62F on fluoxetine 40mg x 5 months for PTSD/MDD, warfarin x 4 years for A.fib, stroke. Labs WNL, INR is therapeutic.
Situation 1: New complaints of bleeding of gums for 10-20 minutes
In this situation I would likely require more information as to the setting of the gum bleeding. Is this after brushing with a hard toothbrush? Eating hard crackers?
Situation 2: Pale, poor energy, falls 2-3x/month
As Jamie, I would re-draw my CBC. However, the presence or absence anemia could be a red herring, and I would order further bloodwork, including B12, thyroid, sodium. I would instruct the patient to see her PCP to get a full workup if none of my labs came back with an obvious cause.
Situation 3: Reports dark tarry stools since dose increase of fluoxetine
In this situation I would have the patient self-report to the ER. Working in an intensive care unit, I can attest that GI bleeders are the people who can present with few symptoms beyond tarry stools before they immediately decompensate and require a rapid transfusion machine
Situation 4: New complaints of bruises lasting at least 1 week and are slow to completely heal
In all of these cases, I would consider the response to fluoxetine. If the patient were previously very unstable and was now functioning well, I would be reticent to change the fluoxetine and might consider the severity of the increased bleeding (IE gums with heavy toothbrushing vs GI bleed) before doing so.