From Tizanidine to Smoking: 9 Fluvoxamine Interactions to Watch For

Fluvoxamine is a medication that treats obsessive-compulsive disorder (OCD) in adults and children age 8 and older. It belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs). If you’ve been prescribed fluvoxamine or are considering it, it’s helpful to be aware that it can interact with a number of other medications and substances. Here’s what you should know.

Fluvoxamine interactions at a glance

Below is a list of possible fluvoxamine interactions. Keep in mind that you should always review your medication list with your prescriber before starting a new medication so they can identify any possible problems in advance.

Fluvoxamine interactions list:

• Benzodiazepines

• Ramelteon (Rozerem)

• Mexiletine

• Tizanidine (Zanaflex)

• Triptan migraine medications

• Some beta blockers

• Other antidepressants

• Nonsteroidal anti-inflammatory drugs (NSAIDs)

• Blood thinner medications

• Thioridazine

• Pimozide

• Alosetron (Lotronex)

• Clozapine (Clozaril)

• Methadone (Methadose)

• Theophylline

• Lithium (Lithobid)

• Carbamazepine (Tegretol)

• St. John’s wort

• L-tryptophan

• Smoking

Promotion disclosure

Fluvoxamine

Avg retail price

$40.09(Save 62.96%)

GoodRx discount

$14.85

See all discounts

How it works

Use GoodRx to find medications, pharmacies, and discounts.

GoodRx discounts can help you pay less for your prescription.

Bring your free coupon or savings card to the pharmacy.

Let’s take a closer look at 10 fluvoxamine interactions and what you can do to avoid them.

1. Benzodiazepines, such as alprazolam

Benzodiazepines are medications often used to treat anxiety or to help you sleep. Fluvoxamine can raise the levels of some benzodiazepines in the body if they’re taken together. This can raise the risk of sedation and other side effects, such as memory loss.

Benzodiazepines that interact with fluvoxamine include:

• Alprazolam (Xanax)

• Diazepam (Valium)

• Triazolam (Halcion) 

Other benzodiazepines, such as lorazepam (Ativan) and temazepam (Restoril), aren’t likely to interact with fluvoxamine. So they may be a safer option. Your prescriber can help choose the best option for you — just be sure they’re aware you’re taking fluvoxamine before starting any new medications. You should also let your prescriber know if you’re taking a benzodiazepine before starting fluvoxamine. They may need to make changes to protect your safety.

2. Ramelteon (Rozerem)

Ramelteon is a prescription sleep medication. It works similarly to melatonin, a natural hormone that helps regulate your sleep cycle.

Fluvoxamine can cause ramelteon levels to go 100 times higher than usual if they’re taken together. This is a severe interaction, so you shouldn’t take these medications at the same time. If you need a sleep medication while you’re taking fluvoxamine, talk to your prescriber about safer options. And be sure to let them know if you’re already taking ramelteon before starting fluvoxamine so they can make changes to avoid this interaction.

Good to know: Fluvoxamine can also increase melatonin levels in the body. So if you take a melatonin supplement, you may need a lower dosage while you’re taking fluvoxamine. Talk to your prescriber for guidance.

3. Mexiletine

Mexiletine is a medication used to treat irregular heartbeats (arrhythmias). Fluvoxamine can increase mexiletine levels in the body. This can raise the risk of mexiletine side effects, such as nausea, dizziness, and tremors.

EXPERT PICKS: WHAT TO READ NEXT

• How SSRIs compare: Fluvoxamine is a type of medication known as a selective serotonin reuptake inhibitor (SSRI). Learn more about how it compares with other SSRIs, such as fluoxetine (Prozac) and sertraline (Zoloft).

• Living with OCD: Read first-hand accounts of how four people living with obsessive-compulsive disorder manage their symptoms.

• Fluvoxamine dosages: Learn about the recommended fluvoxamine dosages and what to do if you miss a dose.

If needed, you can still take these medications together. But your prescriber will likely keep a close eye on your mexiletine levels and adjust your dosage as needed to keep them within a safe range. So be sure to keep up with your appointments and follow their instructions carefully.

4. Tizanidine

Tizanidine is a muscle relaxer that shouldn’t be taken with fluvoxamine. That’s because fluvoxamine can raise tizanidine levels significantly in the body. This raises the chance of side effects, such as drowsiness and low blood pressure.

If you need a muscle relaxer while you’re taking fluvoxamine, talk to your prescriber about safer options.

5. Other antidepressants

As mentioned, fluvoxamine is an SSRI. This means it increases serotonin levels in your brain to help treat OCD symptoms. Other antidepressant medications also increase serotonin levels. If they’re taken with fluvoxamine, there’s a risk that serotonin levels may go too high, leading to a condition called serotonin syndrome.

