Section 3.2.1.1 Drug Description Tables

Drug Description Table 1

I am Precipitant Drug

Object Drug

Description

Azole Antifungals

Citalopram

Inc.

Concurrent use may increase citalopram levels

Cimetidine

SSRI(Paroxetime, Sertraline)

Inc.

Cimetidine increased steady state paroxetine concentrations by-%50 Cimetidine

Increases Sertraline AUC (50%) cmax(24%) and half-life (26%)

Cyproheptadine

SSRI(Fluoxetine, Paroxetine)

Inc.

The pharmacologic effects of SSRI's may be decreased or reversed

Macrolides

(Erythromycin)

Citalopram

Inc.

Concurrent use may increase Citalopram levels.

MAOI

SSRI's

Inc.

Serious, sometimes fatal, reactions have occurred in patients receiving SSRI's in combinations with an MAOI an in patients who have recently discontinued the SSRI and then are started on an MAOI.

Barbiturates

SSRI(paroxetine)

Dec.

Phenobarbital decreased the AUC and half-life paroxetine by 25% and 38% respectively.

Phenytoin

SSRI(Paroxetine)

Dec.

Phenytoin in reduced the AUC and half-life of Paroxetine by 50% and 35% respectively.

SSRI(Paroxetine and Fluoxetine)

Hydantoins

Inc.

Paroxetine reduced the AUC of phenytoin by 12%. Fluoxetine may increase hydantoin levels.

Smoking

SSRI(Fluvoxamine)

Dec.

Smokers had a 25% increase in the metabolism of fluvoxamine

L-tryptophan

SSRI(Fluvoxamine, Fluoxetine, Paroxeline)

Inc.

Concurrent use with fluoxetine or paroxetine may produce symptoms related to both central toxicity(e.g.headache, sweating, dizziness, agitation, restlessness),and peripheral toxicity(GI e.g. nausea, vomiting) concomittant use is not recommended. Tryptophan may enhance the sertonergic effect of fluvoxamine;use the combination with caution severe vomiting has been reproted with the coadministration of fluvoxamine and tryptophan

SSRI's

Alcohol

Inc/Dec

Although potentiation of impairment of mental and motor skills caused by alcohol has not occurred, concurrent use is not recommended in depressed patients.

SSRI's

Tricyclic Antidepressants

Inc.

Plasma TCA levels may be increased. Use caution when coadministering. Monitor TCA levels, may need to reduce TCA dose.

SSRI's

Sedating/Cisapride

Inc.

Plasma levels of Cisapride may be increased, resulting in QT prolongation or torsades de pointes, sometimes fatal. DO NOT USE CONCURRENTLY. Certrazine, fexofenadine, or loratadine may be safe alternative.

SSRI's (Fluvoxamine, Sertraline, Fluoxetine)

Benzodiazepines

Inc.

Clearance of benzodiazepines metabolized by hepatic oxidation may be decreased;those metabolized by glucuronidation are unlikely to be affected. Coadministration of alprazolam andfluoxetine has resultedin increased alprazolam levels and decreased psychomotor performances. Halve the initial alprazolam dose, and titrate to the lowest effective dose

SSRI's

(Fluvoxamine,Citalopram)

Beta blockers

Inc.

Minimal propranolol levels has increased 5-fold;a slight potentiation of propranolol-induced reduction in heart rate and exercise diastolic blood pressure has occurred. Bradycardia and hypotensoin and a second case of orthostatic hypotension occurred with metoprolol, Atenolol levels were not affected. If coadministering, reduce initial beta blocker dose and be cautious in dose titration.

SSRI's (Fluoxetine, Fluvoxamine)

Buspirone

Dec.

Effects of buspirone may be decreased. Plasma concentrations may be increased with fluvoxamine but clinical response may be decreased. Paradoxical worsening of OCD has occurred.

SSRI(Fluoxetine, Fluvoxamine, Citalopran)

Carbamazepine

Inc.

