Table 15.3 Clinically relevant interactions among antidepressant drugs and other medications:

mechanisms of interactions and potential adverse consequences in the elderly

Reference

Drug combination

Potential consequences

PK/PD and mechanistic interactions

Saraghi et al. (2018)

SSRI (fluoxetine, paroxetine)

Diminished therapeutic effect of

drugs being substrates of

CYP2D6, avoid combination with

tramadol and codeine

Saraghi et al. (2018)

SSRI (sertraline,

paroxetine) + warfarin

Increased risk of bleeding due to

inhibition of CYP 2C9

Ellis et al. (2015)

Duloxetine + isocarboxazid,

linezolid, procarbazine, rasagiline,

selegiline, tranylcypromine

CNS toxicity or serotonin

syndrome

Ellis et al. (2015)

Duloxetine + thioridazine

Risk of arrhythmia due to

increased thioridazine levels

Ellis et al. (2015)

Duloxetine + metoclopramide

Increased risk of extrapyramidal

reactions, or neuroleptic

malignant syndrome

Ellis et al. (2015)

Duloxetine + clozapine

Increased risk of QT prolongation

due to increased plasma-clozapine

levels

Ellis et al. (2015)

Duloxetine + escitalopram,

antiplatelet drugs

Increased risk of bleeding

Ellis et al. (2015)

Duloxetine + citalopram,

fluoxetine, fluvoxamine,

paroxetine, sertraline, tramadol,

triptanes, venlafaxine

Increased risk of serotonin

syndrome

Gareri et al. (2014)

Fluvoxamine + TCAs

(amitriptyline, imipramine,

clomipramine), mirtazapine

Increased serum-concentration

due to inhibition of CYP1A2

isoenzymes

Gareri et al. (2014)

Carbamazepine, phenytoin,

rifampin + TCAs (amitriptyline,

imipramine, clomipramine),

mirtazapine

Decreased serum-concentration

due to induction of CYP1A2

isoenzymes

Gareri et al. (2014)

Fluvoxamine, fluconazole,

ketoconazole, itraconazole,

erythromycin + venlafaxine,

clomipramine, citalopram,

mirtazapine

Increased serum-concentration of

antidepressants due to inhibition

of CYP3A4 isoenzymes

Gareri et al. (2014)

Barbiturates, carbamazepine,

phenytoin, rifampicin,

topiramate + venlafaxine,

clomipramine, citalopram,

mirtazapine

Decreased serum-concentration of

antidepressants due to induction

of CYP3A4 isoenzymes

Gareri et al. (2014)

Fluoxetine, paroxetine,

perphenazine propafenone,

quinidine, thioridazine + TCAs

(amitriptyline, clomipramine,

imipramine, desipramine,)

Increased serum-concentration of

TCAs due to inhibition of

CYP2D6 isoenzymes

(continued)

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