Antidepressants that can interact with fluvoxamine include:

• Monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil) and isocarboxazid (Marplan)

• Other SSRIs, such as sertraline (Zoloft) and fluoxetine (Prozac)

• Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor) and duloxetine (Cymbalta)

• Tricyclic antidepressants (TCAs), such as amitriptyline and nortriptyline (Pamelor)

• Atypical antidepressants, such as bupropion (Wellbutrin) and trazodone (Desyrel)

You shouldn’t take fluvoxamine and an MAOI at the same time. And fluvoxamine can raise the levels of TCAs in the body along with the risk of serotonin syndrome. So you may need a lower TCA dosage if these medications are combined.

For other antidepressants, your prescriber may decide that the benefits of taking them with fluvoxamine outweigh the risks. In this case, you should be aware of the signs and symptoms of serotonin syndrome, such as:

• Sweating

• Nausea and vomiting

• Shaking

• Confusion

• Fever

• Seizures

Serotonin syndrome is typically mild, but it can be life-threatening if it isn’t treated. So be sure to seek medical care right away if any signs or symptoms appear.

Good to know: Herbal supplements can also increase serotonin levels. St. John’s wort and L-tryptophan are common examples. Get your prescriber’s OK before taking any supplements with fluvoxamine.

6. Triptans

Triptans are a class of medications that treat migraine headaches. Like antidepressants, triptans can raise serotonin levels, so there’s a risk for serotonin syndrome if you take them with fluvoxamine.

Common triptans include:

• Sumatriptan (Imitrex)

• Rizatriptan (Maxalt)

• Zolmitriptan (Zomig)

You should only take a triptan along with fluvoxamine if your prescriber OKs it. You should also keep an eye out for signs of serotonin syndrome and seek medical care if they occur.

7. Propranolol and metoprolol

Propranolol (Inderal) and metoprolol (Lopressor) are beta-blocker medications. They’re prescribed for high blood pressure and other heart-related conditions.

Fluvoxamine can raise the levels of these beta blockers in the body. This can lead to side effects such as low blood pressure or a decreased heart rate. But this interaction isn’t the same for all beta blockers. For example, atenolol (Tenormin) levels aren’t affected by fluvoxamine. 

If you need to take a beta blocker that interacts with fluvoxamine, your prescriber may need to lower your beta blocker dosage to prevent any issues. Or they may switch you to a different beta blocker to avoid the interaction altogether. But you shouldn’t make any changes to your medications on your own — it can be dangerous to stop taking a beta blocker suddenly.

8. Blood thinners and NSAIDs

Fluvoxamine and other SSRIs can raise the risk of bleeding. If you take them with another medication that also has this risk, the chance of bleeding goes up.

Other medications that can increase your bleeding risk include:

• NSAIDs, such as ibuprofen and naproxen

• Blood thinners, such as warfarin (Coumadin, Jantoven), clopidogrel (Plavix), and apixaban (Eluquis)

You can take fluvoxamine with these medications, but only if your prescriber OKs it. Be aware that NSAIDs are common ingredients in several types of over-the-counter (OTC) medications. So check the ingredients list carefully.

Keep an eye out for signs of bleeding if you’re taking fluvoxamine with another medication that raises your bleeding risk. These include mild bleeding, such as when brushing your teeth or bruising more easily. Seek medical care if serious bleeding occurs, such as blood in your urine or stool, vomiting blood, or a bruise that continues to grow.

9. Smoking cigarettes

Smoking can also interact with fluvoxamine. In studies, smoking reduced fluvoxamine levels by about 25%. If fluvoxamine levels are lower than they should be, the medication may not work as well.

Let your prescriber know if you smoke or vape nicotine before starting fluvoxamine. You should also let them know if you stop smoking while you’re taking fluvoxamine. They may need to adjust your dosage to ensure you’re getting the right amount of medication.

Good to know: Even without a possible drug interaction, smoking is harmful to your health. Your healthcare team can provide resources, including medications, to help you quit smoking. Don’t hesitate to reach out to them for support and guidance.

Why trust our experts?

Written by:

Jill Barat, PharmD

Jill Barat, PharmD has nearly 10 years of experience as a pharmacist, including serving as the pharmacist in charge at an independent sterile and non-sterile compounding pharmacy. She also worked as the head of medical content for a telemedicine company.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Ferras Bashqoy, PharmD, BCCCP, BCPPS

Ferras Bashqoy, PharmD, BCCCP, BCPPS, is a clinical pharmacotherapy specialist in the Neonatal Intensive Care Unit (NICU) at Hassenfeld Children’s Hospital in New York City. His favorite part of the job is working with preterm newborns because they are strong and mighty despite their size.

Our editorial standards

Meet our experts