interaction
8 interactions related to interaction
fluoxetine + sam-e
SAM-e has its own serotonergic and mood-elevating activity, so combining it with fluoxetine can add to your overall serotonin tone. In theory this can raise the risk of serotonin syndrome, and in vulnerable people it can tip mood into hypomania or mania. Because fluoxetine clears slowly, this caution lingers for weeks after the last dose. The evidence is mostly case reports involving other antidepressants and general guidance about combining SAM-e with serotonin-raising drugs, rather than fluoxetine-specific data.
fluoxetine + tryptophan
Fluoxetine blocks serotonin reuptake while tryptophan supplies the raw material for serotonin synthesis, and the combination can produce an excitatory reaction or serotonin syndrome. Fluoxetine's long-acting active metabolite means this risk persists for weeks after the last dose.
sertraline + kava
Kava (Piper methysticum) is a central nervous system depressant with a documented risk of serious liver injury, and combining it with sertraline raises the chance of additive sedation and additive liver stress. Kava also inhibits drug-metabolizing enzymes, and a case report describes prolonged serotonin syndrome in a patient taking kava alongside a serotonergic antidepressant.
fluoxetine + saffron
Saffron (Crocus sativus) has its own mild antidepressant activity, including serotonergic effects shown in randomized controlled trials. Combining a standardized saffron extract with fluoxetine theoretically adds to serotonergic tone, but augmentation trials adding saffron on top of existing antidepressants found it well tolerated, with no reported cases of serotonin syndrome. The interaction is best treated as plausible rather than documented.
dairy + digoxin
Dairy is a dietary source of calcium, and calcium status modestly influences how digoxin acts on the heart. The dietary-dairy effect is minor on its own; the more relevant scenario is large stacked calcium loads (dairy plus supplements plus calcium-containing antacids) or intravenous calcium in a hospital setting. Milk proteins may also slightly reduce digoxin absorption from oral doses, but the effect is small and usually not clinically meaningful.
sertraline + sam-e
SAM-e (S-adenosyl-L-methionine) has its own antidepressant and serotonergic activity, so combining it with the SSRI sertraline can add serotonergic effects on top of each other. Case reports describe serotonin-toxicity-like presentations and treatment-emergent mania in patients combining SAM-e with serotonergic antidepressants.
sertraline + tryptophan
Sertraline is a selective serotonin reuptake inhibitor (SSRI) that increases serotonin signaling, and L-tryptophan is the dietary precursor your body converts into serotonin. Taking them together can push serotonergic activity too high, raising the risk of serotonin syndrome (agitation, tremor, sweating, fast heart rate, and in severe cases fever, rigidity, and seizures).
energy drinks + lithium
The caffeine in energy drinks increases how fast the kidneys clear lithium, so swings in caffeine intake can shift serum lithium in either direction. Heavy or rising caffeine intake can pull lithium toward the lower, less effective end of its narrow range, while abruptly cutting or stopping caffeine while on a stable lithium dose can push serum lithium up into the toxic range. Because lithium has one of the narrowest therapeutic windows in psychiatry, the variability of energy drink use is the real hazard.