Drug interactions
Escitalopram + Fluvoxamine
Severity: Major
Escitalopram 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
Two SSRIs together increase the risk of serotonin syndrome without evidence of added benefit. Fluvoxamine inhibits CYP2C19, which can raise escitalopram concentrations and its dose-related QT effect.
What this interaction means in plain words
Escitalopram 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.
Escitalopram belongs to Central Nervous System; Fluvoxamine belongs to Central Nervous System.
Why it happens
Additive serotonergic effects plus fluvoxamine CYP2C19 inhibition reducing escitalopram clearance.
What to do
Avoid combining two SSRIs. If switching, taper one before starting the other and monitor for serotonin toxicity and QTc.
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 Fluvoxamine
- Agomelatine + Fluvoxamine Contraindicated
- Alosetron + Fluvoxamine Contraindicated
- Fezolinetant + Fluvoxamine Contraindicated
- Fluvoxamine + Isocarboxazid Contraindicated
- Fluvoxamine + Mavacamten Contraindicated
- Fluvoxamine + Methylene blue Contraindicated
Other interactions of Escitalopram
- Cisapride + Escitalopram Contraindicated
- Citalopram + Escitalopram Contraindicated
- Escitalopram + Isocarboxazid Contraindicated
- Escitalopram + Methylene blue Contraindicated
- Escitalopram + Phenelzine Contraindicated
- Escitalopram + Pimozide Contraindicated
Frequently asked questions
Can I take Escitalopram with Fluvoxamine?
MediHelp rates the interaction as major. Escitalopram 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. Two SSRIs together increase the risk of serotonin syndrome without evidence of added benefit. Fluvoxamine inhibits CYP2C19, which can raise escitalopram concentrations and its dose-related QT effect.
How serious is the interaction between Escitalopram 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 combining two SSRIs. If switching, taper one before starting the other and monitor for serotonin toxicity and QTc.
What other medicines interact with Fluvoxamine?
MediHelp also lists interactions of Fluvoxamine with, for example, Agomelatine, Alosetron, Fezolinetant. The full list is on the Fluvoxamine page.
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