Fluoxetine
Pronounced
"flew-OX-eh-teen"
Drug Interactions
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Fluoxetine can stay in your body for many weeks after your last dose and may interact with many other medications. Before using any medication, tell your doctor or pharmacist if you have taken fluoxetine in the previous 5 weeks.
Some products that may interact with this drug are: other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen/naproxen, "blood thinners" such as dabigatran/warfarin).
Taking MAO inhibitors with his medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for 2 weeks before and at least 5 weeks after treatment with this medication. Ask your doctor when to start or stop taking this medication.
This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include pimozide, thioridazine, vinblastine, antiarrhythmics (such as propafenone, flecainide), tricyclic antidepressants (such as desipramine, imipramine), among others.
Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has told you to take low-dose aspirin to prevent heart attack or stroke (usually 81-162 milligrams a day), you should keep taking the aspirin unless your doctor tells you not to.
The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including other SSRIs such as citalopram/paroxetine, SNRIs such as duloxetine/venlafaxine), tryptophan, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.
Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine). Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
This medication may interfere with certain medical/lab tests (such as brain scan for Parkinson's disease), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.
Negative Interactions
3- Potential Negative Interaction
Fluoxetine
5-HTP
Fluoxetine works by increasing serotonin activity in the brain. 5-HTP is converted to serotonin in the brain, and taking it with fluoxetine may increase fluoxetine-induced side effects. Until more is known, 5-HTP should not be taken with any SSRI drug, including fluoxetine.
- Potential Negative Interaction
Fluoxetine
L-Tryptophan
L-tryptophan is an amino acid found in protein-rich foods. Foods rich in L-tryptophan are not believed to cause any problems during fluoxetine use. However, dietary supplements of L-tryptophan taken during fluoxetine treatment have been reported to cause headache, sweating, dizziness, agitation, restlessness, nausea, vomiting, and other symptoms.
L-TryptophanFluoxetine- Threlkeld DS, ed. Central Nervous System Drugs, Antidepressants, Selective Serotonin Reuptake Inhibitors. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1997, 264r-4s.
- Potential Negative Interaction
Fluoxetine
St. John’s Wort
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
There have been no published reports about negative consequences of combining St. John’s wort (Hypericum perforatum) (Hypericum perforatum) (Hypericum perforatum) and fluoxetine. One case has been reported of an interaction between St. John’s wort and a weak serotonin reuptake inhibitor drug known as trazodone that is vaguely similar to fluoxetine. In another case, a patient experienced grogginess, lethargy, nausea, weakness, and fatigue after taking one dose of paroxetine (Paxil®, another SSRI drug) after ten days of St. John’s wort use. Nevertheless, some doctors are concerned about the possibility of an interaction between St. John’s wort and fluoxetine causing side effects (e.g., mental confusion, muscle twitching, sweating, flushing) known collectively as serotonin syndrome. Until more is known about interactions and adverse actions, people taking any SSRI drugs, including fluoxetine, should avoid St. John’s wort, unless they are being closely monitored by a doctor.
St. John’s WortFluoxetine- Demott K. St. John's wort tied to serotonin syndrome. Clinical Psychiatry News 1998;26:28.
- Gordon JB. SSRIs and St. John's wort: possible toxicity? Am Fam Physician 1998;57:950.
- Bekman SE, Sommi RW, Switzer J. Consumer sue of St. John's wort: A survey on effectiveness, safety, and tolerability. Pharmacotherapy 2000;20:568-74.
- Lantz MS, Buchalter E, Giambanco V. St. John's wort and antidepressant drug interaction in the elderly. J Geriatr Psychiatry Neurol 1999;12:7-10.
Supportive Interactions
4- Replenish Depleted Nutrients
Fluoxetine
Melatonin
Administration of fluoxetine for six weeks significantly lowered melatonin levels in people with seasonal affective disorder (SAD) and in healthy persons as well. Further study is needed to determine if this might interfere with sleeping or whether melatonin supplementation might be appropriate.
MelatoninFluoxetine- Childs PA, Rodin I, Martin NJ, et al. Effect of fluoxetine on melatonin in patients with seasonal affective disorder and matched controls. Br J Psychiatry 1995;166:196-8.
- Support Medicine
Fluoxetine
DHEA
DHEA (Dehydroepiandrosterone) supplementation (50 mg per day) has been shown to restore the response of beta-endorphin, a brain chemical involved in pain and pleasure sensations, to fluoxetine. Further research is needed to determine if this drug combination is safe for long-term use.
DHEAFluoxetine- Stomati M, Rubino S, Spinetti A, et al. Endocrine, neuroendocrine and behavioral effects of oral dehydroepiandrosterone sulfate supplementation in postmenopausal women. Gynecol Endocrinol 1999;13:15-25.
- Support Medicine
Fluoxetine
Folic Acid
Low blood levels of folic acid have been correlated to poor response to fluoxetine. Furthermore, the addition of folic acid to fluoxetine appears to enhance the effectiveness of the drug. A double-blind trial found that depressed women receiving 500 mcg of folic acid per day in addition to fluoxetine experienced significant improvement in their symptoms, as well as fewer side effects, compared with women receiving only fluoxetine. Similar results were not observed in men; however, men appear to have a higher requirement for folic acid than do women, so a higher intake may be necessary.
Folic AcidFluoxetine- Fava M, Borus JS, Alpert JE, et al. Folate, vitamin B12, and homocysteine in major depressive disorder. Am J Psychiatry 1997;154:426-8.
- Coppen A, Bailey J. Enhancement of the antidepressant action of fluoxetine by folic acid: a randomised, placebo controlled trial. J Affect Disord 2000 Nov;60(2):121-30.
- Reduce Side Effects
Fluoxetine
Ginkgo
Ginkgo biloba extract (GBE) may reduce the side effects experienced by some persons taking SSRIs such as fluoxetine or sertraline. An open-label study with elderly, depressed persons found that 200–240 mg of GBE daily was effective in alleviating sexual side effects in both men and women taking SSRIs. One case study reported that 180–240 mg of GBE daily reduced genital anesthesia and sexual side effects secondary to fluoxetine use in a 37-year-old woman.
GinkgoFluoxetine- Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998;24:139-45.
- Ellison JM, DeLuca P. Fluoxetine-induced genital anesthesia relieved by Ginkgo biloba extract. J Clin Psychiatry 1998;59:199-200.
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