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Luvox CR and Remeron RD

Determining the interaction of Luvox CR and Remeron RD and the possibility of their joint administration.

Check result:

Luvox CR <> Remeron RD

Relevance: 12.09.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

FluvoxaMINE may significantly increase the blood levels of mirtazapine. This may increase the risk and/or severity of side effects such as dizziness, drowsiness, restlessness, confusion, difficulty concentrating, impairment in thinking and judgment, dry mouth, constipation, low blood pressure, and heart rhythm abnormalities. In addition, combining these types of medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms during treatment. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as selective serotonin reuptake inhibitors (SSRIs) and other antidepressants may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MONITOR CLOSELY: Coadministration with fluvoxamine may significantly increase the plasma concentrations of mirtazapine. The proposed mechanism is inhibition by fluvoxamine of CYP450 1A2, 2D6 and 3A4, the isoenzymes responsible for the metabolic clearance of mirtazapine. Increases in serum mirtazapine concentrations by three- to fourfold were observed in two patients following the addition of fluvoxamine. One patient reported feeling more anxious with the combination.

MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients receiving mirtazapine with fluvoxamine should have mirtazapine levels measured following the initiation, change of dosage, or withdrawal of fluvoxamine, and be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. The potential risk for serotonin syndrome should be considered even when administering serotonergic agents sequentially, as some agents may demonstrate a prolonged elimination half-life. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures.

References

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Luvox CR

Generic Name: fluvoxamine

Brand name: Luvox CR, Luvox

Synonyms: n.a.

What is Luvox CR?

Remeron RD

Generic Name: mirtazapine

Brand name: Remeron, Remeron SolTab

Synonyms: Mirtazapine

What is Remeron RD?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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