01 Do not borrow a two-week SSRI card
Sertraline and most other SSRIs use a two-week wait before an MAOI. Fluoxetine does not. The Prozac insert says at least five weeks after stopping, perhaps longer after chronic or high-dose treatment. Forty milligrams daily for months is both chronic and not a baby dose.
The other arrow is fourteen days after the MAOI before starting fluoxetine. Mix the arrows and you either rush serotonin syndrome or you leave someone untreated for no reason.
Linezolid and IV methylene blue are MAOI-type problems in the moment. The hospital needs the 40 mg history, not a "I stopped last Tuesday" shrug. See the leaf for the 30-day 40 mg level ranges the insert quotes.
02 How to write dates that a hospitalist can use
Last 40 mg date. Last 20 mg date if you cut. Planned MAOI name. Other serotonergic drugs. Linezolid if that is in play. That is the card. "I stopped recently" is not a card.
The clock starts from the last fluoxetine of any dose unless a specialist rewrites it. A cut to 20 mg is still fluoxetine.
Five weeks toward an MAOI. Fourteen days the other way. Two weeks is the other SSRIs' gap. Do not copy a sertraline card onto Prozac.
After 30 days at 40 mg/day the insert quotes wide norfluoxetine ranges. Feeling clear is not empty.
The leaf has the numbers. This file is the switch.
03 When depression is bad and someone wants Friday anyway
Bad depression is why they want the MAOI. It is not a reason this margin can shorten five weeks. If they proceed on day 16, that is their documented risk, not a Bordeaux blessing.
Do not start a kitchen MAOI from a relative's bottle on day 20 because a forum said four weeks is enough. The insert says at least five, perhaps longer after chronic or high-dose treatment. Forty milligrams for months is that setting.
Linezolid for an infection is a same-day two-team call. Do not take the next 40 mg to stay even and do not stop silently.
IV methylene blue in a procedure is the same class of problem. Say Prozac on the anesthesia list.
Elise will not count your personal day 37.
04 When depression is bad and Friday still has to wait
Bad depression is why they want the MAOI. It is not a reason this margin can shorten five weeks. If they proceed on day 16, that is their documented risk, not a Bordeaux blessing.
Do not start a kitchen MAOI from a relative's bottle on day 20 because a forum said four weeks is enough. The insert says at least five, perhaps longer after chronic or high-dose treatment. Forty milligrams for months is that setting.
Thirty-two days is still short of 35. "Almost" is how day-32 charts get written.
A serotonin-syndrome home checklist does not empty norfluoxetine. Do not start an MAOI because you do not have clonus tonight.
If you already have rigidity, fever, or agitation on leftover fluoxetine plus another serotonergic drug, that is emergency care, not a Friday green light.
05 Norfluoxetine is why the bottle can be empty and the interaction still live
After 30 days at 40 mg/day, fluoxetine levels in the insert sit about 91-302 ng/mL and norfluoxetine about 72-258 ng/mL. Those species do not vanish on day 8. People feel "clear" because the capsule is gone. The enzyme and the serotonin risk are not clear.
Dose changes also take weeks to show fully in plasma. That is why a last-minute 40-to-20 cut does not create a short washout. The clock starts from the last fluoxetine of any dose unless a specialist says otherwise.
The activation ink is first-weeks. This file is the switch.
| Direction | Minimum labeled wait |
|---|---|
| Fluoxetine -> psychiatric MAOI | 5 weeks (longer if high/chronic) |
| Psychiatric MAOI -> fluoxetine | 14 days |
| Other SSRIs -> MAOI (typical) | 2 weeks - do not copy onto Prozac |
| Linezolid / IV methylene blue | Treat as an MAOI-type emergency conversation |
06 How to count five weeks from the last fluoxetine of any dose
The clock starts from the last 40 mg or the last 20 mg if you cut. A cut is still fluoxetine. "I stopped recently" is not a card a hospitalist can use.
