Fluoxetine and Selegiline – Lack of Significant Interaction

Abstract

The use of the combination of fluoxetine, an anti-depressant serotonin uptake inhibitor, and selegiline, a monoamine oxidase -B inhibitor, was reviewed in a large population of patients with Parkinson's disease. All records were reviewed from a Parkinson's disease clinic to determine how many patients were treated simultaneously with selegiline and fluoxetine. Patient characteristics, duration and dose of treatment, side effects and reasons for discontinuation were noted. Twenty-three patients received both medications at the same time. No additional side effects were noted with the combination therapy that had not already been reported with each medication alone. No serious side effects were found. In this clinic population, fluoxetine and selegiline were used in combination without major side effects, but further observation is warranted.Resume: Fluoxetine et selegiline -absence d'interaction significative. Nous avons revu I'utilisation combined de la fluoxetine, un anti-depresseur inhibant la captation de la serotonine, et de la selegiline, un inhibiteur de la (MAO)-B, dans une grande population de patients atteints de la maladie de Parkinson. Tous les dossiers d'une clinique de Parkinson ont ete revises pour determiner combien de patients avaient ete trails simultan^ment par la selegiline et la fluoxetine. Les caracteristiques des patients, la duree du traitement et la dose, les effets secondaires et les raisons de cessation du traitement ont ete relev6s. Vingt-trois patients ont recu les deux medicaments en meme temps. Aucun effet secondaire, qui n'avait pas et6 rapportd avec chacun des medicaments administre' en monotheYapie, n'a ete note avec la therapie combinee. Aucun effet secondaire grave n'a 6t6 rapporte. Dans la population de cette clinique, la fluoxetine et la selegiline ont ete utilisees en combinaison, sans effet secondaire majeur. Cependant d'autres observations sont requises pour certifier cette absence d'interaction significative.Can. J. Neurol. Sci. 1994; 21: 259-261 Fluoxetine and selegiline are two recently released medications. The anti-depressant fluoxetine is a serotonin uptake inhibitor. 1 Selegiline, used predominantly for enhancing the effects of levodopa in Parkinson's disease (PD), is a monoamine oxidase (MAO)-B inhibitor, 2 when used in the recommended dose of 10 mg per day. If this dose is exceeded, it is no longer a selective MAO-B inhibitor. 3 As serotonin is metabolized by MAO-A, 4 blocking this enzyme enhances serotonin's action. An interaction between nonspecific MAO inhibitors and fluoxetine can produce a "serotonin syndrome" with tremor, agitation, restlessness, confusion, hypomania, hypertension and diarrhea. 5 The risk varies with the type of MAO inhibitor, 6 and in some instances the two types of medication can be used in combination quite safely. 7 The current manufacturer's recommendation is that fluoxetine (Dista Products) should not be taken with any MAO inhibitor. Although there is little convincing evidence that the combination of fluoxetine-selegiline...

Monoamine Reuptake Inhibitors in Parkinson’s Disease

“…However, the combination of fluoxetine and selegiline in PD patients appears to be generally safe and well tolerated. Thus, in a series of 23 PD patients taking the two drugs concomitantly, no adverse effects other than those associated with each of the two drugs taken individually were reported [222]. …”

Efficacy, safety, and patient preference of monoamine oxidase B inhibitors in the treatment of Parkinson's disease

“…Originally described in patients taking nonselective MAO inhibitors,73 it is now most commonly seen in patients taking more than one drug with serotonergic activity (often selective serotonin reuptake inhibitors [SSRIs] or tricyclic antidepressants in combination with MAO inhibitors) 74. Treatment generally consists of supportive care and discontinuing the offending agent 75. Though serotonin syndrome is potentially quite dangerous, there does not appear to be a serious risk of developing it while taking selective MAO-B at PD doses, even when taking an SSRI as well.…”

“…Though serotonin syndrome is potentially quite dangerous, there does not appear to be a serious risk of developing it while taking selective MAO-B at PD doses, even when taking an SSRI as well. Two retrospective studies have failed to show evidence of serotonin syndrome in patients taking selegiline and an SSRI 75,76. A survey of members of the Parkinson Study Group found 4568 PD patients treated with a combination of selegiline and an SSRI.…”

Rasagiline in treatment of Parkinson’s disease

“…Many patients with PD suffer from concurrent mood disorders, including depression and anxiety (Lauterbach 2004), and therefore use of SSRIs and other antidepressants in this population is common. The possibility of interactions arising as a result of use of selective MAOIs in conjunction with SSRIs, tricyclic, or other antidepressant medications in PD has been raised by several investigators (Suchowersky and deVries 1990;Blackwell 1991;Ritter and Alexander 1997), although careful retrospective studies of selegiline use have failed to fi nd such an interaction (Waters 1994;Toyama and Iacono 1994;Richard et al 1997). The TEMPO trial allowed limited use of amitriptyline, paroxetine, sertraline, and trazodone, and both amitriptyline and trazodone were allowed in the LARGO study at low and stable doses.…”