Why come off slowly
Stopping fluoxetine is usually harder than starting it. The relationship between the dose you take and its effect on the brain isn't a straight line — at lower doses, even a small reduction in milligrams can be a large change in effect. This is why prescribers increasingly recommend hyperbolic tapering: smaller and smaller reductions as the dose gets lower, rather than fixed steps.
In practice that means the standard strengths — designed for the treatment range, not for coming off — often can't give you the small doses the end of a taper needs. That's where a method like the one below, so you can measure a precise fraction, comes in.
The liquid method, step by step
- Cut a tablet to the portion you need with a pill cutter.
- Crush the piece between two spoons over a small plate.
- Stir it into a measured volume of water to make a known concentration — it will look cloudy, which is expected.
- Stir again immediately before drawing your dose; the active ingredient settles quickly.
- Measure your prescribed dose with an oral syringe and take it.
- Make a fresh liquid each day and discard any unused liquid in the rubbish.
Your step-by-step taper schedule
This is the Fluoxetine schedule from the RELEASE Toolkit, reproduced with permission. It's a starting point to discuss with your prescriber — you can pause, slow down or speed up depending on how you feel. Aim to reduce roughly every 2–4 weeks.
| Step | Daily dose | Liquid option (1mg/ml) | Compounded capsules |
|---|---|---|---|
| 1 | 20mg | 1 × 20mg tablet or capsule | — |
| 2 | 10mg | ½ × 20mg tablet | 2 × 5mg capsules |
| 3 | 5mg | 5ml liquid | 1 × 5mg capsule |
| 4 | 3mg | 3ml liquid | 3 × 1mg capsules |
| 5 | 2mg | 2ml liquid | 2 × 1mg capsules |
| 6 | 1mg | 1ml liquid | 1 × 1mg capsule |
| 7 | 0.5mg | 0.5ml liquid | 2 × 0.25mg capsules |
| 8 | 0.25mg | 0.25ml liquid | 1 × 0.25mg capsule |
| 9 | Stop | You've completed the taper 🎉 | |
Highlighted steps are the most important — do not skip them.
| Step | Daily dose | Liquid option (1mg/ml) | Compounded capsules |
|---|---|---|---|
| 1 | 40mg | 2 × 20mg tablets or capsules | — |
| 2 | 20mg | 1 × 20mg tablet or capsule | — |
| 3 | 15mg | ½ × 20mg tablet & 5ml liquid | 3 × 5mg capsules |
| 4 | 10mg | ½ × 20mg tablet | 2 × 5mg capsules |
| 5 | 7mg | 7ml liquid | 1 × 5mg & 1 × 2mg capsule |
| 6 | 5mg | 5ml liquid | 1 × 5mg capsule |
| 7 | 4mg | 4ml liquid | 2 × 2mg capsules |
| 8 | 3mg | 3ml liquid | 3 × 1mg capsules |
| 9 | 2.5mg | 2.5ml liquid | 1 × 2mg & 2 × 0.25mg capsules |
| 10 | 2mg | 2ml liquid | 1 × 2mg capsule |
| 11 | 1.5mg | 1.5ml liquid | 1 × 1mg & 2 × 0.25mg capsules |
| 12 | 1mg | 1ml liquid | 1 × 1mg capsule |
| 13 | 0.75mg | 0.75ml liquid | 3 × 0.25mg capsules |
| 14 | 0.5mg | 0.5ml liquid | 2 × 0.25mg capsules |
| 15 | 0.25mg | 0.25ml liquid | 1 × 0.25mg capsule |
| 16 | Stop | You've completed the taper 🎉 | |
Highlighted steps are the most important — do not skip them.
| Step | Daily dose | Daily tablets / liquid (1mg/ml) |
|---|---|---|
| 1 | 40mg | 2 × 20mg tablets |
| 2 | 30mg | 1½ × 20mg tablets |
| 3 | 20mg | 1 × 20mg tablet |
| 4 | 15mg | ½ × 20mg tab & 5ml liquid |
| 5 | 12.5mg | ½ × 20mg tab & 2.5ml liquid |
| 6 | 10mg | ½ × 20mg tablet |
| 7 | 8.2mg | 8.2ml liquid |
| 8 | 6.8mg | 6.8ml liquid |
| 9 | 5.8mg | 5.8ml liquid |
| 10 | 5mg | 5ml liquid |
| 11 | 4.3mg | 4.3ml liquid |
| 12 | 3.8mg | 3.8ml liquid |
| 13 | 3.3mg | 3.3ml liquid |
| 14 | 3mg | 3ml liquid |
| 15 | 2.6mg | 2.6ml liquid |
| 16 | 2.3mg | 2.3ml liquid |
| 17 | 2.1mg | 2.1ml liquid |
| 18 | 1.8mg | 1.8ml liquid |
| 19 | 1.6mg | 1.6ml liquid |
| 20 | 1.4mg | 1.4ml liquid |
| 21 | 1.3mg | 1.3ml liquid |
| 22 | 1.1mg | 1.1ml liquid |
| 23 | 1mg | 1ml liquid |
| 24 | 0.9mg | 0.9ml liquid |
| 25 | 0.8mg | 0.8ml liquid |
| 26 | 0.7mg | 0.7ml liquid |
| 27 | 0.6mg | 0.6ml liquid |
| 28 | 0.5mg | 0.5ml liquid |
| 29 | 0.4mg | 0.4ml liquid |
| 30 | 0.3mg | 0.3ml liquid |
| 31 | 0.25mg | 0.25ml liquid |
| 32 | 0.2mg | 0.2ml liquid |
| 33 | 0.12mg | 0.12ml liquid |
| 34 | 0.06mg | 0.06ml liquid |
| 35 | Stop | You've completed the taper 🎉 |
Highlighted steps are the most important — do not skip them.
- Do not skip the final small-dose steps — they're the most important for preventing withdrawal.
- Don't skip days, alternate days, or suddenly stop.
- If withdrawal symptoms appear, you can return to your previous dose; when ready, reduce more slowly.
Schedule © The University of Queensland (RELEASE Toolkit), reproduced with permission. Dosing guidance: Dr Mark Horowitz.
Measuring smaller doses accurately
Use the right tool for your method — an oral syringe for liquids (your pharmacist can supply 1 mL, 5 mL and 10 mL sizes), or a milligram scale for weighing. Choose the smallest measuring tool that fits your dose: it's far more accurate for tiny amounts.
- Measure slowly and double-check before you take your dose.
- Read at eye level, against the syringe plunger's flat edge.
- Keep the concentration or method the same each day so doses stay consistent.
What withdrawal can feel like
Withdrawal effects vary a lot between people. They often come in waves — harder days followed by windows of feeling more like yourself. Common, usually-manageable effects include dizziness, "brain zaps", nausea, vivid dreams, irritability and low mood. They tend to ease if you hold at your current dose for a while before reducing again.
Questions for your appointment
- How quickly is it safe for me to reduce, and by how much each step?
- How long should I hold at each dose before the next reduction?
- What should I do on a bad day — hold, slow down, or pause?
- Which symptoms mean I should contact you sooner?
- Would a compounded oral liquid be more accurate for my lowest doses?