This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
When these two medicines are taken together, your body may not process clozapine as quickly.
What might happen:
Your blood levels of clozapine may increase. You may experience a fast heartbeat, low blood pressure, fatigue, dizziness, increased salivation, seizures or decreased breathing.
What you should do about this interaction:
If you experience these problems, contact your doctor right away. The dose of your medicines may be need to be adjusted. Your healthcare professionals (e.g. doctor or pharmacist) may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
1.Markowitz JS, Gill HS, Lavia M, Brewerton TD, DeVane CL. Fluvoxamine-clozapine dose-dependent interaction. Can J Psychiatry 1996 Dec;41(10):670-1.
2.Dequardo JR, Roberts M. Elevated clozapine levels after fluvoxamine initiation. Am J Psychiatry 1996 Jun;153(6):840-1.
3.DuMortier G, Lochu A, Colen de Melo P, Ghribi O, Roche-Rabreau D, DeGrassat K, Desce JM. Elevated clozapine plasma concentrations after fluvoxamine initiation. Am J Psychiatry 1996 May;153(5):738-9.
4.Hiemke C, Weigmann H, Hartter S, Dahmen N, Wetzel H, Muller H. Elevated levels of clozapine in serum after addition of fluvoxamine. J Clin Psychopharmacol 1994 Aug;14(4):279-81.
5.Szegedi A, Wiesner J, Hiemke C. Improved efficacy and fewer side effects under clozapine treatment after addition of fluvoxamine. J Clin Psychopharmacol 1995 Apr;15(2):141-3.
6.Silver H, Kaplan A, Jahjah N. Fluvoxamine augmentation for clozapine-resistant schizophrenia. Am J Psychiatry 1995 Jul;152(7):1098.
7.Wetzel H, Anghelescu I, Szegedi A, Wiesner J, Weigmann H, Harter S, Hiemke C. Pharmacokinetic interactions of clozapine with selective serotonin reuptake inhibitors: differential effects of fluvoxamine and paroxetine in a prospective study. J Clin Psychopharmacol 1998 Feb;18(1):2-9.
8.Jerling M, Lindstrom L, Bondesson U, Bertilsson L. Fluvoxamine inhibition and carbamazepine induction of the metabolism of clozapine: evidence from a therapeutic drug monitoring service. Ther Drug Monit 1994 Aug; 16(4):368-74.
9.Centorrino F, Baldessarini RJ, Frankenburg FR, Kando J, Volpicelli SA, Flood JG. Serum levels of clozapine and norclozapine in patients treated with selective serotonin reuptake inhibitors. Am J Psychiatry 1996 Jun; 153(6):820-2.
10.Brewerton TD, Shannon M. Possible clozapine exacerbation of bulimia nervosa. Am J Psychiatry 1992 Oct;149(10):1408-9.
11.Joos AA, Konig F, Frank UG, Kaschka WP, Morike KE, Ewald R. Dose-dependent pharmacokinetic interaction of clozapine and paroxetine in an extensive metabolizer. Pharmacopsychiatry 1997 Nov;30(6):266-70.
12.Anghelescu I, Szegedi A, Schlegel S, Weigmann H, Hiemke C, Wetzel H. Combination treatment with clozapine and paroxetine in schizophrenia: safety and tolerability data from a prospective open clinical trial. Eur Neuropsychopharmacol 1998 Dec;8(4):315-20.
13.Taylor D, Ellison Z, Ementon Shaw L, Wickham H, Murray R. Co-administration of citalopram and clozapine: effect on plasma clozapine levels. Int Clin Psychopharmacol 1998 Jan;13(1):19-21.
14.Bess AL, Cunningham SR. Dear Healthcare Provider: Important drug warning and new information about Clozaril. Novartis Pharmaceuticals Corporation December, 2005.
15.Clozaril (clozapine tablets) US prescribing information. Novartis Pharmaceuticals Corporation March, 2013.