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The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotoninExamples include street drugs such as MDMAecstasyStJohn’s wortcertain antidepressantsincluding other SSRIs such as fluoxetine/paroxetineSNRIs such as duloxetine/venlafaxinetryptophanamong othersThe risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.
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You should not stop using fluvoxamine suddenlyFollow your doctor’s instructions about tapering your dose.
All SSRIsincluding fluvoxamineshould not be taken with any of the monoamine oxidase inhibitorMAOIclass of antidepressants such as isocarboxazidMarplanphenelzineNardiltranylcypromineParnateand procarbazineMatulaneother drugs that inhibit monoamine oxidase such as linezolidZyvoxand intravenous methylene blueSuch combinations may lead to confusionhigh blood pressuretremorand increased activityFluvoxamine should not be administered within 14 days of discontinuing an MAO inhibitorand MAO inhibitors should not be administered within 14 days of stopping fluvoxamineSimilar reactions occur if fluvoxamine is combined with other drugsfor exampletryptophanStJohn’s wortmeperidineDemeroland tramadolUltramthat increase serotonin in the brainFluvoxamine can inhibit the elimination of clozapineClozarilnecessitating dosage reductions of clozapineFluvoxamine also may inhibit the elimination and increase the blood levels of theophyllineTheodurUniphylalprazolamXanaxand triazolamHalcionleading to side effects from these drugsFluvoxamine may increase the effect of warfarinCoumadinJantovenleading to excessive bleedingWarfarin therapy should be monitored more frequently in patients who also are taking fluoxetineCombining SSRIs with aspirinnonsteroidal anti-inflammatory drugs or other drugs that affect bleeding may increase the likelihood of upper gastrointestinal bleedingFluvoxamine may increase blood levels of tizanidineZanaflexthioridazineMellarilalosetronLotronexand pimozideOrapleading to increased side effects of these drugs.
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