Psychiatric Drug Reactions and Interactions
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Observe seizure frequency Fluoxetine Antiepileptics, carbamazepine and phenytoin Increased plasma concentrations of carbamazepine and phenytoin with fluoxetine Monitor plasma concentrations of carbamazepine and phenytoin. Adjust dose if necessary. No similar reports with paroxetine and an interaction appears unlikely with citalopram. Paroxetine Antiepileptics, carbamazepine and phenytoin Reported to decrease plasma concentration of paroxetine Clinical significance not clear.
Washout periods essential when switching.
Serotonin syndrome reported with concurrent use Use the combination of tramadol and an SSRI very cautiously especially at high doses. Alternative analgesic may be preferable All Tricyclic antidepressants Increased plasma concentrations of TCA and increased adverse effects. Risk of serotonin syndrome especially with clomipramine Increases are variable but can be in the order of 3—4 times and more. Increases usually less significant or negligible with citalopram. If the combination is judged necessary, start with the lowest dose of TCA and monitor for dose related adverse effects, e.
Cases of serotonin syndrome with fluoxetine reported Monitor for symptoms of serotonin syndrome. Reduce dose if necessary All Lithium Neurotoxic symptoms and serotonin like syndrome occasionally reported Addition of lithium to an SSRI can be beneficial and is usually uneventful.
Observe for adverse effects All Selegiline Hypertension, CNS excitation, serotonin syndrome Avoid this combination as serious interactions have been reported. Manufacturers advise to avoid. Occasional reports of serotonin syndrome Concurrent use of sumatriptan and SSRIs not usually a problem but monitor for any adverse effects when the combination is started.
Serotonin syndrome possible, especially with clomipramine Increases are variable but can be in the order of 3 — 4 times and more. Limit alcohol intake Antiarrhythmic drugs, e. Refer to specialised texts. CNS depressants e. Benzodiazepines Antihistamines Antipsychotics Increased CNS depression, sedation Warn patient about increased drowsiness Clonidine Antihypertensive effects of clonidine are reduced or abolished Avoid concurrent use Warfarin Occasional reports of changes in INR Evidence for an interaction is poor and inconclusive.
Monitor INR as normal Lithium Neurotoxic symptoms and serotonin-like syndrome occasionally reported Concurrent use can be beneficial and is usually uneventful. Monitor for increased dose related adverse effects. Reduce dose of TCA if necessary.
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Tramadol Increased risk of seizures. Possibility of serotonin syndrome especially with clomipramine Adverse effects unlikely but be aware of symptoms. Comments There are currently no comments for this article. Make a comment:. Please login to make a comment. This article is 12 years and 6 months old.
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Fluoxetine and paroxetine may reduce metabolism of some benzodiazepines. Increased INR and increased bleeding risk due to antiplatelet effect. Monitor INR and advise patients to report signs of bleeding. Monitor heart rate. Interaction not reported with citalopram. Serotonin syndrome and lowering of seizure threshold theoretically possible.
Unlikely to be a problem if epilepsy well controlled. Observe seizure frequency. Increased plasma concentrations of carbamazepine and phenytoin with fluoxetine. Monitor plasma concentrations of carbamazepine and phenytoin. Reported to decrease plasma concentration of paroxetine. Clinical significance not clear. Monitor clinical response. Concurrent use not contraindicated but be aware of increased risk of bleeding especially in those with additional risk factors. Monoamaine oxidase inhibitors MAOIs , including moclobemide.
Avoid concurrent use.
Refer to product prescribing information and reference texts. Increased plasma concentrations of antipsychotics. Monitor for dose related adverse effects and reduce dose of antipsychotic if necessary. Both tramadol and SSRIs lower seizure threshold. Serotonin syndrome reported with concurrent use.
Overview of Adverse Drug Reactions - Drugs - MSD Manual Consumer Version
Use the combination of tramadol and an SSRI very cautiously especially at high doses. Alternative analgesic may be preferable.
Increased plasma concentrations of TCA and increased adverse effects. Toxic epidermal necrolysis. Ventricular tachycardia. Merck and Co. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Manual was first published in as a service to the community.
Learn more about our commitment to Global Medical Knowledge. Common Health Topics. Prevalence of adverse drug reactions. Common adverse drug reactions.
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Test your knowledge. The effect a drug has on a person may be different from what is expected. Which of the following is NOT considered to be a major factor in the effect a drug has on a particular person? Some people have difficulty breathing due to illnesses which constrict their airways such as asthma. Medications for these respiratory symptoms can be given by inhalation. Common types of Add to Any Platform. Click here for the Professional Version.
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