What drugs interact with Zoloft and Prozac?
All SSRIs, including Zoloft, should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example
- isocarboxazid (Marplan),
- phenelzine (Nardil),
- tranylcypromine (Parnate),
- selegiline (Eldepryl, Emsam, Elazar), and
- procarbazine (Matulane).
Other drugs that inhibit monoamine oxidase include
Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. (A period of 14 days without treatment should lapse when switching between Zoloft and MAOIs.) Similar reactions occur when Zoloft is combined with other drugs for example, tryptophan, St. John’s wort, meperidine (Demerol, Meperitab), tramadol (ConZip, Synapryn FusePaq, Ultram) that increase serotonin in the brain.
Cimetidine (Cimetidine Acid Reducer, Tagamet HB ) may increase the levels in blood of Zoloft by reducing the elimination of Zoloft by the liver. Increased levels of Zoloft may lead to more side effects.
Zoloft increases the blood level of pimozide (Orap) by 40%. High levels of pimozide can affect electrical conduction in the heart and lead to sudden death. Therefore, patients should not receive treatment with both pimozide and Zoloft.
Taking Prozac with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.
Many drugs can interact with Prozac. Tell your doctor about all your current medicines and any you start or stop using, especially:
- any other antidepressant
- St. John’s wort
- tryptophan (sometimes called L-tryptophan)
- a blood thinner — warfarin (Coumadin, Jantoven)
- medicine to treat anxiety, mood disorders, thought disorders, or mental illness — amitriptyline, buspirone, desipramine, lithium, nortriptyline, and many others
- medicine to treat ADHD or narcolepsy — Adderall, Concerta, Ritalin, Vyvanse, Zenzedi, and others
- migraine headache medicine — rizatriptan, sumatriptan, zolmitriptan
- narcotic pain medicine — fentanyl, oxycodone, hydrocodone, and others
Taking monoamine oxidase inhibitors (MAOIs) with Prozac may cause a serious (possibly fatal) drug interaction. Avoid taking MAOIs (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with Prozac. Most MAOIs should also not be taken for 2 weeks before and at least 5 weeks after treatment with Prozac. Ask your doctor when to start or stop taking this medication.
The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/”ecstasy,” St. John’s wort, certain antidepressants (including other SSRIs such as citalopram/paroxetine, SNRIs such as duloxetine/venlafaxine), tryptophan, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.
Many drugs besides Prozac may affect the heart rhythm (QT prolongation), including pimozide and thioridazine, among others. Aspirin can increase the risk of bleeding when used with Prozac. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81 to 325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise.
Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (such as codeine).