▶ Fluvoxamine moderately to markedly increases the exposure
to aminophylline. Avoid.rStudy
▶ Fluvoxamine decreases the clearance of anaesthetics, local
(ropivacaine). Avoid prolonged use.oStudy
▶ Fluvoxamine is predicted to increase the exposure to
anagrelide.oTheoretical → Also see TABLE 4 p. 1375
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to dapoxetine. Adjust dapoxetine dose with moderate
inhibitors of CYP3A4, p. 821.oTheoretical
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to SSRIs (citalopram, escitalopram, fluoxetine,
fluvoxamine, paroxetine, sertraline).rTheoretical → Also see
▶ Fluvoxamine is predicted to increase the exposure to
(propafenone). Monitor and adjust dose.
▶ SSRIs (fluoxetine, paroxetine) are predicted to increase the
exposure to anticholinesterases, centrally acting (galantamine).
Monitor and adjust dose.oStudy
▶ Antiepileptics (fosphenytoin, phenytoin) decrease the
concentration of paroxetine.oStudy
▶ Sertraline potentially increases the risk of toxicity when given
with antiepileptics (fosphenytoin, phenytoin). Monitor
concentration and adjust dose.rAnecdotal
▶ SSRIs (fluoxetine, fluvoxamine) are predicted to increase the
concentration of antiepileptics (fosphenytoin, phenytoin).
Monitor and adjust dose.rAnecdotal
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to dapoxetine. Adjust
dose with moderate inhibitors of CYP3A4, p. 821.
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to moderately increase the exposure to dapoxetine.
Avoid potent inhibitors of CYP3A4 or adjust dapoxetine dose,
▶ Antifungals, azoles (voriconazole) are predicted to increase the
exposure to citalopram.rTheoretical → Also see TABLE 9
▶ Antihistamines, sedating (cyproheptadine) potentially decrease
the effects of SSRIs.oAnecdotal
▶ Apalutamide is predicted to decrease the exposure to
citalopram. Avoid or monitor.nStudy → Also see TABLE 9
▶ Aprepitant is predicted to increase the exposure to dapoxetine.
Adjust dapoxetine dose with moderate inhibitors of CYP3A4,
▶ SSRIs (fluoxetine, paroxetine) are predicted to moderately
increase the exposure to aripiprazole. Adjust aripiprazole dose,
increases the exposure to asenapine.o ▶ Paroxetine
moderately increases the exposure to asenapine.
▶ SSRIs (fluoxetine, paroxetine) are predicted to markedly
1530 Sodium stibogluconate — SSRIs BNF 78
▶ Fluvoxamine moderately increases the concentration of beta
blockers, non-selective (propranolol).oStudy
▶ SSRIs (fluoxetine, paroxetine) are predicted to increase the
beta blockers, selective (metoprolol, nebivolol).
is predicted to increase the exposure to dapoxetine.
Theoretical → Also see TABLE 13 p. 1378
▶ Fluvoxamine markedly decreases the clearance of caffeine
citrate. Monitor and adjust dose.rStudy
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to dapoxetine. Adjust dapoxetine dose
with moderate inhibitors of CYP3A4, p. 821.oTheoretical
▶ SSRIs (fluoxetine, fluvoxamine) are predicted to increase the
cilostazol dose, p. 232.o ▶ Cinacalcet
is predicted to increase the exposure to dapoxetine.
▶ Fluvoxamine is predicted to increase the exposure to
cinacalcet. Adjust dose.oTheoretical
▶ SSRIs (fluoxetine, fluvoxamine) potentially increase the
exposure to clobazam. Adjust dose.oTheoretical
▶ SSRIs (fluoxetine, fluvoxamine) are predicted to decrease the
efficacy of clopidogrel. Avoid.rTheoretical → Also see
▶ Fluvoxamine increases the concentration of clozapine. Monitor
side effects and adjust dose.rStudy
▶ Cobicistat is predicted to moderately increase the exposure to
dapoxetine. Avoid potent inhibitors of CYP3A4 or adjust
dapoxetine dose, p. 821.rStudy
▶ Crizotinib is predicted to increase the exposure to dapoxetine.
