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Medical Author:

Mary L Windle, PharmD

Pharmacy Editor:

Omudhome Ogbru, PharmD

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

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Tell the doctor what medications are currently being taken because many medicines interact with SSRIs. Do not take any nonprescription or herbal medications without first consulting the doctor or pharmacist. The following are examples of interactions, but they do not represent a complete list.

When an SSRI is administered with 5-HT1 agonists, such as sumatriptan (Imitrex) or zolmitriptan (Zomig), weakness and incoordination, although rare, have been reported.

SSRIs may increase the blood levels and risk of toxicity of certain medications, including the following:

• Highly protein-bound medicines such as warfarin (Coumadin) and digoxin
(Lanoxin)
• Antiarrhythmic medicines such as propafenone (Rythmol) or flecainide (Tambocor)
• Beta blockers such as propranolol (Inderal) or metoprolol (Lopressor, Toprol XL)
• Tricyclic antidepressants such as amitriptyline (Elavil)
• Benzodiazepines such as alprazolam (Xanax), diazepam (Valium), midazolam (Versed), or triazolam (Halcion)
• carbamazepine (Tegretol)
• cisapride (Propulsid)
• clozapine (Clozaril)
• cyclosporine (Neoral, Sandimmune)
• haloperidol (Haldol)
• thioridazine (Mellaril)
• phenytoin (Dilantin)
• pimozide (Orap)
• theophylline (Theo-Dur, TheoBid)

The following substances may increase toxicity of SSRIs:

• Alcohol or other drugs that depress the central nervous system
• Diuretics (water pills)
• MAOIs (may cause serious, and sometimes fatal, reactions)
• St. John's wort
• Decongestants such as pseudoephedrine (Sudafed)
• lithium
(Eskalith, Lithobid)
• sibutramine (Meridia, Zolpmist)
• zolpidem (Ambien) or other medications used for insomnia

• Photosensitivity (increased risk of sunburn) (Use protective clothing, such as long sleeves and hats, and sunscreen to decrease the risk of sunburn.)
• Rash
• Nausea
• Dry mouth
• Constipation
• Low blood sodium levels (in people who are dehydrated or taking diuretics)
• Low blood sugar levels
• Drowsiness (Caution is advised when operating machinery, driving, or performing other tasks that require alertness.)
• Sexual dysfunction such as delayed ejaculation, erectile difficulties, and impotence (in men) and difficulty reaching climax or orgasm (in women)
• Withdrawal-like symptoms in newborns (Women who take SSRIs in late pregnancy [third trimester] may have newborns who require prolonged hospitalization due to withdrawal-like symptoms such as shortness of breath, constant crying, feeding difficulty, or low blood sugar levels.)
• Manic episodes in persons with bipolar disorder (If not combined with a mood-stabilizing medication, SSRIs may induce manic episodes in individuals with bipolar disorder [manic depression].)
• Kidney or liver impairment precautions (The doctor may draw blood samples to check for kidney or liver impairment before prescribing SSRIs.)

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