Fluvoxamine Grapefruit juice

Others Acetaminophen, amiodarone, carbamazepine, delavirdine, efavirenz, nevirapine, quinidine, repaglinide, sildenafil, tadalafil, trazodone, vardenafil Amiodarone, amprenavir, atazanavir, ciprofloxacin, cisapride, clarithromycin, diltiozem, erythromycin, fluconazole, fluvoxamine, grapefruit juice (in high ingestion), indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, norfloxacin, ritonavir, telithromycin, troleandomycin, verapamil, voriconazole Carbamazepine, efavirenz, glucocorticoids, macrolide antibiotics, nevirapine, phenytoin, phenobarbital, rifabutin, rifapentine, rifampin, St. John s wort... 

Clinically important, potentially hazardous interactions with alcohol, aprepitant, clarithromycin, CNS depressants, delavirdine, digoxin, efavirenz, fluconazole, fluoxetine, fluvoxamine, grapefruit juice, indinavir, itraconazole, ivermectin, kava, ketoconazole, propoxyphene, ritonavir, saquinavir, St John s wort... 

HIV protease inhibitors Indinavir Nelfinavir Ritonavir Saquinavir Amiodarone not Azithromycin Cimetidme Clarithromycin . Diltiazem Erythromycin Fluoxetine Fluvoxamine Grapefruit Juice Itraconazole Ketoconazole Mibefradil Nefezodone Troleandomydn Verapamil... 

Clarithromycin, danazol, diltiazem, erythromycin, fluconazole, fluvoxamine, grapefruit juice, itraconazole, ketoconazole, methylprednisolone, methyltestosterone, nicardipine, norethisterone, protease inhibitors, verapamil... 

The use of many inhibitors of the cytochrome P450 isoenzyme CYP3A4 with pimozide is contraindicated since they are expected to increase plasma levels of pimozide, which is likely to result in QT prolongation and associated arrhythmias. The manufacturers specifically mention azole antifungals, fluvoxamine, grapefruit juice, nefazodone, protease inhibitors, and zileuton. Drugs that are known to cause clinically relevant CYP3A4 inhibition are listed in Table 1.4 , (p.6). 

Quetiapine 3A4 2D6, 2C9 Carbamazepine and phenytoin topiramate prednisolone. Fluvoxamine fluoxetine sertraline (high dose) CYP3A4 substrates grapefruit juice. 

Tolterodine undergoes hepatic metabolism involving CYP450 2D6 and 3A4 isoenzymes. Therefore, elimination can be impaired by CYP450 3A4 inhibitors including fluoxetine, sertraline, fluvoxamine, macrolide antibiotics, imidazoles, and grapefruit juice. 

Hori H, Yoshimura R, Ueda N, et al. Grapefruit juice-fluvoxamine interaction— is it risky or not J Clin Psychopharmacol 2003 23(4) 422-424. 

Drugs that have been shown, or would be expected, to increase plasma carbamazepine levels include cimetidine, danazol, diltiazem, macrolides, erythromycin, troleandomycin, clarithromycin, fluoxetine, fluvoxamine, nefazodone, loratadine, terfenadine, isoniazid, niacinamide, nicotinamide, propoxyphene, azoles (e.g., ketaconazole, itraconazole, and fluconazole), acetazolamide, verapamil, grapefruit juice, ... 

Drugs that may inhibit cytochrome P450 metabolism of other drugs include amiodarone, androgens, atazanavir, chloramphenicol, cimetidine, ciprofloxacin, clarithromycin, cyclosporine, delavirdine, diltiazem, diphenhydramine, disulfiram, enoxacin, erythromycin, fluconazole, fluoxetine, fluvoxamine, furanocoumarins (substances in grapefruit juice), indinavir, isoniazid, itraconazole, ketoconazole, metronidazole, mexile-tine, miconazole, nefazodone, omeprazole, paroxetine, propoxyphene, quinidine, ritonavir, sulfamethizole, verapamil, voriconazole, zafirlukast, and zileuton. 

Ozdemir V, Kalow W, Okey AB, Lam MS, Albers LJ, Reist C, Fourie J, Posner P, Collins EJ, Roy R. Treatment-resistance to clozapine in association with ultrarapid CYP1A2 activity and the C A polymorphism in intron 1 of the CYP1A2 gene effect of grapefruit juice and low-dose fluvoxamine. J Clin Psychopharmacol 2001 21 603-607. 

FLUVOXAMINE, SERTRALINE GRAPEFRUIT JUICE Possibly t efficacy and t adverse effects Possibly 1 metabolism Clinical significance unclear... 

Increased depressive effects when taken with other CNS depressants Inhibitors of CYP450 3A, such as nefazodone, fluvoxamine, fluoxetine, and even grapefruit juice, may decrease clearance of alprazolam and thereby raise alprazolam plasma levels and enhance sedative side effects alprazolam dose may need to be lowered... 

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... 

The future of psychopharmacotherapy may include creative dietary or other pharmacological manipulations of the CYP enzyme system to achieve a positive treatment response. Recently, it was demonstrated that levels of cyclosporine (an expensive immunosuppressive agent) were dramatically increased in patients who were concomitantly administered grapefruit juice (Hollander et al. 1995). In other studies, paroxetine and fluoxetine were used to raise desipramine levels in superextensive me-tabolizers who were nonresponsive to standard doses (Kraus et al. 1996). Also, the authors used fluvoxamine to augment olanzapine and clozapine concentrations when a lack of response was obtained at standard or upper-level doses. Because per-pill costs of many of today s newer-generation psychoactive compounds often prove prohibitive, use of dietary and pharmacological CYP inhibitors could have significant pharmacoeconomic implications. 

Grapefruit juice appears to raise fluvoxamine levels, which resuited in adverse effects in one patient. Sertraline plasma levels are also increased by grapefruit juice. 

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