Fluvoxamine Duloxetine

Beta agonists (terbutaline, albuterol) Theophylline Antidepressants Bupropion Citalopram Escitalopram Duloxetine Fluoxetine Fluvoxamine... 

Drugs that may affect duloxetine include inhibitors of CYP1A2 (eg, fluvoxamine, guinolone antibiotics), inhibitors of CYP2D6 (eg, fluoxetine, guinidine, paroxetine), and alcohol. 

A2 Tertiary amine TCAs, duloxetine, theophylline, phenacetin, TCAs (demethylation), clozapine, diazepam, caffeine Fluvoxamine, fluoxetine, moclobemide, ramelteon Tobacco, omeprazole... 

ANTIDEPRESSANTS-duloxetine, modobemide, SSRIs - escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, TCAs - amitriptyline, clomipramine, desipramine, doxepin, imipramine... 

Fluoxetine, paroxetine, bupropion, duloxetine, and other CYP450 2D6 inhibitors may increase TCA concentrations Fluvoxamine, a CYP450 1A2 inhibitor, can decrease the conversion of imipramine to desmethylimipramine (desipramine) and increase imipramine plasma concentrations Cimetidine may increase plasma concentrations of TCAs and cause anticholinergic symptoms Phenothiazines or haloperidol may raise TCA blood concentrations May alter effects of antihypertensive drugs may inhibit hypotensive effects of clonidine... 

Reuptake inhibitors, which include the tricyclic and tetracyclic antidepressants (TCAs and TeCAs),the SSRIs (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), the serotonin and norepinephrine reuptake inhibitors (SNRIs duloxetine, milnacipran, and venlafaxine), and the norepinephrine and dopamine reuptake inhibitor (bupropion). 

The SSRIs normally appear not to interact with the triptans, but there are a few rare cases of dyskinesias when sumatriptan was given with an SSRl, and there is some evidence to surest that the serotonin syndrome may occasionally develop. Venlafaxine and duloxetine are predicted to interact similarly. Fluvoxamine modestly inhibits the metabolism of frovatriptan, and may inhibit the metabolism of zolmitriptan. 

The manufacturers of duloxetine contraindicate the concurrent use of MAOIs because of the theoretical risk of the serotonin syndrome. Similarly they recommend caution with other serotonergic drugs, including the SSRIs, venlafaxine, and tryptophan. Fluvoxamine should not be used with duloxetine, because it markedly increases duloxetine levels. Low-dose paroxetine caused a modest increase in the duloxetine ATJC, and fluoxetine is predicted to interact similarly. 

Fluvoxamine. Fluvoxamine 100 mg daily increased the AUC of duloxetine five- to sixfold, and decreased its clearance by about 77% in 14 healthy subjects. " Similar increases in duloxetine plasma levels were found in 15 healthy subjects who were given fluvoxamine 50 to 100 mg daily and... 

Fluvoxamine is a potent inhibitor of the cytochrome P450 isoenzyme CYPl A2, by which duloxetine is, in part, metabolised. Therefore concurrent use raises duloxetine levels. Although the clinical relevance of the increases in duloxetine levels have not been assessed, the manufacturer considers that the rise with fluvoxamine is so marked that the combination should be avoided. " The UK manufacturers specifically contraindicate concurrent use. - Other SSRIs have minimal effects on this isoenzyme, and would therefore not be expected to interact by this route, but see also paroxetine, below. 

Small D, Loghin C, Lucas R, Knadler MP, Zhang L, Chappell J, Bergstrom R, Callaghan JT. Pharmacokinetic evaluation of combined duloxetine and fluvoxamine dosing in CYP2D6 poor metabolizers. Clin Pharmacol Ther (2005) 77, P37. 

Inhibitors Fluvoxamine , (above), a potent inhibitor of the cytochrome P450 isoenzyme CYP1A2, markedly increases duloxetine levels. The manufaeturers prediet that some quinolones (they name ciprofloxacin and enoxacin) will have the same eifeet and suggest that their eoneurrent use with duloxetine should be avoided. " For a list of elinieally signiiioant CYP1A2 inhibitors, see Table 1.2 , (p.4). 

In a study on the effects of maca for sexual dysfunction induced by selective serotonin reuptake inhibitors (SSRI), patients who were stable on an SSRI (patients were taking escitalopram, citalopram, sertraline, venlafexine, fluoxetine, paroxetine, duloxetine, or fluvoxamine) were orally administered 1.5 or 3 g of maca daily for 12 weeks. No adverse effects of maca, including effects on SSRI efficacy, were reported, and patients in the high dose group had a modest improvement in depression (Dording et al. 2008). 

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