Drug interactions
Clomipramine + Fluvoxamine
Severity: Major
Clomipramine and Fluvoxamine: 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
Fluvoxamine strongly inhibits CYP1A2 and CYP2C19 and can markedly raise clomipramine levels while lowering formation of its metabolite desmethylclomipramine. This increases the risk of tricyclic toxicity such as seizures, arrhythmias and anticholinergic effects, and both drugs are serotonergic so serotonin syndrome can occur.
What this interaction means in plain words
Clomipramine 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.
Clomipramine belongs to Central Nervous System; Fluvoxamine belongs to Central Nervous System.
Why it happens
Fluvoxamine inhibits CYP1A2 and CYP2C19 metabolism of clomipramine, and both drugs add serotonergic activity.
What to do
Avoid the combination where possible; if used, start with a much lower clomipramine dose, monitor plasma levels and ECG, and watch for serotonin syndrome.
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 Clomipramine
- Arsenic trioxide + Clomipramine Contraindicated
- Clomipramine + Dofetilide Contraindicated
- Clomipramine + Droperidol Contraindicated
- Clomipramine + Isocarboxazid Contraindicated
- Clomipramine + Methylene blue Contraindicated
- Clomipramine + Pentamidine 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 Clomipramine with Fluvoxamine?
MediHelp rates the interaction as major. Clomipramine 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 can markedly raise clomipramine levels while lowering formation of its metabolite desmethylclomipramine. This increases the risk of tricyclic toxicity such as seizures, arrhythmias and anticholinergic effects, and both drugs are serotonergic so serotonin syndrome can occur.
How serious is the interaction between Clomipramine 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 the combination where possible; if used, start with a much lower clomipramine dose, monitor plasma levels and ECG, and watch for serotonin syndrome.
What other medicines interact with Clomipramine?
MediHelp also lists interactions of Clomipramine with, for example, Arsenic trioxide, Dofetilide, Droperidol. The full list is on the Clomipramine page.
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