From the FDA Drug Label
If the decision has been made to discontinue treatment, medication should be tapered, as rapidly as is feasible, but with recognition that abrupt discontinuation can be associated with certain symptoms
- Tapering is recommended when discontinuing fluoxetine (Prozac) to avoid certain symptoms associated with abrupt discontinuation.
- The duration of treatment in this case is 2 months, and the dose is 20 milligrams, but the drug label does not provide specific tapering instructions for this scenario.
- Given the long elimination half-life of fluoxetine, it is likely that tapering will be necessary to minimize the risk of withdrawal symptoms, but the exact tapering schedule is not specified in the label 1.
From the Research
It is highly recommended to taper off Prozac (fluoxetine) even at a 20 mg dose taken for two months to minimize potential withdrawal symptoms. A gradual discontinuation helps minimize potential withdrawal symptoms, which can include dizziness, irritability, anxiety, headaches, and flu-like symptoms. For a 20 mg dose taken for two months, a common tapering schedule might involve reducing to 10 mg daily for 1-2 weeks, then 10 mg every other day for 1-2 weeks before stopping completely. However, Prozac has a long half-life (2-3 days for the parent compound and 7-9 days for its active metabolite), which creates a natural tapering effect and makes withdrawal symptoms less common compared to other antidepressants. This is why some patients on lower doses for shorter durations might be able to stop without formal tapering. The decision to taper should always be made in consultation with a healthcare provider who can consider individual factors such as sensitivity to medication changes, underlying condition severity, and previous experiences with medication discontinuation, as suggested by recent studies 2. Some studies suggest that tapering regimens longer than 4 weeks may be more effective in reducing withdrawal symptoms 3, but the optimal tapering schedule is not well established. Healthcare professionals should make patients aware of potential withdrawal symptoms they may experience before they wean off antidepressants, regularly review their progress, and consider helping them access psychological support whilst weaning off, as highlighted in a recent personal account of antidepressant discontinuation 4. Additionally, clinical guidance needs to be updated to provide appropriate evidence-based information, advice, and recommendations for how best to support patients when coming off of antidepressants, as emphasized in a Cochrane review of approaches for discontinuation versus continuation of long-term antidepressant use 5. Overall, a careful and individualized approach to tapering off Prozac is necessary to minimize withdrawal symptoms and ensure a safe and successful discontinuation.