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Contraindications and drug interaction

One major contraindication of SSRIs is the concomitant use of MAOIs (monoamine oxidase inhibitors). This is likely to cause severe serotonin syndrome/toxidrome.

People taking SSRIs should also avoid taking pimozide (an antipsychotic diphenylbutylpiperidine derivative). Tramadol hydrochloride (or Ultram, Ultracet) can, in rare cases, produce seizures when taken in conjunction with an SSRI or tricyclic antidepressant. Liver impairment is another contraindication for medications of this type.

SSRIs may increase blood levels and risk of toxicities of certain medications:

  1. highly protein-bound medications like warfarin (coumadin) and digoxin
  2. antiarrhythmic agents like propafenone (Rythmol) or flecainide (Tambocor)
  3. beta blockers like metoprolol (Toprol xl) or propranolol (Inderal)
  4. Tricyclic antidepressants like amitriptyline (Elavil, Endep) etc.
  5. triptans like sumatriptan (Imitrex, Imigran) etc.
  6. benzodiazepines like alprazolam (Xanax) or diazepam (Valium)[citation needed]
  7. carbamazepine (Tegretol)
  8. cisapride (Propulsid)
  9. clozapine (Clozaril)
  10. ciclosporin (Neoral)
  11. haloperidol (Haldol)
  12. phenytoin (Dilantin)
  13. pimozide (Orap)
  14. theophylline (Theo-dur)

Certain drugs may increase toxicities of SSRIs:

  1. alcohol and other CNS depressants
  2. Methylene Blue dye
  3. diuretics (water pills)
  4. MAOIs - possibly fatal serotonin syndrome/toxidrome
  5. sympathomimetic drugs like pseudoephedrine (Sudafed)
  6. lithium
  7. sibutramine (Meridia)
  8. MDMA (ecstasy)
  9. zolpidem (ambien)[17]
  10. dextromethorphan (cough suppressant) - increased risk of serotonin syndrome/toxidrome
  11. tramadol (synergistic serotoninergic effect said to increase risk of seizure or serotonin syndrome/toxidrome)
  12. pethidine/meperidine - increased risk of serotonin syndrome/toxidrome

SSRIs also directly interfere with ligands of 5-HT receptors, like the psychedelics and entactogens. SSRIs strongly attenuate the effects of tryptamine psychedelics like psilocybin and LSD, and almost completely eliminate the serotonergic effects of phenethylamine psychedelics like mescaline and MDMA. The exact mechanism that causes this interaction is still unclear

http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor

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