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Based on the mechanism of action of SNRIs and SSRIsincluding SARAFEMand the potential for serotonin syndromecaution is advised when SARAFEM is coadministered with other drugs that may affect the serotonergic neurotransmitter systemssuch as triptanslinezolidan antibiotic which is a reversible non-selective MAOIlithiumtramadolor StJohn’s Wortsee WARNINGS AND PRECAUTIONSThe concomitant use of SARAFEM with SNRIsSSRIsor tryptophan is not recommendedsee DOSAGE AND ADMINISTRATIONCONTRAINDICATIONSWARNINGS AND PRECAUTIONSand DRUG INTERACTIONS

There are no adequate and well-controlled studies examining sexual dysfunction with fluoxetine treatmentWhile it is difficult to know the precise risk of sexual dysfunction associated with the use of SSRIsphysicians should routinely inquire about such possible side effects.

Rarelymales may have a painful or prolonged erection lasting 4 or more hoursIf this occursstop using this drug and get medical help right awayor permanent problems could occur.

A major depressive episode may be the initial presentation of Bipolar DisorderIt is generally believedthough not established in controlled trialsthat treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for Bipolar DisorderWhether any of the symptoms described for clinical worsening and suicide risk represent such a conversion is unknownHoweverprior to initiating treatment with an antidepressantpatients with depressive symptoms should be adequately screened to determine if they are at risk for Bipolar Disordersuch screening should include a detailed psychiatric historyincluding a family history of suicideBipolar Disorderand depressionIt should be noted that SARAFEM is not indicated for the treatment of depressive episodes associated with Bipolar I Disorder.

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