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Drug Interactions between Carbex and Prozac Weekly

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

FLUoxetine selegiline

Applies to: Prozac Weekly (fluoxetine) and Carbex (selegiline)

CONTRAINDICATED: By inhibiting serotonin metabolism, monoamine oxidase inhibitors (MAOIs) may potentiate the pharmacologic activity of selective serotonin reuptake inhibitors (SSRIs) and increase the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: In general, SSRIs should not be used concurrently with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, procarbazine). At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with SSRIs, and vice versa. Due to the long half-life of fluoxetine and its active metabolite, norfluoxetine, a washout period of 5 weeks minimum is recommended when switching from fluoxetine to an MAOI. Similarly, a washout period of 3 weeks is recommended when switching from vortioxetine to an MAOI.

References

  1. Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7
  2. Schulz R, Antonin KH, Hoffmann E, et al. "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther 46 (1989): 528-36
  3. Kline SS, Mauro LS, Scala-Bennett DM, Zick D "Serotonin syndrome versus neuroleptic malignant death syndrome as a cause of death." Clin Pharm 8 (1989): 510-4
  4. Sternbach H "Danger of MAOI therapy after fluoxetine withdrawal." Lancet 2 (1988): 850-1
  5. Nierenberg DW, Semprebon M "The central nervous system serotonin syndrome." Clin Pharmacol Ther 53 (1993): 84-8
  6. Sternbach H "The serotonin syndrome." Am J Psychiatry 148 (1991): 705-13
  7. Feighner JP, Boyer WF, Tyler DL, Neborsky RJ "Adverse consequences of fluoxetine-MAOI combination therapy." J Clin Psychiatry 51 (1990): 222-5
  8. Suchowersky O, deVries J "Possible interactions between deprenyl and prozac." Can J Neurol Sci 17 (1990): 352-3
  9. Ciraulo DA, Shader RI "Fluoxetine drug-drug interactions. II." J Clin Psychopharmacol 10 (1990): 213-7
  10. Ciraulo DA, Shader RI "Fluoxetine drug-drug interactions: I. Antidepressants and antipsychotics." J Clin Psychopharmacol 10 (1990): 48-50
  11. Graham PM, Ilett KF "Danger of MAOI therapy after fluoxetine withdrawal." Lancet 2 (1988): 1255-6
  12. Bhatara VS, Bandettini FC "Possible interaction between sertraline and tranylcypromine." Clin Pharm 12 (1993): 222-5
  13. "Product Information. Zoloft (sertraline)." Roerig Division PROD (2001):
  14. Suchowersky O, deVries JD "Interaction of fluoxetine and selegiline." Can J Psychiatry 35 (1990): 571-2
  15. "Product Information. Prozac (fluoxetine)." Dista Products Company PROD (2001):
  16. "Product Information. Paxil (paroxetine)." GlaxoSmithKline PROD (2001):
  17. Brannan SK, Talley BJ, Bowden CL "Sertraline and isocarboxazid cause a serotonin syndrome." J Clin Psychopharmacol 14 (1994): 144-5
  18. Graber MA, Hoehns TB, Perry PJ "Sertraline-phenelzine drug interaction: a serotonin syndrome reaction." Ann Pharmacother 28 (1994): 732-5
  19. Ruiz F "Fluoxetine and the serotonin syndrome." Ann Emerg Med 24 (1994): 983-5
  20. "Product Information. Luvox (fluvoxamine)." Solvay Pharmaceuticals Inc PROD (2001):
  21. Phillips SD, Ringo P "Phenelzine and venlafaxine interaction." Am J Psychiatry 152 (1995): 1400-1
  22. Darcy PF, Griffin JP "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev 14 (1995): 211-31
  23. De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5
  24. Fischer P "Serotonin syndrome in the elderly after antidepressive monotherapy." J Clin Psychopharmacol 15 (1995): 440-2
  25. Corkeron MA "Serotonin syndrome - a potentially fatal complication of antidepressant therapy." Med J Aust 163 (1995): 481-2
  26. Beasley CM Jr, Masica DN, Heiligenstein JH, Wheadon DE, Zerbe RL "Possible monoamine oxidase inhibitor-serotonin uptake inhibitor interaction: fluoxetine clinical data and preclinical findings." J Clin Psychopharmacol 13 (1993): 312-20
  27. Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763
  28. "Product Information. Celexa (citalopram)." Forest Pharmaceuticals PROD (2001):
  29. Chan BSH, Graudins A, Whyte IM, Dawson AH, Braitberg G, Duggin GG "Serotonin syndrome resulting from drug interactions." Med J Aust 169 (1998): 523-5
  30. "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals (2002):
  31. Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6
  32. Gillman PK "Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity." Br J Anaesth (2005):
  33. Paruchuri P, Godkar D, Anandacoomarswamy D, Sheth K, Niranjan S "Rare case of serotonin syndrome with therapeutic doses of paroxetine." Am J Ther 13 (2006): 550-552
  34. Jimenez-Genchi A "Immediate switching from moclobemide to duloxetine may induce serotonin syndrome." J Clin Psychiatry 67 (2006): 1821-1822
  35. "Product Information. Brintellix (vortioxetine)." Takeda Pharmaceuticals America (2013):
View all 35 references

