understand Prozac’s label and other paperwork that may come with the drug. The label may include colored stickers that describe interactions. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you didn’t get paperwork with Prozac, ask your pharmacist to print a copy for you.)

If you have trouble reading or understanding this information, your doctor or pharmacist can help.

Taking Prozac exactly as prescribed can also help prevent interactions.

What should I ask my doctor?

If you still have questions about Prozac and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

• If I take Prozac with a drug it interacts with, will I be monitored more closely during my treatment?
• Do other drugs that could treat my condition have similar interactions to Prozac?
• Do I have any health factors that raise my risk of interactions with Prozac?

To learn more about Prozac, see these articles:

• Prozac (fluoxetine)
• Side Effects of Prozac: What You Need to Know
• Dosage Details for Prozac
• Prozac and Cost: What You Need to Know

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.