Interactions

Drug-Drug

• Serious, potentially fatal reactions (serotonin syndrome) may occur with MAO inhibitors

• Smoking may ↓ effectiveness of fluvoxamine

• Concurrent use with tricyclic antidepressants may ↑ plasma levels of fluvoxamine

• Drugs that affect serotonergic neurotransmitter systems, including linezolid , tramadol , and triptans, ↑ risk of serotonin syndrome

• ↓ metabolism and may ↑ effects of some beta blockers ( propranolol ), alosetron (avoid concurrent use), some benzodiazepines (avoid concurrent diazepam ), carbamazepine , methadone , lithium , theophylline (↓ dose to 33% of usual dose), ramelteon (avoid concurrent use), warfarin , and l-tryptophan

• ↑ risk of bleeding with NSAIDS , aspirin , clopidogrel , or warfarin

• ↑ blood levels and risk of toxicity from clozapine (dosage adjustments may be necessary)

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