Drug interactions
Amoxapine + Fluoxetine
Severity: Major
Amoxapine and Fluoxetine: major interaction.
Last updated Sources: US FDA label
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
Both drugs raise serotonergic and noradrenergic activity, so serotonin syndrome is possible. Fluoxetine also inhibits CYP2D6 and can raise amoxapine concentrations, increasing anticholinergic effects, seizure risk and cardiac toxicity.
What this interaction means in plain words
Amoxapine and Fluoxetine 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.
Why it happens
Additive serotonergic effects, and CYP2D6 inhibition by fluoxetine reduces amoxapine metabolism.
What to do
Avoid the combination where possible. If both are used, start amoxapine at a low dose, monitor for serotonin toxicity and TCA toxicity, and consider ECG monitoring.
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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References
Other interactions of Fluoxetine
- Fluoxetine + Isocarboxazid Contraindicated
- Fluoxetine + Mavacamten Contraindicated
- Fluoxetine + Methylene blue Contraindicated
- Fluoxetine + Phenelzine Contraindicated
- Fluoxetine + Pimozide Contraindicated
- Fluoxetine + Rasagiline Contraindicated
Frequently asked questions
Can I take Amoxapine with Fluoxetine?
MediHelp rates the interaction as major. Amoxapine and Fluoxetine 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. Both drugs raise serotonergic and noradrenergic activity, so serotonin syndrome is possible. Fluoxetine also inhibits CYP2D6 and can raise amoxapine concentrations, increasing anticholinergic effects, seizure risk and cardiac toxicity.
How serious is the interaction between Amoxapine and Fluoxetine?
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 the combination where possible. If both are used, start amoxapine at a low dose, monitor for serotonin toxicity and TCA toxicity, and consider ECG monitoring.
What other medicines interact with Fluoxetine?
MediHelp also lists interactions of Fluoxetine with, for example, Isocarboxazid, Mavacamten, Methylene blue. The full list is on the Fluoxetine page.
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