Moderate
Probable
Deskripsi
Fluoxetine can enhance insulin sensitivity and potentiate hypoglycaemia in patients on insulin therapy, particularly during the first weeks of treatment.
Mekanisme
SSRIs, including fluoxetine, increase peripheral glucose utilisation through serotonin-mediated enhancement of insulin signalling; this pharmacodynamic additive effect lowers blood glucose beyond the effect of insulin alone.
Signifikansi Klinis
Case reports and small studies have documented unexplained hypoglycaemic episodes shortly after initiating fluoxetine in insulin-dependent diabetic patients.
Penatalaksanaan
Increase blood glucose monitoring when initiating or titrating fluoxetine; anticipate possible insulin dose reduction of 10–25%; educate patient on hypoglycaemia recognition and management.