Duloxetine/fluoxetine interaction
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Serotonin syndrome in an elderly patient: case report An 85-year-old man developed serotonin syndrome shortly after his treatment was changed from fluoxetine to duloxetine. The man, who had a history of bipolar disorder and depression, was admitted with suicidal ideation. He started receiving fluoxetine titrated up to 30mg daily [initial dosage not stated]. After a 3-week hospital stay, he was discharged on fluoxetine [duration of treatment not stated]. During the following week, his depressive symptoms continued despite resolution of his suicidal ideation. Fluoxetine was replaced by duloxetine 20mg daily. One week after fluoxetine cessation, he presented with a 5-day history of back stiffness, nausea, vague abdominal complaints and generalised muscle spasms. He had generalised muscle rigidity, lower-extremity myoclonus, diffuse abdominal tenderness, muscle power 3/5 over the left upper and lower extremities and tongue fasciculation. His clinical presentation and Hunter’s criteria indicate serotonin syndrome. Duloxetine was discontinued and the man received supportive measures. Over the following few days, his symptoms resolved. Author comment: "Significant serum concentrations can persist 5 weeks after fluoxetine discontinuation. Therefore, the introduction of a new serotonergic medication within 1 month after fluoxetine is stopped is risky for excessive serotonin accumulation. . . Duloxetine and fluoxetine are moderate CYP2D6 inhibitors, and because both are metabolized though [sic] CYP2D6, substituting one for the other within a short period of time can prolong each other’s half-life . . . and potentiate serotonin syndrome." Liu P-T, et al. Serotonin syndrome in an octogenarian after switch from fluoxetine to duloxetine. Journal of the American Geriatrics Society 57: 2384-2385, No. 12, 801156526 Dec 2009 - USA
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Reactions 16 Jan 2010 No. 1284
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