Fluoxetine drug-drug interactions: I. Antidepressants and antipsychotics

As clinical experience with fluoxetine grows, so do reports of drug interactions. The most common adverse interaction appears to be inhibition of drug metabolism. Other antidepressants are so affected, and toxicity may result if proper dosage adjustments are not made. Pharmacodynamic interactions may also occur, as evidenced by a serotonergic syndrome with concomitant administration of MAOIs and fluoxetine. Some have speculated that worsening of EPS in some fluoxetine-treated patients may be explained by alterations in serotonergic/dopaminergic balance, although a pharmacokinetic explanation may also fit some cases. Fluoxetine has been greeted with an enthusiasm that claims some advantages over other antidepressants. We should be mindful that any unique therapeutic benefits may be accompanied by a unique adverse effects profile and a special propensity for drug-drug interactions.