MajorSSRI (selective serotonin reuptake inhibitor)×Selective serotonin reuptake inhibitors
Updated · Methodology
Mechanism
Fluoxetine belongs to the same class, and its SmPC warns about serotonergic reactions when it is combined with other serotonergic agents. Two SSRIs bring no added benefit, while the serotonergic effect stacks.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia, sweating, diarrhoea, tachycardia, and in severe cases hyperthermia and rigidity. Symptoms usually appear within a day of adding the second drug or raising the dose. In patients with cardiac risk factors QTc is tracked separately.
Management
Stopping fluoxetine does not end the interaction at once: its SmPC gives a half-life of 4-6 days, and 4-16 days for the active metabolite norfluoxetine. A switch is measured in weeks, and the same label requires this to be taken into account when changing antidepressant.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- AEMPS: Ficha técnica de Seropram 30 mg (citalopram) (2024)– AEMPS CIMA, nregistro 63564, revisión 01/2024, secciones 4.2, 4.3 y 4.4
- AEMPS: Ficha técnica de Luramon 20 mg (fluoxetina) (2024)– AEMPS CIMA, nregistro 64970, revisión 05/2024, secciones 4.4, 4.5 y 5.2