Drug Interaction Report

Asenapine Transdermal Patch and Fluoxetine: Interaction Details

A pharmacist-reviewed analysis of the Asenapine Transdermal Patch and Fluoxetine interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Fluoxetine

RECONCILE
+

Asenapine Transdermal Patch

Secuado Secuado®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Jul 11, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 377 documented Asenapine Transdermal Patch interactions, 276 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
unspecified
Evidence
theoretical
Severity
Major

What happens

Increased FLUoxetine exposure, an increased asenapine exposure and an increased risk of QT interval prolongation

Interaction Deep Dive

Avoid concomitant use of asenapine and FLUoxetine (QT prolonging CYP2D6 inhibitor/substrate) as it may result in an increased exposure of asenapine and/or FLUoxetine and may cause additive QT effects123. Consider ECG assessment and periodic ECG monitoring if initiating treatment with FLUoxetine in patients with risk factors for QT interval prolongation and ventricular arrhythmia. Discontinue FLUoxetine and obtain a cardiac evaluation if patients develop signs or symptoms consistent with ventricular arrhythmia 4.

Why it happens (mechanism)

Inhibition of CYP2D6-mediated metabolism of FLUoxetine; inhibition of CYP2D6-mediated metabolism of asenapine; additive effects on the QT interval

Literature reports

1 report — tap to read

a) FLUoxetine use is associated with reports of QT interval prolongation and ventricular arrhythmia, included torsade de pointes 4.

Common questions

Can I take Asenapine Transdermal Patch and Fluoxetine together?

Increased FLUoxetine exposure, an increased asenapine exposure and an increased risk of QT interval prolongation Always confirm with your pharmacist or prescriber before making any change.

How serious is the Asenapine Transdermal Patch and Fluoxetine interaction?

It is rated major. Potentially serious — often needs a change or close monitoring.

How quickly could this interaction happen?

The documented onset is "unspecified". The timing of this interaction is not well characterized.

How strong is the evidence for this interaction?

The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.

Questions for your pharmacist

  • Does my dose of Asenapine Transdermal Patch or Fluoxetine need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there a safer alternative to one of these medications for me?

References (4)

  1. Product Information: SAPHRIS(R) oral sublingual tablets, asenapine oral sublingual tablets. Allergan USA, Inc. (per DailyMed), Madison, NJ, 2021. DailyMed
  2. Product Information: SECUADO® transdermal system, asenapine transdermal system. Noven Therapeutics LLC (per DailyMed), Miami, FL, 2023. DailyMed
  3. Product Information: Asenapine oral sublingual tablets, asenapine oral sublingual tablets. Alembic Pharmaceuticals Ltd (per DailyMed), Bedminster, NJ, 2025. DailyMed
  4. Product Information: PROZAC(R) oral capsules, fluoxetine oral capsules. Lilly USA LLC (per FDA), Indianapolis, IN, 2023. DailyMed
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Fluoxetine

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Asenapine Transdermal Patch

Keep reading about Asenapine Transdermal Patch

All Asenapine Transdermal Patch interactions (377) Asenapine Transdermal Patch drug information
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Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Fluoxetine + Activated Charcoal American Hellebore Arsenic Cesium Ephedra Grapefruit Lithium Sida Cordifolia + 155 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.