Basic Information
ID DDInter1439 and DDInter1220
Interaction Serotonin reuptake inhibitors may potentiate the pharmacologic response to sympathomimetic agents.
Management In general, amphetamines and other sympathomimetic appetite suppressants should not be combined with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Close monitoring for enhanced sympathomimetic effects and possible serotonin syndrome is recommended if these agents must be used together.
References [1] Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998): [2] Barrett J, Meehan O, Fahy T "SSRI and sympathomimetic interaction." Br J Psychiatry 168 (1996): 253 [3] Prior FH, Isbister GK, Dawson AH, Whyte IM "Serotonin toxicity with therapeutic doses of dexamphetamine and venlafaxine." Med J Aust 176 (2002): 240-1 [4] Walters AM "Sympathomimetic-fluoxetine interaction." J Am Acad Child Adolesc Psychiatry 31 (1992): 565-6 [5] Bostwick JM, Brown TM "A toxic reaction from combining fluoxetine and phentermine." J Clin Psychopharmacol 16 (1996): 189-90 [6] Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6 [7] Mendelson J, Jones RT, Upton R, Jacob P 3rd "Methamphetamine and ethanol interactions in humans." Clin Pharmacol Ther 57 (1995): 559-68 [8] "Product Information. Didrex (benzphetamine)" Pharmacia and Upjohn, Kalamazoo, MI. [9] "Product Information. Suprenza (phentermine)." Akrimax Pharmaceuticals, Cranford, NJ. [10] Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7 [11] "Product Information. Fycompa (perampanel)." Eisai Inc, Teaneck, NJ. [12] Gilman AG, Rall TW, Nies AS, Taylor P, eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 8th ed." New York, NY: Pergamon Press Inc. (1990): [13] "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc, Rockville, MD.
Alternative for Phendimetrazine -
Alternative for Milnacipran N06A
Trazodone Tryptophan St. John's Wort Nefazodone Oxitriptan Maprotiline
Mirtazapine Viloxazine
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.