SSRIs(continued)
fluvoxamine, paroxetine, sertraline).rTheoretical→Also see
TABLE 9p. 849
▶Fluvoxamineis predicted to increase the exposure to
antiarrhythmics(propafenone). Monitor and adjust dose.
oStudy
▶SSRIs(fluoxetine, paroxetine)are predicted to increase the
exposure toanticholinesterases, centrally acting(galantamine).
Monitor and adjust dose.oStudy
▶Antiepileptics(fosphenytoin, phenytoin)decrease the
concentration ofparoxetine.oStudy
▶Sertralinepotentially increases the risk of toxicity when given
withantiepileptics(fosphenytoin, phenytoin). Monitor
concentration and adjust dose.rAnecdotal
▶SSRIs(fluoxetine, fluvoxamine)are predicted to increase the
concentration ofantiepileptics(fosphenytoin, phenytoin).
Monitor and adjust dose.rAnecdotal
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure todapoxetine. Adjust
dapoxetinedose with moderate inhibitors of CYP3A4.
oTheoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to moderately increase the exposure todapoxetine.
Avoid potent inhibitors of CYP3A4 or adjustdapoxetinedose.
rStudy
▶Antifungals, azoles(voriconazole)are predicted to increase the
exposure tocitalopram.rTheoretical→Also seeTABLE 9
p. 849
▶Antihistamines, sedating(cyproheptadine)potentially decrease
the effects ofSSRIs.oAnecdotal
▶Aprepitantis predicted to increase the exposure todapoxetine.
Adjustdapoxetinedose with moderate inhibitors of CYP3A4.
oTheoretical
▶SSRIs(fluoxetine, paroxetine)are predicted to moderately
increase the exposure toaripiprazole. Adjustaripiprazoledose,
p. 249.oStudy
▶Fluvoxamineincreases the exposure toasenapine.o
Study
▶Paroxetinemoderately increases the exposure toasenapine.
oStudy
▶SSRIs(fluoxetine, paroxetine)are predicted to markedly
increase the exposure toatomoxetine. Adjust dose.r
Study
▶Fluvoxaminemoderately increases the concentration ofbeta
blockers, non-selective(propranolol).oStudy
▶SSRIs(fluoxetine, paroxetine)are predicted to increase the
exposure tobeta blockers, selective(metoprolol, nebivolol).
oStudy
▶Bupropionis predicted to increase the exposure todapoxetine.
oTheoretical→Also seeTABLE 13p. 850
▶Fluvoxaminemarkedly decreases the clearance ofcaffeine
citrate. Monitor and adjust dose.rStudy
▶Calcium channel blockers(diltiazem, verapamil)are predicted to
increase the exposure todapoxetine. Adjustdapoxetinedose
with moderate inhibitors of CYP3A4.oTheoretical
▶SSRIs(fluoxetine, fluvoxamine)are predicted to increase the
exposure tocilostazol. Adjustcilostazoldose.o
Theoretical→Also seeTABLE 4p. 847
▶Cinacalcetis predicted to increase the exposure todapoxetine.
oTheoretical
▶Fluvoxamineis predicted to increase the exposure to
cinacalcet. Adjust dose.oTheoretical
▶SSRIs(fluoxetine, fluvoxamine)potentially increase the
exposure toclobazam. Adjust dose.oTheoretical
▶SSRIs(fluoxetine, fluvoxamine)are predicted to decrease the
efficacy ofclopidogrel. Avoid.rTheoretical→Also see
TABLE 4p. 847
▶Fluvoxamineincreases the concentration ofclozapine. Monitor
side effects and adjust dose.rStudy
▶Cobicistatis predicted to moderately increase the exposure to
dapoxetine. Avoid potent inhibitors of CYP3A4 or adjust
dapoxetinedose.rStudy
▶Crizotinibis predicted to increase the exposure todapoxetine.
