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| Interactions: | AlprazolamAdverse Effect: an increased risk of alprazolam toxicity (somnolence, dizziness, ataxia, slurred speech, hypotension, psychomotor impairment)
Clinical Management: Monitor patients for signs and symptoms of alprazolam intoxication.
AmitriptylineAdverse Effect: Amitriptyline toxicity (dry mouth, urinary retention, sedation)
Clinical Management: Consider monitoring Amitriptyline levels following the addition of fluoxetine; lower doses of the tricyclic agent are often required. An initial dosage reduction by 50% to 75% of the tricyclic with the addition of fluoxetine might be considered if clinically appropriate. Because of the long half-life of the active metabolite norfluoxetine, it may be appropriate to wait a couple of weeks before advancing the dose of the Amitriptyline if fluoxetine is discontinued from therapy.
Amoxapine Adverse Effect: Increased amoxapine concentration and toxicity (anticholinergic effects, sedation, cardiac effects)
Clinical Management: Consider monitoring Amoxapine levels following the addition of fluoxetine; lower doses of the Amoxapine is often required. An initial dosage reduction by 50% to 75% of the Amoxapine with the addition of fluoxetine might be considered if clinically appropriate. Because of the long half-life of the active metabolite norfluoxetine, it may be appropriate to wait a couple of weeks before advancing the dose of the Amoxapine if fluoxetine is discontinued from therapy.
Aspirin Adverse Effect: Potentiation of fluoxetine allergic reaction (hives)
Clinical Management: Aspirin should be avoided in patients who are allergic to fluoxetine.
Astemizole Adverse Effect: cardiotoxicity (QT interval prolongation, torsades de pointes, cardiac arrest) Clinical Management: Concomitant use of astemizole and fluoxetine is not recommended.
Atorvastatin Decreased hepatic metabolism of simvastatin and atorvastatin
Buspirone Adverse Effect: worsening of psychiatric symptoms
Clinical Management: If possible, the combination of fluoxetine and buspirone should be avoided.
CarbamazepineAdverse Effect: carbamazepine toxicity (ataxia, nystagmus, diplopia, headache, vomiting, apnea, seizures, coma)
Clinical Management: Due to the potential increase carbamazepine levels, patients should be monitored for evidence of carbamazepine toxicity when fluoxetine is added to therapy.
ChlordiazepoxideAdverse Effect: Chlordiazepoxide toxicity (dry mouth, urinary retention, sedation) Clinical Management: Consider monitoring tricyclic antidepressant levels following the addition of fluoxetine; lower doses of the tricyclic agent are often required. An initial dosage reduction by 50% to 75% of the tricyclic with the addition of fluoxetine might be considered if clinically appropriate. Because of the long half-life of the active metabolite norfluoxetine, it may be appropriate to wait a couple of weeks before advancing the dose of the tricyclic antidepressant if fluoxetine is discontinued from therapy.
Cimetidine Adverse Effect: An increased risk of fluoxetine toxicity (nausea, headache, anxiety, hypotension)
Clinical Management: Monitor patients for signs of fluoxetine toxicity (nausea, headache, anxiety, hypotension). Doses of fluoxetine may need to be adjusted when cimetidine is added to or withdrawn from therapy. The use of another H2 receptor antagonist (such as famotidine) with lower interaction potential might be considered.
Clarithromycin Adverse Effect: delirium and psychosis
Clinical Management: Clarithromycin should be avoided in patients treated with fluoxetine.
Clomipramine Adverse Effect: Clomipramine toxicity (dry mouth, urinary retention, sedation)
Clinical Management: Monitor Clomipramine levels following the addition of fluoxetine; lower doses of the Clomipramine is often required. An initial dosage reduction by 50% to 75% of the tricyclic with the addition of fluoxetine might be considered if clinically appropriate. Because of the long half-life of the active metabolite norfluoxetine, it may be appropriate to delay increasing the dose of the Clomipramine for one to two weeks if fluoxetine is discontinued from therapy.
Clozapine Adverse Effect: An increased risk of clozapine toxicity (sedation, seizures, hypotension) Clinical Management: Monitor the therapeutic efficacy of clozapine and for any evidence of toxicity, particularly when the daily clozapine dose exceeds 300 mg or 3.5 mg/kg. Lower clozapine dosage may be required in some clinical situations.
Cyproheptadine Adverse Effect: decreased fluoxetine efficacy
Clinical Management: Monitor patients for a reduction in fluoxetine efficacy. When cyproheptadine is coadministered with fluoxetine, fluoxetine doses might need to be adjusted upward. In some cases, it may be necessary to withdraw cyproheptadine.
