interaction
8 interactions related to interaction
fluoxetine + sam-e
SAM-e has independent antidepressant and serotonergic activity, and combining it with fluoxetine can additively raise serotonergic tone, increasing the risk of serotonin syndrome and hypomania. Fluoxetine's long half-life means this risk persists for weeks after the last dose.
fluoxetine + tryptophan
Fluoxetine blocks serotonin reuptake while tryptophan supplies raw material for serotonin synthesis, and the combination can produce serotonin syndrome. Fluoxetine's very long half-life (active metabolite norfluoxetine persists for weeks) extends the window of risk well beyond the last dose.
sertraline + kava
Kava (Piper methysticum) has central nervous system depressant effects and a documented risk of hepatotoxicity, and combining it with sertraline raises the risk of additive sedation and liver injury. Sertraline itself is associated with hepatic adverse effects in a small subset of users, and stacking hepatotoxic agents is discouraged.
fluoxetine + saffron
Saffron (Crocus sativus) has independent antidepressant activity, including serotonergic effects demonstrated in randomized controlled trials, and combining it with fluoxetine can theoretically add to serotonergic tone. Fluoxetine's long half-life extends the window of potential interaction for weeks after the last dose.
dairy + digoxin
Dairy products contribute calcium that, when combined with intravenous calcium or high oral loads, can potentiate digoxin's effects on the heart and increase the risk of arrhythmias. Dietary fiber and milk proteins may also modestly reduce digoxin absorption from oral capsules and tablets.
sertraline + sam-e
SAM-e (S-adenosyl-L-methionine) has its own antidepressant and serotonergic effects, and combining it with the SSRI sertraline can additively raise serotonergic activity and increase the risk of serotonin syndrome. Case reports describe mania and serotonin-toxicity-like presentations in patients combining SAM-e with SSRIs.
sertraline + tryptophan
Sertraline is a selective serotonin reuptake inhibitor (SSRI) that increases synaptic serotonin, and L-tryptophan is the dietary precursor to serotonin. Combining them can excessively elevate serotonergic activity, raising the risk of serotonin syndrome (agitation, tremor, hyperthermia, autonomic instability).
energy drinks + lithium
The caffeine in energy drinks increases renal clearance of lithium by raising glomerular filtration rate and sodium excretion, which can lower serum lithium below the therapeutic window and trigger relapse of bipolar symptoms. Conversely, abrupt reduction or cessation of high caffeine intake while on a stable lithium dose can push serum lithium into the toxic range; a published case report documented a 24% rise in serum lithium after caffeine withdrawal.