Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) drug, related to Prozac®. It is used primarily to treat obsessive-compulsive disorder and is under investigation to treat depression.

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

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.

Melatonin

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.

Ginkgo

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.

Alcohol

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.

Grapefruit

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

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.