Interactions between ramelteon and Luvox cr (fluvoxamine)
fluvoxamine and ramelteon (Major Drug-Drug)
GENERALLY AVOID: Coadministration with fluvoxamine may significantly increase the plasma concentrations and pharmacologic effects of ramelteon. The mechanism is fluvoxamine inhibition of ramelteon metabolism via CYP450 1A2. According to the product labeling for ramelteon, pretreatment with fluvoxamine (100 mg orally twice daily for 4 days) increased the peak plasma concentration (Cmax) and systemic exposure (AUC) of ramelteon (16 mg single oral dose on day 4) by an average of 70- and 190-fold, respectively, compared to administration of ramelteon alone.
MANAGEMENT: Given the magnitude of the interaction, ramelteon should not be prescribed in combination with fluvoxamine. Other SSRIs such as citalopram, escitalopram, fluoxetine, paroxetine, or sertraline may be safer alternatives in ramelteon-treated patients, since they are generally believed to have little, if any, effect on CYP450 1A2.