Adjustdapoxetinedose with moderate inhibitors of CYP3A4.
oTheoretical▶SSRIs(fluoxetine, paroxetine)are predicted to slightly increase
the exposure todarifenacin.nStudy
▶Fluvoxaminemoderately increases the exposure todiazepam.
oStudy
▶Fluvoxamineis predicted to increase the exposure todopamine
receptor agonists(ropinirole). Adjust dose.oStudy
▶Fluvoxaminemarkedly increases the exposure toduloxetine.
Avoid.rStudy→Also seeTABLE 18p. 851→Also seeTABLE 13
p. 850→Also seeTABLE 4p. 847
▶SSRIs(fluoxetine, paroxetine)are predicted to increase the
exposure toeliglustat. Avoid or adjust dose—consult product
literature.rStudy
▶Fluvoxamineis predicted to increase the exposure toerlotinib.
Monitor side effects and adjust dose.oTheoretical
▶Fluvoxamineincreases the concentration offrovatriptan.
rStudy→Also seeTABLE 13p. 850
▶Grapefruit juicemoderately increases the exposure to
sertraline. Avoid.oStudy
▶H 2 receptor antagonists(cimetidine)slightly increase the
exposure toSSRIs(citalopram, escitalopram). Adjust dose.
oStudy
▶H 2 receptor antagonists(cimetidine)slightly increase the
exposure toSSRIs(paroxetine, sertraline).oStudy
▶Fluoxetineincreases the concentration ofhaloperidol. Adjust
dose.oAnecdotal
▶Fluvoxamineincreases the concentration ofhaloperidol.
Adjust dose.oStudy
▶HIV-protease inhibitorsare predicted to moderately increase
the exposure todapoxetine. Avoid potent inhibitors of
CYP3A4 or adjustdapoxetinedose.rStudy
▶Idelalisibis predicted to moderately increase the exposure to
dapoxetine. Avoid potent inhibitors of CYP3A4 or adjust
dapoxetinedose.rStudy
▶Imatinibis predicted to increase the exposure todapoxetine.
Adjustdapoxetinedose with moderate inhibitors of CYP3A4.
oTheoretical
▶Fluoxetineis predicted to increase the exposure tolomitapide.
Separate administration by 12 hours.qTheoretical
▶Fluvoxamineis predicted to increase the exposure to
lomitapide. Separate administration by 12 hours.o
Theoretical
▶Fluvoxamineis predicted to increase the exposure toloxapine.
Avoid.qTheoretical
▶Macrolides(clarithromycin)are predicted to moderately
increase the exposure todapoxetine. Avoid potent inhibitors
of CYP3A4 or adjustdapoxetinedose.rStudy
▶Macrolides(erythromycin)are predicted to increase the
exposure todapoxetine. Adjustdapoxetinedose with moderate
inhibitors of CYP3A4.oTheoretical
▶Fluvoxaminevery markedly increases the exposure to
melatonin. Avoid.rStudy
▶Netupitantis predicted to increase the exposure todapoxetine.
Adjustdapoxetinedose with moderate inhibitors of CYP3A4.
oTheoretical
▶SSRIspotentially increase the risk of prolonged
neuromuscular blockade when given withneuromuscular
blocking drugs, non-depolarising(mivacurium).q
Theoretical
▶Nilotinibis predicted to increase the exposure todapoxetine.
Adjustdapoxetinedose with moderate inhibitors of CYP3A4.
oTheoretical
▶Fluvoxaminemoderately increases the exposure toolanzapine.
Adjust dose.rAnecdotal
▶SSRIs(fluoxetine, paroxetine)are predicted to decrease the
efficacy ofopioids(codeine).oTheoretical
▶SSRIs(fluoxetine, paroxetine)are predicted to decrease the
efficacy ofopioids(tramadol).rStudy→Also seeTABLE 13
p. 850
▶Fluvoxamineis predicted to increase the exposure to
pentoxifylline.oTheoretical
▶Paroxetinemarkedly increases the exposure tophenothiazines
(perphenazine).rStudy
▶Fluvoxamineis predicted to moderately increase the exposure
topirfenidone. Avoid.oStudy990 SSRIs—SSRIs BNFC 2018 – 2019
Interactions|Appendix 1A1