Drug interactions
Fluvoxamine + Propafenone
Severity: Major
Fluvoxamine and Propafenone: major interaction.
Last updated Sources: Health Canada product monograph
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 inhibits CYP1A2 and CYP2C19 and weakly CYP3A4, and propafenone is metabolized by CYP2D6, CYP3A4 and CYP1A2. Inhibition of its secondary pathways can raise propafenone levels, especially in CYP2D6 poor metabolizers or when a CYP2D6 inhibitor is also used. This increases the risk of conduction abnormalities, arrhythmia and neurological effects.
What this interaction means in plain words
Fluvoxamine and Propafenone 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; Propafenone belongs to Cardiovascular.
Why it happens
Fluvoxamine inhibits CYP1A2 and CYP3A4 pathways of propafenone metabolism.
What to do
Monitor ECG (PR and QRS intervals) and heart rate, and reduce the propafenone dose as necessary. Consider an alternative antidepressant such as sertraline if the interaction is problematic.
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 Propafenone
- Dofetilide + Propafenone Contraindicated
- Dronedarone + Propafenone Contraindicated
- Nilotinib + Propafenone Contraindicated
- Nirmatrelvir / ritonavir + Propafenone Contraindicated
- Nirmatrelvir + Propafenone Contraindicated
- Pimozide + Propafenone 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 Fluvoxamine with Propafenone?
MediHelp rates the interaction as major. Fluvoxamine and Propafenone 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 inhibits CYP1A2 and CYP2C19 and weakly CYP3A4, and propafenone is metabolized by CYP2D6, CYP3A4 and CYP1A2. Inhibition of its secondary pathways can raise propafenone levels, especially in CYP2D6 poor metabolizers or when a CYP2D6 inhibitor is also used. This increases the risk of conduction abnormalities, arrhythmia and neurological effects.
How serious is the interaction between Fluvoxamine and Propafenone?
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 ECG (PR and QRS intervals) and heart rate, and reduce the propafenone dose as necessary. Consider an alternative antidepressant such as sertraline if the interaction is problematic.
What other medicines interact with Propafenone?
MediHelp also lists interactions of Propafenone with, for example, Dofetilide, Dronedarone, Nilotinib. The full list is on the Propafenone page.
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