Zolmitriptan Fluvoxamine

Clinically important, potentially hazardous interactions with amitriptyline, amoxapine, bupropion, citalopram, clomipramine, desipramine, doxepin, fluoxetine, fluvoxamine, imipramine, meperidine, nefazodone, nortriptyline, paroxetine, pizotifen, protriptyline, rizatriptan, sertraline, sibutramine, sumatriptan, trimipramine, tryptophan, venlafaxine, zolmitriptan... 

Clinically important, potentially hazardous interactions with desvenlafaxine, dextromethorphan, dihydroergotamine, ephedra, ergot, fluoxetine, fluvoxamine, isocarboxazid, linezolid, lithium, MAO inhibitors, meperidine, methysergide, naratriptan, nefazodone, paroxetine, phenelzine, rizatriptan, sertraline, sumatriptan, tranylcypromine, tryptophan, venlafaxine, verapamil, zolmitriptan, zuclopenthixol... 

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. 

A two-period crossover, double-blind study in 20 subjects given fluoxetine 20 mg or a placebo daily for 28 days, with zolmitriptan 10 mg on day 28, found that the pharmacokinetics of zolmitriptan were unaffected by fluoxetine. Only very slight changes were seen in the pharmacokinetics of its active metabolite. Sertraline, paroxetine, and citalopram are also not expected to alter the pharmacokinetics of zolmitriptan. However, fluvoxamine, a CYP1A2 inhibitor, is predicted to increase levels of zolmitriptan, based on the known interaction with cimetidine (see Triptans Zolmitriptan + Cimetidine , p.608). 

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