fluvoxamine-maleate and Clomipramine Interactions

Interactions between fluvoxamine-maleate(fluvoxamine) and Clomipramine (clomiPRAMINE)

clomiPRAMINE and fluvoxamine (Major Drug-Drug)

GENERALLY AVOID: Coadministration with fluvoxamine may significantly increase the plasma concentrations of some tricyclic antidepressants (TCAs). The proposed mechanism is fluvoxamine inhibition of multiple hepatic microsomal enzymes involved in the metabolic clearance of TCAs. Mild to moderate increases in plasma levels have been reported for desipramine, while significant increases of several fold have been reported for clomipramine, imipramine, and trimipramine. Pharmacodynamically, the combination of fluvoxamine (or any other selective serotonin reuptake inhibitor) and a TCA may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5HT1A receptors.

MANAGEMENT: In general, the use of fluvoxamine (or other SSRIs) with TCAs should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Pharmacologic response and plasma TCA levels should be monitored more closely whenever fluvoxamine is added to or withdrawn from therapy in patients stabilized on their existing antidepressant regimen, and the TCA dosage adjusted as necessary. Patients should be monitored closely for signs and symptoms of TCA toxicity (e.g., sedation, dry mouth, blurred vision, constipation, urinary retention) and/or excessive serotonergic activity (e.g., CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia).