4- Fluvoxamine Foods

FLUVOXAMINE FOOD-CHARGRILLED MEAT, BROCCOLI, CABBAGE, SPROUTS 1 plasma concentrations of fluvoxamine with loss of therapeutic efficacy Fluvoxamine and fluoxetine are metabolized mainly by CYP1A2 isoenzymes, while the role of CYP1A2 in the metabolism of sertraline is probably not clinically significant Monitor for lack of therapeutic effect. When inducers are withdrawn, monitor for fluvoxamine toxicity... 

Time to reach peak plasma level decreased from 8 hours post-dosing to 5.5 hours. Food does not appear to affect systemic bioavailability of fluoxetine although it may delay absorption. Fluvoxamine and citalopram bioavailability is not affected by food. Thus, fluoxetine, fluvoxamine, and citalopram may be given with or without food. 

Ramelteon is affected by alcohol, azole antifungals, fluvoxamine, and rifampin. Drug/Food interactions Ramelteon should not be taken with or immediately after a high-fat meal. 

Bromocriptine (Parl el) [Antiparkinsonian Agent/Dopamine Receptor Agonist] Uses Parkin on Dz, hyperprolactinemia, acromegaly, pituitary tumors Action Direct-acting on the striatal dopamine receptors X prolactin secretion Dose Initial, 1.25 mg PO bid titrate to effect, w/ food Caution [B, ] Contra Severe ischemic heart Dz or PVD Disp Tabs, caps SE X BP, Raynaud phenomenon (vasospastic disorder resulting in discoloration of the fmgers/toes), dizziness, N, hallucinations Interactions T Effects W/ erythromycin, fluvoxamine, nefazodone, sympathomimetics, antihypertensives X effects W/ phenothiazines, antipsychotics EMS Monitor BP may cause intolerance to EtOH OD May cause NA, severe hypotension give IV fluids symptomatic and supportive... 

Substrates Inhibitors Inducers CYP1A2 Acetaminophen, caffeine, clozapine, imipramine, theophylline, propranolol Most fluoroquinolone antibiotics, fluvoxamine, cimetidine Tobacco smoking, charcoal-broiled foods, cruciferous vegetables, omeprazole... 

The prototypical serotonin reuptake inhibitor (SRI) medication is the non-selective agent clomipramine, a tricyclic antidepressant (TCA). The Selective SRIs (SSRIs) include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and citalo-pram (Celexa). The Food and Drug Administration (FDA) approved clinical indications for these medications are described in Table 22.1. 

The selective serotonin reuptake inhibitors (SSRls) have received increased attention in the treatment of anxiety disorders. With the recent Food and Drug Administration (FDA) approval of fluoxetine and fluvoxamine in the treatment of obsessive-compulsive disorder, it has been made clear that this... 

Nausea Usually transient and dose-related. May improve with dose reduction or symptomatic measures (e.g., food, antacids, addition of drugs that block 5-HT 3 receptors, such as cisapride). There has been increasing concern about using cisapride in combination with antidepressants that can substantially inhibit CYP 3A3/4 (i.e., fluvoxamine, nefazodone). The reason is that high levels of cisapride can cause arrhythmias as a result of delayed intracardiac conduction. 

A2 Acetaminophen, antipyrine, caffeine, clomipramine, phenacetin, tacrine, tamoxifen, theophylline, warfarin Smoking, charcoal-broiled foods, cruciferous vegetables, omeprazole Galangin, furafylline, fluvoxamine... 

CANNABIS FLUVOXAMINE 1 levels, with risk of therapeutic failure Induction of CYP1 A2-mediated metabolism by any form of smoking. Foods (e.g. broccoli, cabbage, Brussels sprouts, chargrilled meat) also induce this isoenzyme Watch for poor response to fluvoxamine conversely, watch for toxic effects if a previously heavy cannabis user stops smoking... 

Use with CYP450 3A4 inhibitors (e.g., drugs such as fluoxetine, sertraline, fluvoxamine, and nefazodone foods such as grapefruit juice) can raise pimozide levels and increase the risks of dangerous arrhythmias... 

Clinically important, potentially hazardous interactions with amitriptyline, amoxapine, amphetamines, bupropion, citalopram, clomipramine, cyproheptadine, desipramine, dextroamphetamine, dextromethorphan, diethylpropion, dopamine, doxepin, entacapone, ephedrine, epinephrine, fluoxetine, fluvoxamine, imipramine, levodopa, mazindol, meperidine, methamphetamine, nefazodone, nortriptyline, paroxetine, phendimetrazine, phentermine, phenylephrine, phenylpropanolamine, pizotifen, protriptyline, pseudoephedrine, rizatriptan, sertraline, sibutramine, sumatriptan, sympathomimetics, tramadol, tricyclic antidepressants, trimipramine, tryptophan, tyramine-containing foods, venlafaxine, zolmitriptan... 

Dosing and Administration. SSRIs should be initiated at doses similar to those used for the treatment of depression and administered as a single daily dose with or without food (except for fluvoxamine). If the patient suffers from comorbid panic disorder, the SSRI dose should be started at one-fourth or one-half of the normal antidepressant dose. Patients should receive the starting dose for 2 to 4 weeks before it is increased slowly (i.e., paroxetine 10 mg/day and sertraline 50 mg/day) in weekly intervals as necessary to obtain a response. Safety for paroxetine in SAD was demonstrated in doses up to 60 mg/day, but additional therapeutic benefits above 20 mg/day were not shown. The maximum dosage of sertraline used in patients with SAD was 200 mg/day. ... 

The Food and Drug Administration (FDA) has approved five antidepressants for the management of OCD clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline. In adolescents with OCD, CBT is generally selected first for mild OCD, but CBT plus an SSRI (e.g., fluoxetine, fluvoxamine, sertraline, or paroxetine) are used for more severe OCD. In adults, CBT is the initial choice for mild OCD, and CBT plus an SSRI or an SSRI alone is selected for more severe OCD. Figure 70-2 is an algorithm for the treatment of OCD. 

The increase in caffeine levels with concurrent use would seem to be established. There are no reports of caffeine toxicity arising from this interaction and one study found no increase in the pharmacodynamic or adverse effects of caffeine despite a large increase in the levels. However, an increase in the stimulant and adverse effects of caffeine (headache, jitteriness, restlessness, insomnia) may be possible in susceptible patients if they continue to consume large amounts of caffeine-containing food or drinks (tea, coffee, cola drinks, chocolate, etc.) or take caffeine-containing medications. They should be warned to reduce their caffeine intake if problems develop. It has been suggested that some of the adverse effeets of fluvoxamine (i.e. nervousness, restlessness and insomnia) could in fact be caused by caffeine toxicity. However, a preliminary study, as well as the study reported above, found that caffeine intake had a limited effect on the frequency of adverse effects of fluvoxamine. ... 

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