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Drug and food interactions

Major

selegiline food

Applies to: Carbex (selegiline)

GENERALLY AVOID: Foods that contain large amounts of tyramine may precipitate a hypertensive crisis in patients treated with monoamine oxidase inhibitors (MAOIs). The mechanism is inhibition of MAO-A, the enzyme responsible for metabolizing exogenous amines such as tyramine in the gut and preventing them from being absorbed intact. Once absorbed, tyramine is metabolized to octopamine, a substance that is believed to displace norepinephrine from storage granules. Although selegiline is considered a selective inhibitor of MAO-B, the selectivity may not be absolute even at recommended dosages. Rare cases of hypertensive reactions associated with ingestion of tyramine-containing foods have been reported in patients taking the recommended daily oral dose of selegiline. Data for transdermal selegiline indicate that the 6 mg/24 hour dosage may be given safely without dietary restrictions. However, limited data are available for higher dosages.

MANAGEMENT: Patients treated with oral selegiline and transdermal selegiline (greater than 6 mg/24 hour) should preferably avoid consumption of products that contain large amounts of amines and protein foods in which aging or breakdown of protein is used to increase flavor. These foods include cheese (particularly strong, aged or processed cheeses), sour cream, wine (particularly red wine), champagne, beer, pickled herring, anchovies, caviar, shrimp paste, liver (particularly chicken liver), dry sausage, salamis, figs, raisins, bananas, avocados, chocolate, soy sauce, bean curd, sauerkraut, yogurt, papaya products, meat tenderizers, fava bean pods, protein extracts, yeast extracts, and dietary supplements. Caffeine may also precipitate hypertensive crisis so its intake should be minimized as well. At least 14 days should elapse following discontinuation of selegiline therapy before these foods may be consumed. Specially designed reference materials and dietary consultation are recommended so that an appropriate and safe diet can be planned. Patients should also be advised to promptly seek medical attention if they experience potential signs and symptoms of a hypertensive crisis such as severe headache, visual disturbances, difficulty thinking, stupor or coma, seizures, chest pain, unexplained nausea or vomiting, and stroke-like symptoms. The recommended dosages of selegiline should not be exceeded, as it can increase the risk of nonselective MAO inhibition and a hypertensive crisis.

References

  1. Goldberg LI "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA 190 (1964): 456-62
  2. Nuessle WF, Norman FC, Miller HE "Pickled herring and tranylcypromine reaction." JAMA 192 (1965): 142-3
  3. Sweet RA, Liebowitz MR, Holt CS, Heimberg RG "Potential interactions between monoamine oxidase inhibitors and prescribed dietary supplements." J Clin Psychopharmacol 11 (1991): 331-2
  4. McGrath PJ, Stewart JW, Quitkin FM "A possible L-deprenyl induced hypertensive reaction." J Clin Psychopharmacol 9 (1989): 310-1
  5. "Product Information. Eldepryl (selegiline)." Somerset Pharmaceuticals Inc PROD (2001):
  6. Lefebvre H, Noblet C, Morre N, Wolf LM "Pseudo-phaeochromocytoma after multiple drug interactions involving the selective monoamine oxidase inhibitor selegiline." Clin Endocrinol (Oxf) 42 (1995): 95-8
  7. Zetin M, Plon L, DeAntonio M "MAOI reaction with powdered protein dietary supplement." J Clin Psychiatry 48 (1987): 499
  8. Domino EF, Selden EM "Red wine and reactions." J Clin Psychopharmacol 4 (1984): 173-4
  9. Tailor SA, Shulman KI, Walker SE, Moss J, Gardner D "Hypertensive episode associated with phenelzine and tap beer--a reanalysis of the role of pressor amines in beer." J Clin Psychopharmacol 14 (1994): 5-14
  10. Pohl R, Balon R, Berchou R "Reaction to chicken nuggets in a patient taking an MAOI." Am J Psychiatry 145 (1988): 651
  11. Ito D, Amano T, Sato H, Fukuuchi Y "Paroxysmal hypertensive crises induced by selegiline in a patient with Parkinson's disease." J Neurol 248 (2001): 533-4
  12. "Product Information. Emsam (selegiline)." Bristol-Myers Squibb (2006):
View all 12 references

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Moderate

FLUoxetine food

Applies to: Prozac Weekly (fluoxetine)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 4 references

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Moderate

selegiline food

Applies to: Carbex (selegiline)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of central nervous system (CNS)-active agents. Use in combination may result in additive CNS depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled against driving, operating machinery, or engaging in potentially hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  4. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  5. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 5 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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