Drug
Fluvoxamine
Pronounced
"flew-VOX-uh-meen"
Drug Interactions
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Some products that may interact with this drug are: other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen/naproxen, "blood thinners" such as dabigatran/warfarin).
Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has told you to take low-dose aspirin to prevent heart attack or stroke (usually 81-162 milligrams a day), you should keep taking the aspirin unless your doctor tells you not to. Ask your doctor or pharmacist for more details.
Many drugs besides fluvoxamine may affect the heart rhythm (QT prolongation), including pimozide, thioridazine, among others.
This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include alosetron, clozapine, methadone, melatonin, ramelteon, tacrine, tizanidine, vorasidenib, certain benzodiazepines (such as alprazolam, diazepam, triazolam), tricyclic antidepressants (such as imipramine), among others.
Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.
The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including other SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), tryptophan, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.
This medication can increase the effects of caffeine. Avoid drinking large amounts of beverages containing caffeine (coffee, tea, colas) or eating large amounts of chocolate or taking nonprescription products that contain caffeine.
Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine).
Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
Cigarette smoking decreases blood levels of this medication. Tell your doctor if you smoke or if you have recently stopped smoking.
This medication may interfere with certain medical/lab tests (such as brain scan for Parkinson's disease), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.
Negative Interactions
5- Potential Negative Interaction
Fluvoxamine
5-HTP
Fluvoxamine works by increasing serotonin activity in the brain. 5-HTP (5-Hydroxytryptophan) and L-tryptophan are converted to serotonin in the brain, and taking them with fluvoxamine may increase fluvoxamine-induced side effects. Until more is known, 5-HTP and L-tryptophan should not be taken with any SSRI drug, including fluvoxamine.
- Potential Negative Interaction
Fluvoxamine
Grapefruit
In a study of healthy volunteers, ingestion of 250 ml (approximately 8 ounces) of grapefruit juice along with fluvoxamine increased the blood level of fluvoxamine by 60%, compared with ingestion of fluvoxamine with water. Because a higher concentration of the drug could increase its adverse effects, individuals should not consume grapefruit or grapefruit juice around the same time they take fluvoxamine.
GrapefruitFluvoxamine- Hori H, Yoshimura R, Ueda N, et al. Grapefruit juice-fluvoxamine interaction: is it risky or not? J Clin Psychopharmacol 2003;23:422-4 [Letter].
- Potential Negative Interaction
Fluvoxamine
L-Tryptophan
Fluvoxamine works by increasing serotonin activity in the brain. 5-HTP (5-Hydroxytryptophan) and L-tryptophan are converted to serotonin in the brain, and taking them with fluvoxamine may increase fluvoxamine-induced side effects. Until more is known, 5-HTP and L-tryptophan should not be taken with any SSRI drug, including fluvoxamine.
- Potential Negative Interaction
Fluvoxamine
Pomegranate
Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice. The degree of inhibition is about the same for each of these juices. Therefore, it would be reasonable to expect that pomegranate juice might interact with fluvoxamine in the same way that grapefruit juice does.
PomegranateFluvoxamine- Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. Am J Cardiol 2006;98:705-6.
- Summers KM. Potential drug-food interactions with pomegranate juice. Ann Pharmacother 2006;40:1472-3.
- Potential Negative Interaction
Fluvoxamine
St. John’s Wort
One report describes a case of serotonin syndrome in a patient who took St. John’s wort and trazodone, a weak SSRI drug. The patient experienced mental confusion, muscle twitching, sweating, flushing, and ataxia. In another case, a patient experienced grogginess, lethargy, nausea, weakness, and fatigue after taking one dose of paroxetine (Paxil®, an SSRI drug related to fluvoxamine) after ten days of St. John’s wort. Until more is known about interactions and adverse actions, people taking any SSRI drugs, including fluvoxamine, should avoid St. John’s wort, unless they are being closely monitored by a doctor.
St. John’s WortFluvoxamine- Demott K. St. John's wort tied to serotonin syndrome. Clinical Psychiatry News 1998;26:28.
- Gordon JB. SSRIs and St. John's wort: possible toxicity? Am Fam Physician 1998;57:950.
Supportive Interactions
2- Support Medicine
Fluvoxamine
Yohimbe
The alkaloid yohimbine (Pausinystalia yohimbe) from the African yohimbe tree affects the nervous system in a way that may complement fluvoxamine. One report studied depressed people who had not responded to fluvoxamine. When 5 mg of yohimbine was added three times each day, there was significant improvement. Some people required higher amounts of yohimbine before their depression improved. Because yohimbine can have side effects, it should only be taken under a doctor’s supervision. Yohimbine is a prescription drug, but standardized extracts of yohimbe that contain yohimbine are available as a supplement.
- Reduce Side Effects
Fluvoxamine
Ginkgo
Ginkgo biloba extract may reduce the side effects experienced by some persons taking SSRIs such as fluoxetine or sertraline. An open-label study with elderly, depressed persons found that 200 to 240 mg of ginkgo daily was effective in alleviating sexual side effects in both men and women taking SSRIs.
One case study reported that 180–240 mg of GBE daily reduced genital anesthesia and sexual side effects secondary to fluoxetine use in a 37-year-old woman.
GinkgoFluvoxamine- Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998;24:139-45.
- Ellison JM, DeLuca P. Fluoxetine-induced genital anesthesia relieved by Ginkgo biloba extract. J Clin Psychiatry 1998;59:199-200.
Explanation Required
1- Needs Explanation
Fluvoxamine
Melatonin
Fluvoxamine has been shown to significantly raise the amount of melatonin in the blood after oral administration. Researchers suggest that fluvoxamine may inhibit elimination of melatonin, but the clinical significance of this finding is as yet unclear.
MelatoninFluvoxamine- Härtter S, Grözinger M, Weigmann H, et al. Increased bioavailability of oral melatonin after fluvoxamine coadministration. Clin Pharmacol Ther 2000;67:1-6.