Serum carbamazepine levels may be increased with Fluoxetine or fluvoxamine possibly resulting in toxicity. The clearance of Citalopram may be increased.

Drug Description Table 2

Precipitant Drug

Object Drug

Description

SSRI (Fluoxetine)

Cyclosporin

Inc.

An elevated cyclosporin trough was reported in a 59-year old patient during concomitteant administration

SSRI (Fluvoxamine)

Diltiazenn

Inc.

Bradycardia has occurred with concurrent use.

SSRI's (Fluoxetine, Paroxetine)

Digoxin

Dec.

Paroxetine decreased the AUC of digoxin by 15%. The concurrent administration of paroxetine and digoxin should be undertaken with caution.

SSRI's (Fluvuxamine, Fluoxetine)

Haloperidol

Inc.

Serum concentrations of haloperidol may be increased, recall memory and allentional function tests may be delayed.

SSRI's (Fluoxetine, Fluvoxamine, Citalopram)

Lithium

Inc/Dec.

Lithium levels may be increased or decreased by fluoxetine with possible neurotoxicity and serotonergic effects. In healthy volunteers, sertraline did no affect lithium levels. It is recommended that plasma lithium levels be monitored following initiation of sortraline, fluoxetine, and italopram with appropriate adjustments to lithium dose. Although no significant pharmacokinetic effects have been demonstrated, monitor plasma lithium levels. Concurrent use may enhance serotonergic effects of ciralopram. use caution with co-administering. Lithium may enhance the serotonergic effects of Huvoxamine, Use with caution in combination. seizures have been reported.

Lithium

SSRI (Fluvoxamine)

Inc.

SSRI (Fluvoxamine)

Methadone

Inc.

Significantly increased methadone (Plasma level: dose) ratios have occurred. One patient developed opioid intoxication, another had opioid withdrawl symptoms with fluvoxamine discontinuation.

SSRI's (Fluoxeine)

Pimozide

Inc.

A single case report has suggested possible additive effects of pimozide and fluoxetine leading to bradycardia.

SSRI (Paroxetine)

Procyclidine

Inc.

Paroxetine increased the AUC, cmax and cmin of procyclidine by 35%, 36% and 67% respectively. Reduce procyclidine dose if anticholinergic effects occur.

SSRI's

St.John's Wort

Inc.

Increased sedative-hypnotic effects may occur

SSRI(Paroxetine, fluvoxamune)

Sumatriptan

Inc.

Weakness, hyperreflexia, and incoordination have occurred with co-administration Observe patient closely.

SSRI(Fluvoxamine)

Sympathomimetics

Inc.

Increased sensitivity to effect of sympathomimetics and increased serotonin sympathomimetics may occur.

SSRI's(Fluvoxamine)

Tacrine

Inc.

Plasma tacrine concentrations may be elevated, increasing the pharmacologic and adverse effects.

SSRI(Fluvoxamine, Paroxetine)

Theophylline

Inc.

Clearance of theophylline may be decreased by 3-fold. Reduce dosage. Elevated theophylline level have occurred with paroxetine. It is Recommended that theophylline levels be monitored when these drugs are concurrently administered.

SSRI(Sertraline)

Tolbutamude

Inc.

In one study sertraline significantly decreased the clearance of Tolbutamude(16%) Clinical significance is unkown

SSRI's

Warfarim

Inc.

A pharmacodynamic interaction of altered anticoagulant effects including increased bleeding diathesis with unalterd prothrombin time (PT) may occur with paroxetine or fluoxetine.Concurrent administration of sertraline and warfarin and citalopram has resulted in an 8% and 5% increase in PT respectively, and delayed PT normalization. Fluvoxamine increased warfarin plasma levels by 98%. PT was prolonged.Monitor PT. Use caution with concomittant administration and monitor patient.

Inc. = Object drug increased Dec.= Object drug decreased Inc/Dec. = Undetermined clinical effect

Reference: Facts and Comparisons Jan. 2000