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| Depression |  |
Drug Interaction Guide For SSRI Antidepressants
The following is a list of interactions between SSRI antidepressants and other common medications/drugs.
| SSRI Interactions With: |
Interaction of SSRI antidepressants with other antidepressants
| Interaction of SSRI antidepressants with | Results in |
| tricyclic and tetracyclic antidepressants | SSRls can cause TCA levels to increase. Abnormal heart rhythms can result. |
| SSRI antidepressants | Not usually combined. Increase in SSRI blood levels can result. |
| Monoamine oxidase inhibitors (MAOls) | Serotonin syndrome - This is a dangerous and potentially fatal syndrome which includes rapid changes in vital signs (fever, oscillations in blood pressure), sweating, nausea, vomiting, rigid muscles, myoclonus, agitation, delirium, seizures, and coma. |
| Serotonin antagonists [trazodone (Desyrel) and nefazodone (Serzone)] | Blood levels of nefazodone or trazodone and their metabolite (mCPP) may increase and cause anxiety |
| Bupropion (Wellbutrin) | Increased risk of seizures; caution required |
| Venlafaxine (Effexor) | May cause increase in levels of venlafaxine |
Interaction of SSRI antidepressants with
Antihistamines
| Interaction of SSRI antidepressants with | Results in |
| Terfenadine (Seldane) and astemizole (Hismanal) | Fluvoxamine (luvox) may increase levels of terfenadine and astemizole. Fatal heart rhythms can occur |
| Cyproheptadine (Periactin) | May reverse the effects of SSRls |
Interaction of SSRI antidepressants with Diabetes Medications
| Interaction of SSRI antidepressants with | Results in |
| Tolbutamide (Orinase) | Fluvoxamine (luvox) may increase levels of tolbutamide. Low blood sugar may result. |
| Insulin | Fluvoxamine (luvox) may cause decrease in blood sugar; insulin levels may need to be adjusted |
Interaction of SSRI antidepressants with Heart and Blood-Pressure Medications
| Interaction of SSRI antidepressants with | Results in |
| Gigoxin (Lanoxin) and digitoxin (Crystodigin) | Increase in blood levels of digitoxin and potential toxic effects including mental confusion. |
| Medications for high blood pressure | Levels of beta-blockers including metoprolol (Lopressor) and propranolol (Inderal) also used for angina may increase, leading to excessive heart slowing and ECG abnormalities. Calcium channel blockers including nifedipine (Procardia) and verapamil (Calan) may also increase, leading to more potent effects on blood pressure. |
| Medications for abnormal heart rhythms | SSRI may raise the risk of abnormal heart rhythms when combined with drugs to control heart rhythms, such as flecainide (Tambocor), encainide, mexiletine (Mexitil), and propafenone (Rythmol) |
Interaction of SSRI antidepressants with Other Psychiatric Drugs
| Interaction of SSRI antidepressants with | Results in |
| Benzodiazepines (minor tranquilizers) including alprazolam (Xanax), diazepam (Valium) and others | Levels of benzodiazepines may increase. Excessive drowsiness or confusion. Lower doses of benzodiazepines may be needed, fluvoxamine (Luvox) has strongest effect, but problems have also been reported with fluoxetine (Prozac). Clonazepam (Klonopin) and temazepam (Restoril) may be safer than alprazolam (Xanax) and diazepam (Valium). |
| Buspirone (BuSpar) | May enhance the effects of SSRIs. However, fluoxetine (Prozac) may reduce the effectiveness of BuSpar. Some patients with obsessive compulsive disorder who received this combination experienced a worsening of symptoms |
| Lithium | Can either increase or decrease levels. May lead to lithium toxicity at normal lithium levels |
| L-tryptophan | Can cause agitation, restlessness, and upset stomach as well as the serotonin syndrome |
| Major tranquilizers (neuroleptics) such as haloperidol (Haldol), perphenazine (Trilafon) and thioridazine (Mellaril) | Blood levels of major tranquilizer may increase leading to increased side
effects.
F R |
| Methadone (Dolophine) | Fluvoxamine (Luvox) leads to increase in blood levels. |
| Mood stabilizers and anticonvulsants | SSRls [particularly fluvoxamine (Luvox) and fluoxetine (Prozac)] can cause increase in levels of carbamazepine (Tegretol) and phenytoin (Dilantin). The combination of either SSRI with phenytoin can cause phenytoin toxicity. |
Interaction of SSRI antidepressants with Other Medications
| Interaction of SSRI antidepressants with | Results in |
| Alcohol | Increased drowsiness |
| Caffeine |
fluvoxamine (Luvox) causes levels to increase. Excess nervousness may result. |
| Cisapride (Propulsid) |
Fluvoxamine (Luvox) may increase levels of cisapride.
F |
| Cyclosporine (Sandimmune; Neoral) (an immunosuppressive drug used in organ transplants) - | Levels of cyclosporine may increase |
| Dextromethorphan (a cough suppressant in many over-the-counter medications) | Experienced h |
| Tacrine (Cognex) | Fluvoxamine (Luvox) leads to increase in blood levels |
| Theophylline (Bronkaid) | Fluvoxamine (Luvox) leads to increase in blood levels and can produce toxic , effects, including excess nervousness. |
| Tobacco (smoking) | Levels of fluvoxamine (Luvox) may decrease |
| Warfarin (Coumadin) (a blood thinner) | Fluvoxamine (Luvox) may increase levels of warfarin (Coumadin). Increased bleeding may result. The increased bleeding can also result without any changes in the prothrombin test (this bleeding test is used to monitor the dose of warfarin). |
Source: David D. Burns, M.D.: The Feeling Good Handbook ( Plume)
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