Drug interactions with selective serotonin reuptake inhibitors, especially with other psychotropics

(1) Selective serotonin reuptake inhibitors (SSRIs) are involved in many drug interactions with potentially serious clinical consequences. (2) These interactions involve all SSRIs but particularly fluoxetine, which is the best-studied antidepressant in this family. (3) Because of their long elimination half-life (particularly fluoxetine) the risk of interactions persists for several days or even weeks after SSRI withdrawal. (4) Drug interactions with clinical consequences usually involve combinations of an SSRI with other psychotropics, especially monoamine oxidase inhibitor (MAOI) and tricyclic antidepressants, clozapine, lithium, methadone, etc. (5) The clinical consequences of drug interactions with SSRI are either due to overdosing of the drug combined, or to a serotonin syndrome with neuromuscular and vegetative (autonomic) symptoms. (6) Interactions with a number of other drugs have been reported, especially carbamazepine, phenytoin and oral anticoagulants, with a risk of overdose of these drugs. (7) The risk of hyponatraemia linked to SSRIs seems to be increased during concomitant treatment with diuretics.