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Drug Interactions between Keep Alert and Luvox

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

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Interactions between your drugs

Moderate

caffeine fluvoxaMINE

Applies to: Keep Alert (caffeine) and Luvox (fluvoxamine)

MONITOR: Coadministration with potent CYP450 1A2 inhibitors such as fluvoxamine may increase the plasma concentrations of caffeine in a dose-dependent manner. Caffeine is primarily metabolized by CYP450 1A2 and is considered a probe substrate for the isoenzyme. In 12 healthy volunteers, pretreatment with fluvoxamine for 7 days (10 mg once or twice a day) resulted in a 2-fold increase in the mean 24-hour area under the plasma concentration-time curve (AUC) of a single 100 mg oral dose of caffeine. When the dosage of fluvoxamine was increased (25 mg once or twice a day for 7 days), the mean 24-hour AUC of single-dose caffeine increased 5-fold. The peak plasma concentration (Cmax) of caffeine increased 40% and 141%, respectively, during these treatment phases. Another study found that fluvoxamine (50 mg daily for 4 days, then 100 mg daily for 8 days) decreased the median total clearance of a single 200 mg oral dose of caffeine by 80% and increased the half-life from 5 to 31 hours in eight healthy volunteers.

MANAGEMENT: Caution is advised if caffeine is administered concurrently with potent CYP450 1A2 inhibitors. Dosage adjustment should be considered in patients who experience excessive adverse effects of caffeine such as nausea, vomiting, headache, nervousness, irritability, agitation, restlessness, insomnia, tinnitus, tremors, and tachycardia.

References

  1. Brosen K, Skjelbo E, Rasmussen BB, Poulsen HE, Loft S "Fluvoxamine is a potent inhibitor of cytochrome P4501A2." Biochem Pharmacol 45 (1993): 1211-4
  2. Jeppesen U, Loft S, Poulsen HE, Brosen K "A fluvoxamine-caffeine interaction study." Pharmacogenetics 6 (1996): 213-22
  3. Christensen M, Tybring G, Mihara K, et al. "Low daily 10-mg and 20-mg doses of fluvoxamine inhibit the metabolism of both caffeine (cytochrome P4501A2) and omeprazole (cytochrome P4502C19)." Clin Pharmacol Ther 71 (2002): 141-52

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Drug and food interactions

Moderate

fluvoxaMINE food

Applies to: Luvox (fluvoxamine)

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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Minor

caffeine food

Applies to: Keep Alert (caffeine)

The effect of grapefruit juice on the pharmacologic activity of caffeine is controversial. One report suggests that grapefruit juice increases the effect of caffeine. The proposed mechanism is inhibition of cytochrome P-450 metabolism of caffeine. However, a well-conducted pharmacokinetic/pharmacodynamic study did not demonstrate this effect. The clinical significance of this potential interaction is unknown.

References

  1. "Grapefruit juice interactions with drugs." Med Lett Drugs Ther 37 (1995): 73-4
  2. Maish WA, Hampton EM, Whitsett TL, Shepard JD, Lovallo WR "Influence of grapefruit juice on caffeine pharmacokinetics and pharmacodynamics." Pharmacotherapy 16 (1996): 1046-52

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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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