Adjust dapoxetine dose with moderate inhibitors of CYP3A4,
▶ SSRIs (fluoxetine, paroxetine) are predicted to slightly increase
the exposure to darifenacin.nStudy
moderately increases the exposure to diazepam.
▶ Fluvoxamine is predicted to increase the exposure to dopamine
receptor agonists (ropinirole). Adjust dose.oStudy
▶ Fluvoxamine markedly increases the exposure to duloxetine.
Avoid.rStudy → Also see TABLE 18 p. 1379 → Also see TABLE 13
p. 1378 → Also see TABLE 4 p. 1375
▶ SSRIs (fluoxetine, paroxetine) are predicted to increase the
exposure to eliglustat. Avoid or adjust dose—consult product
▶ Fluvoxamine is predicted to increase the exposure to
▶ Fluvoxamine is predicted to increase the exposure to erlotinib.
Monitor side effects and adjust dose.oTheoretical
increases the concentration of frovatriptan.
Study → Also see TABLE 13 p. 1378
▶ Grapefruit juice moderately increases the exposure to
▶ H2 receptor antagonists (cimetidine) slightly increase the
o SSRIs (citalopram, escitalopram). Adjust dose.
▶ H2 receptor antagonists (cimetidine) slightly increase the
exposure to SSRIs (paroxetine, sertraline).oStudy
▶ Fluoxetine increases the concentration of haloperidol. Adjust
▶ Fluvoxamine increases the concentration of haloperidol.
▶ HIV-protease inhibitors are predicted to moderately increase
the exposure to dapoxetine. Avoid potent inhibitors of
CYP3A4 or adjust dapoxetine dose, p. 821.rStudy
▶ Idelalisib is predicted to moderately increase the exposure to
dapoxetine. Avoid potent inhibitors of CYP3A4 or adjust
dapoxetine dose, p. 821.rStudy
▶ Imatinib is predicted to increase the exposure to dapoxetine.
Adjust dapoxetine dose with moderate inhibitors of CYP3A4,
▶ Fluoxetine is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.qTheoretical
▶ Fluvoxamine is predicted to increase the exposure to
. Separate administration by 12 hours.o
▶ Fluvoxamine is predicted to increase the exposure to loxapine.
▶ Macrolides (clarithromycin) are predicted to moderately
increase the exposure to dapoxetine. Avoid potent inhibitors
of CYP3A4 or adjust dapoxetine dose, p. 821.rStudy
▶ Macrolides (erythromycin) are predicted to increase the
exposure to dapoxetine. Adjust dapoxetine dose with moderate
inhibitors of CYP3A4, p. 821.oTheoretical
▶ Fluvoxamine very markedly increases the exposure to
▶ SSRIs (fluoxetine, fluvoxamine, paroxetine) are predicted to
increase the exposure to mexiletine.oStudy
▶ Netupitant is predicted to increase the exposure to dapoxetine.
Adjust dapoxetine dose with moderate inhibitors of CYP3A4,
▶ SSRIs potentially increase the risk of prolonged
neuromuscular blockade when given with neuromuscular
blocking drugs, non-depolarising
(mivacurium).q ▶ Nilotinib is predicted to increase the exposure to dapoxetine.
Adjust dapoxetine dose with moderate inhibitors of CYP3A4,
▶ Fluvoxamine moderately increases the exposure to olanzapine.
▶ SSRIs (fluoxetine, paroxetine) are predicted to decrease the
efficacy of opioids (codeine).oTheoretical
▶ SSRIs (fluoxetine, paroxetine) are predicted to decrease the
efficacy of opioids (tramadol).rStudy → Also see TABLE 13
▶ Fluvoxamine is predicted to increase the exposure to
▶ Fluvoxamine is predicted to moderately increase the exposure
▶ SSRIs (fluoxetine, paroxetine) are predicted to moderately
increase the exposure to pitolisant. Use with caution and
▶ Fluvoxamine moderately increases the exposure to
pomalidomide. Adjust pomalidomide dose, p. 961.oStudy
▶ Paroxetine slightly increases the exposure to procyclidine.
