Flunirin 20 mg capsules – fluoxetine for depression, OCD and bulimia

Flunirin hard capsules contain fluoxetine, an antidepressant from the group of selective serotonin reuptake inhibitors (SSRIs). Fluoxetine is thought to work by increasing the level of serotonin in the brain, a substance found at lower levels in people with depression, obsessive-compulsive disorder and bulimia nervosa.

Each capsule contains 20 mg fluoxetine (as fluoxetine hydrochloride) and a pack contains 30 capsules. Improvement usually does not happen immediately – depression is treated for at least 6 months, and the dose and duration are decided by the doctor.

What is Flunirin used for and how should it be taken correctly?

Key facts about the medicine

What is Flunirin used for?

According to the package leaflet, Flunirin is used to treat:

• adults: major depressive episodes; obsessive-compulsive disorder; bulimia nervosa – as an addition to psychotherapy, to reduce binge eating and self-induced vomiting;
• children and adolescents aged 8 years and over: moderate to severe major depressive episodes if there is no improvement after 4–6 psychotherapy sessions – and only in combination with psychotherapy.

How is it taken and dosed?

Swallow the capsules whole with water and do not chew them. The medicine can be taken with or between meals; it is best taken at the same time each day. Usual dosage according to the leaflet:

• Doses below 20 mg are not possible with Flunirin 20 mg capsules – medicines of a suitable strength are used for such doses.
• In liver disease or with medicines that affect fluoxetine, the doctor may prescribe a lower dose or dosing every other day.
• Do not take more capsules than prescribed.

Special patient groups

• Children and adolescents (8–18 years): only for moderate to severe depression together with psychotherapy; there is an increased risk of suicide attempts, suicidal thoughts and hostility, and the medicine may slow growth and delay sexual maturation. It must not be used in children under 8 years.
• Older people: the dose is increased carefully, usually up to 40 mg daily; weakness, drowsiness and confusion are more common, especially with diuretics.
• Liver impairment: a lower dose or dosing every other day may be used.

Contraindications – when the medicine must not be used

Do not take Flunirin:

• if you are allergic to fluoxetine or any of the ingredients;
• if you take irreversible non-selective monoamine oxidase inhibitors (MAOIs) – fluoxetine is started at least 2 weeks after stopping them, and MAOIs must not be taken for at least 5 weeks after stopping fluoxetine;
• if you take metoprolol for heart failure (risk of a slow heart rate).

Warnings and precautions

Talk to your doctor before taking the medicine if:

• you have heart problems, a low resting pulse or low salt levels (e.g. after severe diarrhoea and vomiting or due to diuretics);
• you have or have had mania, epilepsy or seizures, or are receiving electroconvulsive therapy;
• you have had a bleeding disorder or take medicines that prevent blood clotting;
• you take tamoxifen;
• you have diabetes (insulin or other diabetes medicines may need adjusting);
• you have liver problems or glaucoma (raised eye pressure);
• you feel restless and cannot sit or stand still (akathisia).

Contact your doctor immediately if you develop fever, muscle stiffness or trembling, confusion and marked agitation – these may be signs of the rare but serious serotonin syndrome. SSRIs can cause sexual dysfunction, which in some cases has persisted after treatment was stopped. The capsules contain lactose.

Interactions with other medicines, food and drink

Tell your doctor about all medicines you take. According to the leaflet:

• do not take together: irreversible non-selective MAOIs and metoprolol (in heart failure);
• risk of serotonin syndrome: moclobemide, linezolid, methylene blue, as well as lithium, selegiline, St John’s wort, tramadol, triptans (migraine medicines) and tryptophan;
• medicines affecting heart rhythm: class IA and III antiarrhythmics, antipsychotics (e.g. pimozide, haloperidol), tricyclic antidepressants, some antibiotics (e.g. moxifloxacin, intravenous erythromycin), antimalarials, antihistamines (e.g. mequitazine, mizolastine);
• risk of bleeding: warfarin and other anticoagulants, ibuprofen, diclofenac and other NSAIDs, acetylsalicylic acid, clozapine;
• other: tamoxifen (its effect may be reduced), phenytoin, cyproheptadine, medicines that lower sodium (diuretics, desmopressin, carbamazepine, oxcarbazepine), medicines that lower the seizure threshold (bupropion, mefloquine, chloroquine) and medicines whose levels fluoxetine may increase (flecainide, propafenone, nebivolol, atomoxetine, risperidone).

Avoid alcohol during treatment.

