I had a resident in a nursing home who had an extensive psych history including episodes of physical aggression and schizophrenia. They also would be extremely obsessive over various different things from time to time. There were followed closely by psychiatry. This patient was receiving a dose of Zyprexa (olanzapine) of 15 mg at bedtime. To help with the obsessive/compulsive disorder (OCD) the psychiatrist ordered Luvox (fluvoxamine) which is an SSRI, but is rarely used due to the potential for multiple drug interactions. Within a few days upon initiation of the Luvox, the patient was extremely lethargic and had a couple of falls. The most likely cause of this was an interaction where Luvox can significantly increase the blood levels of Zyprexa, leading to potential toxicity. If you ever see an order for Luvox, you must look for drug interactions!
Luvox and Zyprexa Interaction
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- Fluvoxamine Drug Interactions - Med Ed 101 - […] significantly increased by a CYP1A2 inhibitor like fluvoxamine. In addition, propranolol and olanzapine are two drugs that I see…
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Wow! That is a scary drug interaction. Thank you for bringing it to my attention!!!
That’sgood. I’m working with patients of diferentes long term facilities and nursing home. The issue that I’m finding is a lot amount of generic medications prescribing for the same diagnostic . A lot of time patients with Alzheimer with atypical antysichotics and the issurance does not approve a mood stabilizer that is better for them. Polypharmacy is common in this type of patient. Trazone, alprazolam, flurazepam for the same patient.It’s not good..
Fluvoxamine is a potent CYP1A2 inhibitor and olanzapine is a substrate. There is almost a 2-3 fold increase of olanzapine concentration when the combination is administered. But, is the combinations so often in real life?
CBD likewise is 1A2, so it’s a good idea to find out what any given patient on Luvox outside of care homes are up to at the pharmacy.
In other news, we’re still prescribing Fluvoxamine. That’s really interesting.