Five weeks toward an MAOI. Fourteen days the other way. Two weeks is the other SSRIs' gap. Do not copy a sertraline card onto Prozac.
After 30 days at 40 mg/day the insert quotes wide norfluoxetine ranges. Feeling clear is not empty. The leaf has the numbers.
Linezolid for an infection is a same-day two-team call. IV methylene blue in a procedure is the same class of problem. Say Prozac on the anesthesia list.
Elise will not count your personal day 37.
07 What not to start during the five weeks
Another SSRI on day 10 "to bridge" can still be a serotonergic pile on leftover norfluoxetine. That bridge is a specialist's, not a forum's.
Tramadol, St John's wort, and extra triptans still belong on the list during the washout. The parent is gone. The metabolite is not.
Do not use the empty bottle as proof you can donate a leftover 40 mg to a friend. The friend inherits your washout math if they start an MAOI later. Do not donate.
If the plan is not an MAOI, five weeks may not be the relevant clock. Do not apply it as a superstition to every switch. Ask which next drug.
Mail us if a sentence used two weeks for Prozac-to-MAOI. That would be a copy error.
08 Bridges that still leave norfluoxetine in the room
Another SSRI on day 10 "to bridge" can still be a serotonergic pile. That bridge is a specialist's, not a forum's.
Tramadol, St John's wort, and extra triptans still belong on the list during the washout. The parent is gone. The metabolite is not.
Do not donate a leftover 40 mg to a friend. The friend inherits your washout math if they start an MAOI later.
If the plan is not an MAOI, five weeks may not be the relevant clock. Do not apply it as a superstition to every switch. Ask which next drug.
Mail us if a sentence used two weeks for Prozac-to-MAOI. That would be a copy error. See the activation ink if the stop was about jitter, not about a switch.
09 Bring dates, not a vibe
Write the last 40 mg date on paper. Write the planned MAOI name. Write other serotonergic drugs. That is the visit. This margin will not count your personal day 37.
If someone wants to start tranylcypromine on day 16 because the depression is bad, the answer is still the five-week line plus a specialist who owns the risk, not a Bordeaux exception.
Elise files the floor. She does not start phenelzine by email.
10 Two arrows, two waits
Five weeks off 40 mg toward an MAOI. Fourteen days the other way. Reviewed 21 August 2026.
Write the last 40 mg date, any 20 mg cut, the planned MAOI name, and other serotonergic drugs. That is the card. Five weeks toward an MAOI. Fourteen days after an MAOI before fluoxetine. Two weeks is the other SSRIs' story. Do not mix those cards.
Feeling clear at day 32 is not empty. The insert allows perhaps longer after chronic or high-dose treatment. Forty milligrams for months is that setting. A home checklist does not empty norfluoxetine.
Linezolid and methylene blue are same-day calls. Do not donate leftover capsules. The leaf keeps the numbers. Mail [email protected] if we used two weeks for Prozac-to-MAOI.
A yogurt half of a 40 mg capsule is still fluoxetine. The five-week clock starts from that last messy dose. Ask for a real 20 mg if 20 mg is the plan. Other switches have other clocks. Do not copy the MAOI gap onto every next antidepressant, and do not copy a two-week sertraline card onto leftover norfluoxetine.
If you need linezolid tomorrow and you swallowed 40 mg this morning, that is a two-team call tonight. Do not take tomorrow's capsule to stay even and do not stop silently. Bring the 40 mg/day duration, not only today's swallow.
Thirty-two days is still short of five weeks. Show them the fluoxetine-specific line. Almost is how day-32 charts get written. If they wait until day 35 and the course was high and long, they may still want longer. That is the insert's perhaps-longer clause. Bring the 40 mg/day duration, not only the stop date.
Anesthesia lists should name Prozac before methylene blue. A procedure week is a two-team week. Do not treat the empty blister as a clearance for Friday. Norfluoxetine is still the long piece.
Do not donate a leftover 40 mg capsule. The friend inherits your washout math if they later start an MAOI.