Pregnancy and breast-feeding

• Pregnancy: there are data indicating an increased risk of congenital heart defects when fluoxetine is taken in the first trimester (about 2 in 100 babies compared with 1 in 100 in the general population). Use in the last three months may cause persistent pulmonary hypertension of the newborn, and irritability, trembling, low muscle tone, persistent crying and difficulty feeding and sleeping have been reported in newborns. Taking it in the month before delivery increases the risk of heavy bleeding after birth. It is used in pregnancy only if the benefit outweighs the risk – decide with your doctor whether to continue or stop gradually.
• Breast-feeding: fluoxetine passes into breast milk and may cause side effects in the baby; breast-feed only if necessary, and the doctor may lower the dose.
• Fertility: in animal studies fluoxetine reduced sperm quality; an effect on human fertility has not been observed.

Driving and using machines

Flunirin may affect judgement and coordination. Do not drive or operate machinery until you know how the medicine affects you.

Possible side effects

Contact your doctor or go to hospital immediately if you have thoughts of self-harm or suicide. Stop treatment and tell your doctor at once if you develop a rash or allergic reaction (itching, swelling of the lips or tongue, wheezing, shortness of breath), or blistering or peeling of the skin.

According to the leaflet:

• very common (more than 1 in 10 people): insomnia, headache, diarrhoea, nausea, tiredness;
• common (up to 1 in 10): loss of appetite and weight, nervousness and anxiety, poor concentration, reduced sex drive and erection problems, sleep disturbances and unusual dreams, dizziness, altered taste, blurred vision, fast heartbeat, flushing, yawning, vomiting, dry mouth, rash and itching, excessive sweating, joint pain, frequent urination, fever;
• uncommon (up to 1 in 100): unusual thoughts, euphoria, suicidal thoughts, teeth grinding, muscle twitching, dilated pupils, ringing in the ears, low blood pressure, nosebleeds, hair loss, easy bruising;
• rare (up to 1 in 1,000): low blood sodium, reduced platelets and white blood cells, aggression, hallucinations, panic attacks, seizures, hepatitis, sensitivity to sunlight.

An increased risk of bone fractures has been observed in patients taking this type of medicine. Most side effects disappear with continued use.

Overdose, missed dose and stopping treatment

• Overdose: contact a doctor or emergency service immediately and take the pack with you. Nausea, vomiting, seizures, heart problems (irregular rhythm, cardiac arrest), lung problems and changes in consciousness from agitation to coma may occur.
• Missed dose: take it as soon as you remember; if it is almost time for the next dose, continue with your usual schedule. Do not take a double dose.
• Stopping treatment: do not stop without your doctor’s advice, even if you feel better. Dizziness, tingling, sleep disturbances, restlessness, tiredness, nausea, trembling and headache may occur on stopping; the doctor reduces the dose gradually over 1–2 weeks.

Related information

In Serbia, fluoxetine is the active substance of Flunirin® 20 mg capsules and Flunisan® 20 mg tablets. Only a doctor or pharmacist can approve switching from one to the other.

Composition, pack and manufacturer

• Active substance: fluoxetine 20 mg per capsule (as fluoxetine hydrochloride).
• Capsule contents: lactose monohydrate; microcrystalline cellulose; crospovidone; magnesium stearate.
• Capsule body and cap: gelatin; yellow and black iron oxide; titanium dioxide; indigo carmine.
• Pack: carton with 3 blisters of 10 capsules (30 capsules).
• Marketing authorisation holder and manufacturer: Galenika AD Beograd, Batajnički drum b.b., Belgrade.

Storage

• Store below 25 °C in the original package to protect from light and moisture.
• Keep out of the sight and reach of children.
• Do not use after the expiry date; return unused medicine to a pharmacy that collects unused medicines.

Frequently asked questions

How long does it take for Flunirin to work?

Improvement usually does not happen immediately – symptoms of depression begin to ease only after a few weeks of treatment. The doctor assesses the effect after 3–4 weeks in depression and after 2 weeks in obsessive-compulsive disorder.

Can I stop taking Flunirin suddenly?

No. Treatment should not be stopped without your doctor’s advice, even if you feel better. The doctor reduces the dose gradually over 1–2 weeks to lower the risk of withdrawal symptoms such as dizziness, tingling, sleep disturbances and restlessness.

Can I take St John’s wort or painkillers with fluoxetine?

St John’s wort, tryptophan, tramadol and triptans increase the risk of serotonin syndrome with fluoxetine, and ibuprofen, diclofenac, aspirin and anticoagulants increase the risk of bleeding. Always check with your doctor or pharmacist first.

Can Flunirin be used in children?

Only in children and adolescents aged 8 to 18 years with moderate to severe depression, together with psychotherapy and under specialist supervision. It must not be used in children under 8 years.

Sources

• ALIMS – Summary of Product Characteristics, Flunirin® 20 mg hard capsules (SmPC, Serbian)
• ALIMS – Package leaflet, Flunirin® 20 mg hard capsules (PIL, Serbian)

Sources checked on: 25 October 2026.