DiazepamAdverse Effect: Higher serum concentrations of diazepam
Clinical Management: Although dose adjustments are thought not to be necessary when fluoxetine and diazepam are given concomitantly, monitor patients for signs and symptoms of excessive diazepam concentrations (sedation, dizziness, ataxia, decreased cognition or motor performance). In some patients, such as the elderly, it may be safer to give a lower dose of diazepam during combination therapy.
Digoxin Adverse Effect: An increased risk of digoxin toxicity (nausea, vomiting, arrhythmias)
Clinical Management: Patients receiving fluoxetine and digoxin therapy concomitantly should be monitored for increasing levels of digoxin, along with signs and symptoms of digoxin toxicity, including anorexia.
Diltiazem Adverse Effect: Diltiazem toxicity (nausea, flushing, cardiovascular effects, edema, headache) Clinical Management: Monitor patients for diltiazem adverse effects. Doses of diltiazem may need to be reduced.
DothiepinAdverse Effect: Dothiepin toxicity (dry mouth, urinary retention, sedation)
Clinical Management: Consider monitoring tricyclic antidepressant levels following the addition of fluoxetine; lower doses of the tricyclic agent are often required. An initial dosage reduction by 50% to 75% of the tricyclic with the addition of fluoxetine might be considered if clinically appropriate. Because of the long half-life of the active metabolite norfluoxetine, it may be appropriate to wait a couple of weeks before advancing the dose of the tricyclic antidepressant if fluoxetine is discontinued from therapy.
Doxepin Adverse Effect: Doxepin toxicity (dry mouth, urinary retention, sedation)
Clinical Management: Consider monitoring tricyclic antidepressant levels following the addition of fluoxetine; lower doses of the tricyclic agent are often required. An initial dosage reduction by 50% to 75% of the Doxepin with the addition of fluoxetine might be considered if clinically appropriate. Because of the long half-life of the active metabolite norfluoxetine, it may be appropriate to wait a couple of weeks before advancing the dose of the Doxepin if fluoxetine is discontinued from therapy.
FluphenazineAdverse Effect: An increased risk of developing acute parkinsonism
Clinical Management: Monitor patients receiving concurrent therapy with fluphenazine and fluoxetine for the development of drug-induced parkinsonism. Therapy with fluoxetine may need to be discontinued.
Haloperidol Adverse Effect: Haloperidol toxicity (pseudoparkinsonism, akathisia, tongue stiffness) Clinical Management: Monitor for extrapyramidal symptoms when fluoxetine is given to patients on neuroleptics.
Imipramine Adverse Effect: Imipramine toxicity (dry mouth, urinary retention, sedation)
Clinical Management: Consider monitoring Imipramine levels following the addition of fluoxetine; lower doses of the Imipramine are often required. An initial dosage reduction by 50% to 75% of the Imipramine with the addition of fluoxetine might be considered if clinically appropriate. If fluoxetine is discontinued from therapy, it may be appropriate to wait a couple of weeks before advancing the dose of the Imipramine because of the long half-life of the active metabolite norfluoxetine.
Ketorolac Adverse Effect: Hallucinations
Clinical Management: Until more information becomes available, this combination should be avoided. An alternative analgesic should be considered if clinically appropriate.
LignocaineReduced hepatic metabolism
Lithium Adverse Effect: Possible lithium toxicity (weakness, tremor, excessive thirst, confusion) Clinical Management: Monitor patients on concurrent lithium and fluoxetine therapy for evidence of lithium toxicity (weakness, tremor, excessive thirst, confusion). In addition, monitor patients for signs and symptoms associated with serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes).
Lovastatin Decreased hepatic metabolism of simvastatin and atorvastatin
MetoprololAdverse Effect: An increased risk of metoprolol adverse effects (shortness of breath, bradycardia, hypotension, acute heart failure)
Clinical Management: A water soluble beta blocker, such as atenolol, should be considered for fluoxetine-treated patients who require a beta blocker. If metoprolol and fluoxetine are coadministered, monitor patients for metoprolol adverse effects. A reduction in the metoprolol dose may be necessary.
MexiletineReduced hepatic metabolism
Moclobemide Adverse Effect: Concomitant administration results in serious of adverse reactions Clinical Management: Start Moclobemide therapy only after an interval of 5 weeks of stopping Fluoxetine.
Nortriptyline Adverse Effect: Nortriptyline toxicity (dry mouth, urinary retention, sedation)
Clinical Management: Consider monitoring tricyclic antidepressant levels following the addition of fluoxetine; lower doses of the tricyclic agent are often required. An initial dosage reduction by 50% to 75% of the tricyclic with the addition of fluoxetine might be considered if clinically appropriate. Because of the long half-life of the active metabolite norfluoxetine, it may be appropriate to wait a couple of weeks before advancing the dose of the tricyclic antidepressant if fluoxetine is discontinued from therapy.
