Duloxetine with Ozanimod Interaction Details
Brand Names Associated with Duloxetine
- Cymbalta®
- Drizalma Sprinkle®
- Duloxetine
Brand Names Associated with Ozanimod
- Ozanimod
- Zeposia®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 11, 2023
Interaction Effect
An increased risk of CNS toxicity or serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes)
Interaction Summary
Concurrent administration or overlapping therapy with DULoxetine and an MAOI may result in CNS toxicity or serotonin syndrome, a hyperserotonergic state characterized by symptoms such as restlessness, myoclonus, changes in mental status, hyperreflexia, diaphoresis, shivering, and tremor. There have been spontaneous reports of serotonin syndrome associated with concomitant use of linezolid and serotonergic agents, including one case report involving DULoxetine. Concomitant administration of DULoxetine and MAOIs is contraindicated, and a minimum of 14 days should elapse after discontinuing the MAOI before initiating therapy with DULoxetine and a minimum of 5 days should elapse after discontinuing DULoxetine before initiating therapy with a MAOI .
Severity
Contraindicated
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Concurrent use of DULoxetine and MAOI is contraindicated. Wait at least 14 days after discontinuing this drug before initiating DULoxetine. Wait at least 5 days after discontinuing DULoxetine before initiating therapy with this drug.
Mechanism Of Interaction
Additive serotonergic effects
Literature Reports
A) In a retrospective cohort study in older adults who were prescribed oral linezolid 600 mg twice daily (N=1134), serotonin syndrome occurred in fewer than 6 patients (less than 0.5%) who were taking a concomitant antidepressant (n=215). In the propensity score-matched cohort (n=332), there was no difference in the risk of clinically significant serotonin syndrome in patients taking concomitant antidepressants and linezolid compared with patients taking linezolid without antidepressants (adjusted risk difference, -1.2%; 95% CI, -2.9% to 0.5%). There was also no difference in the rate of altered mental status or confusion, hospitalization, or death from any cause between groups. Patients were aged 66 years or older, and of those taking an antidepressant, 47.9% were taking an SSRI, 16.7% were taking an SNRI, 7% were taking a tricyclic antidepressant, 3.3% were taking a norepinephrine and dopamine reuptake inhibitor, and none were taking an MAOI .
B) Serotonin syndrome was induced in a 55-year-old woman maintained on DULoxetine 60 mg/day for recurrent depression, following the addition of intravenous linezolid 600 mg every 12 hours to her treatment regimen. The patient was initially admitted to an inpatient oncology center for pain management and treatment of an infected dehiscing abdominal wound. Due to persistence of vancomycin-resistant enterococcus in wound cultures, linezolid was added to the existing regimen. Approximately 3 hours after the first dose of linezolid, the patient demonstrated mental status changes, including confusion, restlessness, agitation, and abnormal movements. Additional symptoms occurring over the following hours included new-onset dense insomnia, disorientation, nonsensical speech, involuntary movements of the extremities, continued agitation, and roving eye movements. Laboratory data were noncontributory; a low-grade fever (38 degrees Celsius) was present. DULoxetine was discontinued and the patient improved throughout the day, returning to baseline mental and physical status by late afternoon. Linezolid was then discontinued, and 2 days later the patient chose to resume DULoxetine at a 30-mg/day dose. DULoxetine was tolerated without incident for the remainder of her hospital stay. A week later, the patient died from malignancy-associated sepsis and renal failure .
Duloxetine Overview
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Duloxetine is used to treat depression in adults and generalized anxiety disorder (GAD; excessive worry and tension that disrupts daily life and lasts for 6 months or longer) in adults and children 7 years of age and older. Duloxetine is also used to treat pain and tingling caused by diabetic neuropathy (damage to nerves that can develop in people who have diabetes) in adults and fibromyalgia (a long-lasting condition that may cause pain, muscle stiffness and tenderness, tiredness, and difficulty falling asleep or staying asleep) in adults and children 13 years of age and older. It is also used to treat ongoing bone or muscle pain such as lower back pain or osteoarthritis (joint pain or stiffness that may worsen over time) in adults. Duloxetine is in a class of medications called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). It works by increasing the amounts of serotonin and norepinephrine, natural substances in the brain that help maintain mental balance and stop the movement of pain signals in the brain.
Ozanimod Overview
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Ozanimod is used to treat adults with relapsing forms of multiple sclerosis (MS; a disease in which the nerves do not function properly and people may experience weakness, numbness, loss of muscle coordination, and problems with vision, speech, and bladder control) including clinically isolated syndrome (CIS; nerve symptom episodes that last at least 24 hours), relapsing-remitting forms (course of disease where symptoms flare up from time to time), or secondary progressive forms (course of disease where relapses occur more often). It is also used to treat ulcerative colitis (a condition which causes swelling and sores in the lining of the colon [large intestine] and rectum) in adults. Ozanimod is in a class of medications called sphingosine l-phosphate receptor modulators. It works by decreasing the action of immune cells that may cause nerve damage.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.