Does fluoxetine cause nosebleeds? (+3 factors)

In this article, we will discuss the nosebleeds associated with fluoxetine. We will also discuss the factors that may increase the risk of nose bleeding and the management of nosebleeds associated with the use of fluoxetine.

Does fluoxetine cause nosebleeds?

Yes, fluoxetine may cause nosebleeds. However, it is not a common side effect of fluoxetine and it rarely occurs in individuals who are taking this medication, based on their overall health status and underlying diseases. 

Fluoxetine is an antidepressant medication that belongs to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). It increases the levels of serotonin in the brain which in turn elevates mood and promotes emotional wellness in individuals suffering from various mental disorders. It is primarily prescribed to treat depression, anxiety, and their associated symptoms (1).

What does research suggest?

According to research, serotonin stored in the platelets is responsible for regulating the functions of platelets including their ability to clot blood. Fluoxetine, which is an SSRI, increases the levels of serotonin in the brain by inhibiting its reuptake but this results in low serotonin levels in the blood cells. The reduced serotonin levels in platelets decrease their ability to clot blood (2).

As a result, the risk of bleeding including nosebleeds is increased with fluoxetine. A research study showed that fluoxetine can cause epistaxis when used in geriatric patients for the management of their underlying depression and anxiety (3).

What factors can increase the risk of nosebleeds while taking fluoxetine?

Fluoxetine may not always cause nosebleeds but there are some factors that increase the risk of nosebleeds while taking fluoxetine. These factors are:

Underlying medical conditions: Taking fluoxetine with underlying medical conditions such as high blood pressure and bleeding disorders increases the risk of nosebleeds. Individuals with underlying nasal conditions such as sinusitis may also increase the risk of nose bleeds by drying and irritating the nasal mucosa (4). 

Drug interactions: Concomitant use of medications that reduce platelet function, such as aspirin, warfarin, and naproxen, with fluoxetine may increase the risk of nosebleeds due to reduced clotting ability. Fluoxetine alone has a negligible effect on coagulation, but using these drugs with fluoxetine may increase the risk of nasal bleeding (5). 

Nose picking: Harsh picking and rubbing of the nose also triggers nosebleeds. Avoid scratching your nose while taking fluoxetine to prevent nosebleeds.

It is imperative to note that certain individuals exhibit higher susceptibility towards certain medications, such as fluoxetine. Hence, even a low dosage of the medication may trigger side effects in such individuals.

How to manage nosebleeds while taking fluoxetine?

If you are taking fluoxetine and experience nosebleeding, you must consult your healthcare provider as soon as possible. Your healthcare provider will evaluate your condition and may adjust the dosage or change your treatment plan accordingly.

  • It is important to remember that, you should not stop taking fluoxetine abruptly without consulting your healthcare provider, as this may lead to withdrawal effects.


  • Using a normal saline solution to maintain adequate moisture in the nasal cavities can help prevent nosebleeds associated with fluoxetine.


  • If you do experience nosebleeding, applying pressure to the nostrils is the first step to manage it. You can compress your nostrils for a few minutes, which is effective in stopping nose bleeding.


  • In cases of excessive nose bleeding, your healthcare provider may prescribe medication to help stop the bleeding, such as oxymetazoline nasal spray.


  • Remember, it is always best to consult your healthcare provider for proper evaluation and treatment of nosebleeds associated with fluoxetine.

What are the common side effects of fluoxetine?

The common side effects of fluoxetine may include (6):

  • nausea
  • vomiting 
  • dizziness
  • weight changes
  • appetite changes
  • drowsiness
  • dry mouth
  • headaches
  • sexual thoughts 
  • fatigue

It is important to note that these side effects occur more frequently in individuals as compared to bleeding disorders including nosebleeds associated with the use of fluoxetine. However, the intensity and frequency of these side effects may vary from one individual to another based on their individual sensitivity to fluoxetine. 


In conclusion, based on my knowledge and experience, fluoxetine rarely causes nosebleeds. This is not a common side effect of fluoxetine and only some individuals may experience nosebleeds while taking fluoxetine, based on their underlying medical condition, individual factors, and overall health status.

However, you should always consult your healthcare provider if you experience nosebleeds while taking fluoxetine or any other SSRI. Your healthcare provider may guide you and alter your treatment plan according to your individual needs.

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Sohel AJ, Shutter MC, Molla M. Fluoxetine. 2022 Jul 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29083803.


Li N, Wallén NH, Ladjevardi M, Hjemdahl P. Effects of serotonin on pla telet activation in whole blood. Blood Coagul Fibrinolysis. 1997 Nov;8(8):517-23. doi: 10.1097/00001721-199711000-00006. PMID: 9491270.


Kaya T, Yücel M, Eraslan Ö, Cinemre H, Tamer A. SEVERE HYPONATREMIA, EPISTAXIS, AND FLUOXETINE. J Ayub Med Coll Abbottabad. 2016 Jan-Mar;28(1):204-5. PMID: 27323598.


Sarhan NA, Algamal AM. Relationship between epistaxis and hypertension: A cause and effect or coincidence? J Saudi Heart Assoc. 2015 Apr;27(2):79-84. doi: 10.1016/j.jsha.2014.09.002. Epub 2014 Sep 16. PMID: 25870500; PMCID: PMC4392352.


Tay HL, Evans JM, McMahon AD, MacDonald TM. Aspirin, nonsteroidal anti-inflammatory drugs, and epistaxis. A regional record linkage case control study. Ann Otol Rhinol Laryngol. 1998 Aug;107(8):671-4. doi: 10.1177/000348949810700808. PMID: 9716869.


NHS Choices. Side effects of fluoxetine [Internet]. 2023 [cited 2023 Oct 25]. Available from: ‌

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