Drug interactions
Fluoxetine + Ramelteon
Severity: Moderate
Fluoxetine and Ramelteon: moderate 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
Fluoxetine can raise ramelteon concentrations by inhibiting its metabolism. This may increase sedation and other adverse effects of ramelteon. Fluvoxamine, a strong CYP1A2 inhibitor, has a much greater effect, and fluoxetine's effect is expected to be smaller.
What this interaction means in plain words
Fluoxetine and Ramelteon can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Fluoxetine belongs to Central Nervous System; Ramelteon belongs to Central Nervous System.
Why it happens
Fluoxetine inhibits CYP2C9 and other CYP enzymes involved in ramelteon metabolism, increasing exposure.
What to do
Monitor for excessive drowsiness and dizziness when starting or adjusting fluoxetine. Reduce the ramelteon dose or stop it if adverse effects appear.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Ramelteon
- Calcium / magnesium / potassium / sodium oxybates + Ramelteon Contraindicated
- Fluvoxamine + Ramelteon Contraindicated
- Ramelteon + Sodium oxybate Contraindicated
- Alfentanil + Ramelteon Moderate
- Amitriptyline + Ramelteon Moderate
- Amobarbital + Ramelteon Moderate
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 Fluoxetine with Ramelteon?
MediHelp rates the interaction as moderate. Fluoxetine and Ramelteon can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Fluoxetine can raise ramelteon concentrations by inhibiting its metabolism. This may increase sedation and other adverse effects of ramelteon. Fluvoxamine, a strong CYP1A2 inhibitor, has a much greater effect, and fluoxetine's effect is expected to be smaller.
How serious is the interaction between Fluoxetine and Ramelteon?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for excessive drowsiness and dizziness when starting or adjusting fluoxetine. Reduce the ramelteon dose or stop it if adverse effects appear.
What other medicines interact with Ramelteon?
MediHelp also lists interactions of Ramelteon with, for example, Calcium / magnesium / potassium / sodium oxybates, Fluvoxamine, Sodium oxybate. The full list is on the Ramelteon page.
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