Monitor and adjust dose.oStudy
▶ Proton pump inhibitors (esomeprazole) are predicted to slightly
to moderately increase the exposure to SSRIs (citalopram,
escitalopram). Monitor and adjust dose.rTheoretical
▶ Proton pump inhibitors (omeprazole) slightly to moderately
increase the exposure to SSRIs (citalopram, escitalopram).
Monitor and adjust dose.rStudy
is predicted to increase the exposure to riluzole.
▶ SSRIs (fluoxetine, paroxetine) are predicted to increase the
exposure to risperidone. Adjust dose.oStudy
▶ Fluvoxamine is predicted to increase the exposure to
▶ SSRIs (fluoxetine, paroxetine) are predicted to increase the
exposure to SSRIs (dapoxetine).oTheoretical → Also see
TABLE 18 p. 1379 → Also see TABLE 13 p. 1378 → Also see TABLE 4
▶ SSRIs potentially increase the risk of prolonged
neuromuscular blockade when given with
▶ SSRIs (fluoxetine, paroxetine) are predicted to decrease the
efficacy of tamoxifen. Avoid.rStudy
▶ Terbinafine is predicted to increase the exposure to fluoxetine.
moderately increases the exposure to paroxetine.
▶ Terbinafine is predicted to increase the exposure to SSRIs
(citalopram, dapoxetine, escitalopram, fluvoxamine, sertraline)
▶ Fluvoxamine moderately to markedly increases the exposure
▶ Fluvoxamine very markedly increases the exposure to
▶ SSRIs (fluoxetine, fluvoxamine) given with a moderate CYP3A4
inhibitor are predicted to increase the exposure to tofacitinib.
Adjust tofacitinib dose, p. 1105.oStudy
▶ SSRIs (fluoxetine, paroxetine) are predicted to increase the
exposure to tricyclic antidepressants. Monitor for toxicity and
adjust dose.rStudy → Also see TABLE 18 p. 1379 → Also see
▶ Fluvoxamine increases the exposure to tricyclic antidepressants
(amitriptyline, imipramine). Adjust dose.rStudy → Also see
TABLE 18 p. 1379 → Also see TABLE 13 p. 1378
▶ Fluvoxamine markedly increases the exposure to tricyclic
antidepressants (clomipramine). Adjust dose.rStudy → Also
see TABLE 18 p. 1379 → Also see TABLE 13 p. 1378
▶ SSRIs (fluoxetine, paroxetine) are predicted to increase the
o ▶ Fluvoxamine is predicted to increase the exposure to
St John’s Wort → see TABLE 13 p. 1378 (serotonin syndrome)
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to slightly decrease the exposure to
aldosterone antagonists (eplerenone). Avoid.oStudy
’s Wort decreases the exposure to aliskiren.o ▶ St John’s Wort moderately decreases the exposure to
▶ St John’s Wort is predicted to decrease the concentration of
▶ St John’s Wort is predicted to decrease the exposure to
antiarrhythmics (dronedarone). Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
antiepileptics (brivaracetam).oTheoretical
▶ St John’s Wort is predicted to decrease the concentration of
(carbamazepine). Monitor and adjust dose.
▶ St John’s Wort is predicted to decrease the concentration of
antiepileptics (fosphenytoin, phenobarbital, phenytoin,
primidone). Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
(perampanel). Monitor and adjust dose.o ▶ St John’s Wort is predicted to decrease the exposure to
antiepileptics (tiagabine). Avoid.nTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
antifungals, azoles (isavuconazole). Avoid.rTheoretical
▶ St John’s Wort moderately decreases the exposure to
antifungals, azoles (voriconazole). Avoid.oStudy
▶ St John’s Wort is predicted to decrease the concentration of
antimalarials (piperaquine). Avoid.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
apixaban. Use with caution or avoid.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
apremilast. Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
aprepitant. Avoid.oTheoretical
o’s Wort is predicted to decrease the exposure to axitinib.
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
bictegravir. Avoid.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to calcium
channel blockers (amlodipine, felodipine, lacidipine,
lercanidipine, nicardipine, nifedipine, nimodipine). Monitor and
▶ St John’s Wort is predicted to decrease the exposure to calcium
channel blockers (diltiazem, verapamil).oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
cariprazine. Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort decreases the concentration of ciclosporin.
o’s Wort is predicted to alter the effects of cilostazol.
