Drug interactions
Amitriptyline + Fluvoxamine
Severity: Major
Amitriptyline and Fluvoxamine: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Fluvoxamine strongly inhibits CYP1A2 and CYP2C19 and moderately CYP2D6, which can substantially raise amitriptyline levels. Combined with additive serotonergic effects, this raises the risk of tricyclic toxicity, arrhythmia and serotonin syndrome.
What this interaction means in plain words
Amitriptyline and Fluvoxamine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Amitriptyline belongs to Central Nervous System; Fluvoxamine belongs to Central Nervous System.
Why it happens
Inhibition of CYP1A2, CYP2C19 and CYP2D6 by fluvoxamine increases amitriptyline exposure, plus additive serotonergic activity.
What to do
Avoid if possible; if used, begin with a much lower amitriptyline dose and monitor plasma levels, ECG and serotonin toxicity.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Amitriptyline
- Amitriptyline + Isocarboxazid Contraindicated
- Amitriptyline + Methylene blue Contraindicated
- Amitriptyline + Phenelzine Contraindicated
- Amitriptyline + Pimozide Contraindicated
- Amitriptyline + Procarbazine Contraindicated
- Amitriptyline + Safinamide Contraindicated
Other interactions of Fluvoxamine
- Agomelatine + Fluvoxamine Contraindicated
- Alosetron + Fluvoxamine Contraindicated
- Fezolinetant + Fluvoxamine Contraindicated
- Fluvoxamine + Isocarboxazid Contraindicated
- Fluvoxamine + Mavacamten Contraindicated
- Fluvoxamine + Methylene blue Contraindicated
Frequently asked questions
Can I take Amitriptyline with Fluvoxamine?
MediHelp rates the interaction as major. Amitriptyline and Fluvoxamine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Fluvoxamine strongly inhibits CYP1A2 and CYP2C19 and moderately CYP2D6, which can substantially raise amitriptyline levels. Combined with additive serotonergic effects, this raises the risk of tricyclic toxicity, arrhythmia and serotonin syndrome.
How serious is the interaction between Amitriptyline and Fluvoxamine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid if possible; if used, begin with a much lower amitriptyline dose and monitor plasma levels, ECG and serotonin toxicity.
What other medicines interact with Amitriptyline?
MediHelp also lists interactions of Amitriptyline with, for example, Isocarboxazid, Methylene blue, Phenelzine. The full list is on the Amitriptyline page.
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