Drug interactions
Fluvoxamine + Hydrocodone
Severity: Major
Fluvoxamine and Hydrocodone: 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 can contribute to serotonin syndrome with opioids. It also inhibits CYP3A4 to some extent, which could raise hydrocodone exposure and sedation.
What this interaction means in plain words
Fluvoxamine and Hydrocodone 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 belongs to Central Nervous System; Hydrocodone belongs to Musculoskeletal.
Why it happens
Additive serotonergic activity plus CYP3A4 inhibition by fluvoxamine increasing hydrocodone levels.
What to do
Monitor for serotonin toxicity and respiratory depression, and use a lower hydrocodone starting dose. Reassess when fluvoxamine is stopped.
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 Hydrocodone
- Alvimopan + Hydrocodone Contraindicated
- Bupropion-naltrexone + Hydrocodone Contraindicated
- Hydrocodone + Isocarboxazid Contraindicated
- Hydrocodone + Olanzapine / samidorphan Contraindicated
- Hydrocodone + Phenelzine Contraindicated
- Alfentanil + Hydrocodone Major
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 Fluvoxamine with Hydrocodone?
MediHelp rates the interaction as major. Fluvoxamine and Hydrocodone 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 can contribute to serotonin syndrome with opioids. It also inhibits CYP3A4 to some extent, which could raise hydrocodone exposure and sedation.
How serious is the interaction between Fluvoxamine and Hydrocodone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for serotonin toxicity and respiratory depression, and use a lower hydrocodone starting dose. Reassess when fluvoxamine is stopped.
What other medicines interact with Hydrocodone?
MediHelp also lists interactions of Hydrocodone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydrocodone page.
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