▶ St John’s Wort is predicted to decrease the exposure to
cobicistat. Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
cobimetinib. Avoid.rTheoretical
▶ St John’s Wort decreases the efficacy of combined hormonal
contraceptives. MHRA advises avoid. For FSRH guidance, see
Contraceptives, interactions p. 794.rAnecdotal
▶ St John’s Wort decreases the anticoagulant effect of coumarins.
▶ St John’s Wort is predicted to decrease the exposure to
crizotinib. Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the efficacy of
desogestrel. MHRA advises avoid. For FSRH guidance, see
Contraceptives, interactions p. 794.rTheoretical
r’s Wort decreases the concentration of digoxin. Avoid.
▶ St John’s Wort decreases the exposure to dolutegravir. Adjust
▶ St John’s Wort is predicted to decrease the exposure to
doravirine. Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the concentration of
▶ St John’s Wort is predicted to moderately decrease the
exposure to elbasvir. Avoid.rStudy
▶ St John’s Wort is predicted to increase the exposure to
▶ St John’s Wort is predicted to decrease the concentration of
elvitegravir. Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the effects of
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the efficacy of
etonogestrel. MHRA advises avoid. For FSRH guidance, see
Contraceptives, interactions p. 794.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the concentration of
everolimus. Avoid or adjust dose.rStudy
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
fesoterodine. Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
fingolimod. Avoid.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
fosaprepitant. Avoid.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to markedly decrease the exposure
1532 SSRIs — St John’s Wort BNF 78
▶ St John’s Wort is predicted to decrease the concentration of
guanfacine. Adjust dose.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to HIVprotease inhibitors. Avoid.rStudy
▶ St John’s Wort is predicted to decrease the efficacy of hormone
replacement therapy.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
idelalisib. Avoid.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort slightly decreases the exposure to irinotecan.
o’s Wort decreases the exposure to ivabradine. Avoid.
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the concentration of
▶ St John’s Wort is predicted to decrease the efficacy of
levonorgestrel. MHRA advises avoid. For FSRH guidance, see
Contraceptives, interactions p. 794.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
lurasidone. Monitor and adjust dose.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
macitentan. Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort moderately decreases the exposure to
midazolam. Monitor and adjust dose.oStudy
▶ St John’s Wort is predicted to decrease the exposure to
midostaurin. Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the concentration of
nevirapine. Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the efficacy of
norethisterone. MHRA advises avoid. For FSRH guidance, see
Contraceptives, interactions p. 794.rAnecdotal
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
ombitasvir. Avoid.rTheoretical
▶ St John’s Wort decreases the exposure to opioids (methadone).
Monitor and adjust dose.rStudy → Also see TABLE 13 p. 1378
▶ St John’s Wort moderately decreases the exposure to opioids
(oxycodone). Adjust dose.oStudy
▶ St John’s Wort is predicted to decrease the exposure to
osimertinib. Avoid.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
palbociclib. Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
panobinostat. Avoid.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
(with ritonavir and ombitasvir). Avoid.r
▶ St John’s Wort is predicted to decrease the exposure to
phosphodiesterase type-5 inhibitors.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort slightly decreases the exposure to pioglitazone.
▶ St John’s Wort is predicted to decrease the exposure to
pitolisant. Monitor and adjust dose.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
rilpivirine. Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
ruxolitinib. Monitor and adjust dose.oTheoretical
▶ St John’s Wort is predicted to decrease the concentration of
sirolimus. Monitor and adjust dose.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort slightly decreases the exposure to statins
▶ St John’s Wort moderately decreases the exposure to statins
▶ St John’s Wort decreases the concentration of tacrolimus.
▶ St John’s Wort is predicted to decrease the exposure to taxanes
▶ St John’s Wort is predicted to decrease the concentration of
temsirolimus. Avoid.rTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
tenofovir alafenamide. Avoid.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
tezacaftor. Avoid.rTheoretical
▶ St John’s Wort potentially decreases the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
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