التداخل بين دولوكسيتين وبروتريبتيلين

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents but also when taken alone.

If concomitant use of Duloxetine Delayed-Release Capsules with other serotonergic drugs is clinically warranted, inform patients of the increased risk for serotonin syndrome and monitor for symptoms.

Other Serotonergic Drugs Prevention or Management Monitor for symptoms of serotonin syndrome when Duloxetine Delayed-Release Capsules is used concomitantly with other drugs that may affect the serotonergic neurotransmitter systems.

If serotonin syndrome occurs, consider discontinuation of Duloxetine Delayed-Release Capsules and/or concomitant serotonergic drugs [see Dosage and Administration ( 2.6 ), Warnings and Precautions ( 5.4 )] .

Mechanism and Clinical Effect(s) Concomitant use of Duloxetine Delayed-Release Capsules with other serotonergic drugs increases the risk of serotonin syndrome.

Anyone considering the use of protriptyline hydrochloride or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need.

Tachycardia and postural hypotension may occur more frequently with protriptyline than with other antidepressant drugs.

The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics, propafenone and flecainide).