Pentazocine Adverse Effect: hypertension, diaphoresis, ataxia, flushing, nausea, dizziness, and anxiety Clinical Management: Until more data are available, concomitant use of fluoxetine and pentazocine should be undertaken with caution.
Phenytoin Adverse Effect: An increased risk of phenytoin toxicity (ataxia, hyperreflexia, nystagmus, tremor)
Clinical Management: Monitor phenytoin serum levels with the addition of fluoxetine and periodically thereafter to assure stability; lower phenytoin dosage may be required with concomitant therapy. Serum levels of phenytoin should be monitored following the discontinuation of fluoxetine; however, because of the long half-life of fluoxetine, decreases in phenytoin levels may not be clinically significant for a few weeks. Careful monitoring is required.
Pimozide Adverse Effect: Bradycardia and somnolence
Clinical Management: Monitor patients for bradycardia and somnolence who are receiving concurrent therapy, particularly elderly and patients with underlying cardiac disease.
PropafenoneAdverse Effect: Increased serum propafenone concentrations
Clinical Management: Monitoring of propafenone levels may be necessary to avoid potential toxicity.
Propranolol Adverse Effect: An increased risk of complete heart block
Clinical Management: Fluoxetine should be prescribed cautiously to patients on propranolol therapy. A baseline electrocardiogram should be considered prior to the initiation of fluoxetine.
Quinidine Adverse Effect: An increased risk of fluoxetine and quinidine toxicity
Clinical Management: Caution should be used if these agents are to be coadministered. Monitor the patient for evidence of elevated fluoxetine and/or quinidine serum concentrations.
Selegiline Adverse Effect: CNS toxicity or serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes)
Clinical Management: Concurrent use of fluoxetine and a MAO inhibitor is contraindicated. Wait at least two weeks after discontinuing a MAO inhibitor before initiating fluoxetine therapy. In addition, wait at least five weeks after discontinuing fluoxetine before initiating therapy with a MAO inhibitor.
Simvastatin Decreased hepatic metabolism of simvastatin and atorvastatin
Sodium ValproateAdverse Effect: A change in valproic acid blood concentration
Clinical Management: When fluoxetine and valproic acid are used concomitantly, measure valproic acid concentrations carefully.
SumatriptanAdverse Effect: An increased risk of weakness, hyperreflexia, and incoordination
Clinical Management: Concomitant use is not recommended. However, if concurrent therapy is deemed to be necessary, closely monitor the patient for adverse effects (weakness, hyperreflexia, incoordination).
Terfenadine Adverse Effect: cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest) Clinical Management: With concomitant therapy, consideration should be given to counsel patients on this potential interaction and instruct them to immediately report to their doctor a increased or irregular heart rate.
Tolterodine tartarateAdverse Effect: Significant reduction in Tolterodine Tartarate metabolism
Clinical Management: Monitor for any untoward actions, Dose adjustments generally is not required.
Tramadol Adverse Effect: an increased risk of seizures
Clinical Management: Caution should be used if tramadol is to be administered to patients receiving concomitant fluoxetine therapy. If possible, avoid this combination.
TrazadoneAdverse Effect: trazodone toxicity (sedation, dry mouth, urinary retention) or serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes)
Clinical Management: Due to the potential for impairment in trazodone metabolism, patients should be monitored for any signs of trazodone toxicity. Occasional dosage reductions of trazodone may be required.
Trimipramine Adverse Effect: Trimipramine toxicity (dry mouth, urinary retention, sedation)
Clinical Management: Consider monitoring tricyclic antidepressant levels following the addition of fluoxetine; lower doses of the tricyclic agent are often required. An initial dosage reduction by 50% to 75% of the tricyclic with the addition of fluoxetine might be considered if clinically appropriate. Because of the long half-life of the active metabolite norfluoxetine, it may be appropriate to wait a couple of weeks before advancing the dose of the tricyclic antidepressant if fluoxetine is discontinued from therapy.
Warfarin Adverse Effect: An increased risk of bleeding
Clinical Management: Closely monitor prothrombin time ratio or international normalized ratio in patients taking concurrent warfarin and fluoxetine. Also observe patients for signs of increased anticoagulation (bruising, petechiae, hematuria, melena). Doses of warfarin may need to be adjusted when fluoxetine is added to or withdrawn from therapy.
ZolpidemAdverse Effect: an increased risk of hallucinations
Clinical Management: Observe patients for hallucinatory activity. Alternative anti-insomnia medication may be warranted. |
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