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The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs and SSRIsincluding SARAFEMalone but particularly with concomitant use of other serotonergic drugsincluding triptanstricyclic antidepressantsfentanyllithiumtramadoltryptophanbuspironeand StJohn’s Wortand with drugs that impair metabolism of serotoninin particularMAOIsboth those intended to treat psychiatric disorders and also otherssuch as linezolid and intravenous methylene blue
Patients on stable doses of phenytoin and carbamazepine have developed elevated plasma anticonvulsant concentrations and clinical anticonvulsant toxicity following initiation of concomitant fluoxetine treatment.
The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs and SSRIsincluding SARAFEMalone but particularly with concomitant use of other serotonergic drugsincluding triptanstricyclic antidepressantsfentanyllithiumtramadoltryptophanbuspironeand StJohn’s Wortand with drugs that impair metabolism of serotoninin particularMAOIsboth those intended to treat psychiatric disorders and also otherssuch as linezolid and intravenous methylene blue
Patients should be monitored closely for changes in behaviorclinical worseningand suicidal tendenciesthis should be done during the initial 1-2 months of therapy and dosage adjustments.
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