Summary of Interactions with Vitamins, Herbs, & Foods
|May Be Beneficial: Depletion or interference—This medication may deplete these substances from the body or interfere with how they work; extra intake may help replenish them.||
|May Be Beneficial: Side effect reduction and/or prevention—These substances may help reduce the likelihood and/or severity of a potential side effect caused by the medication.||
|May Be Beneficial: Supportive interaction—These substances may help this medication work better.||
|Avoid: Reduces drug effectiveness—When taking this medication, avoid these substances as they may decrease the medication's absorption and/or activity in the body.||
|Avoid: Adverse interaction—When taking this medication, avoid these substances, as the combination may cause undesirable or dangerous interactions.||
St. John’s Wort*
|Check: Explanation needed—When taking this medication, read the article details and discuss them with your doctor or pharmacist before taking these substances.||
Interactions with Vitamins
5-Hydroxytryptophan (5-HTP) and L-tryptophan
Fluvoxamine works by increasing serotonin activity in the brain. 5-HTP and L-tryptophan are converted to serotonin in the brain, and taking them with fluvoxamine may increase fluvoxamine-induced side effects. Until more is known, 5-HTP and L-tryptophan should not be taken with any SSRI drug, including fluvoxamine.
Fluvoxamine has been shown to significantly raise the amount of melatonin in the blood after oral administration.1 Researchers suggest that fluvoxamine may inhibit elimination of melatonin, but the clinical significance of this finding is as yet unclear.
Interactions with Herbs
Ginkgo biloba extract may reduce the side effects experienced by some persons taking SSRIs such as fluoxetine or sertraline. An open-label study with elderly, depressed persons found that 200 to 240 mg of ginkgo daily was effective in alleviating sexual side effects in both men and women taking SSRIs.2
One case study reported that 180–240 mg of GBE daily reduced genital anesthesia and sexual side effects secondary to fluoxetine use in a 37-year-old woman.3
St. John’s wort (Hypericum perforatum)
One report describes a case of serotonin syndrome in a patient who took St. John’s wort and trazodone, a weak SSRI drug.4 The patient experienced mental confusion, muscle twitching, sweating, flushing, and ataxia. In another case, a patient experienced grogginess, lethargy, nausea, weakness, and fatigue after taking one dose of paroxetine (Paxil®, an SSRI drug related to fluvoxamine) after ten days of St. John’s wort.5 Until more is known about interactions and adverse actions, people taking any SSRI drugs, including fluvoxamine, should avoid St. John’s wort, unless they are being closely monitored by a doctor.
Yohimbe (Pausinystalia yohimbe)
The alkaloid yohimbine from the African yohimbe tree affects the nervous system in a way that may complement fluvoxamine. One report studied depressed people who had not responded to fluvoxamine. When 5 mg of yohimbine was added three times each day, there was significant improvement. Some people required higher amounts of yohimbine before their depression improved. Because yohimbine can have side effects, it should only be taken under a doctor’s supervision. Yohimbine is a prescription drug, but standardized extracts of yohimbe that contain yohimbine are available as a supplement.
Interactions with Foods & Other Compounds
SSRI drugs, including fluvoxamine, may cause dizziness or drowsiness.6 Alcohol may intensify the drowsiness and increase the risk of accidental injury. People should avoid alcohol-containing products during fluvoxamine treatment.
In a study of healthy volunteers, ingestion of 250 ml (approximately 8 ounces) of grapefruit juice along with fluvoxamine increased the blood level of fluvoxamine by 60%, compared with ingestion of fluvoxamine with water.7 Because a higher concentration of the drug could increase its adverse effects, individuals should not consume grapefruit or grapefruit juice around the same time they take fluvoxamine.
Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice.8 , 9 The degree of inhibition is about the same for each of these juices. Therefore, it would be reasonable to expect that pomegranate juice might interact with fluvoxamine in the same way that grapefruit juice does.
Tobacco (Nicotiana species)
Smoking increases the metabolism of fluvoxamine, which may reduce effectiveness.10 People should avoid smoking while taking fluvoxamine.
1. Härtter S, Grözinger M, Weigmann H, et al. Increased bioavailability of oral melatonin after fluvoxamine coadministration. Clin Pharmacol Ther 2000;67:1–6.
2. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998;24:139–45.
3. Ellison JM, DeLuca P. Fluoxetine-induced genital anesthesia relieved by Ginkgo biloba extract. J Clin Psychiatry 1998;59:199–200.
4. Demott K. St. John’s wort tied to serotonin syndrome. Clin Psychiatr News 1998;26:28.
5. Gordon JB. SSRIs and St. John’s wort: possible toxicity? Am Fam Physician 1998;57:950.
6. Threlkeld DS, ed. Central Nervous System Drugs, Antidepressants, Selective Serotonin Reuptake Inhibitors. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1997, 264s.
7. Hori H, Yoshimura R, Ueda N, et al. Grapefruit juice-fluvoxamine interaction: is it risky or not? J Clin Psychopharmacol 2003;23:422–4 [Letter].
8. Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. Am J Cardiol 2006;98:705–6.
9. Summers KM. Potential drug-food interactions with pomegranate juice. Ann Pharmacother 2006;40:1472–3.
10. Spigset O, Carleborg L, Hedenmalm K, Dahlqvist R. Effect of cigarette smoking on fluvoxamine pharmacokinetics in humans. Clin Pharmacol Ther 1995;58:399–403.
Last Review: 08-17-2011
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