Fluoxetine with Tinzaparin Interaction Details
Brand Names Associated with Fluoxetine
- Fluoxetine
- Prozac®
- Prozac® Weekly
- Rapiflux®
- Sarafem®
- Selfemra®
- Symbyax® (as a combination product containing Fluoxetine, Olanzapine)
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 11, 2023
Interaction Effect
An increased risk of bleeding
Interaction Summary
The release of serotonin by platelets is important for maintaining hemostasis. Case-control and cohort studies have shown that the combined use of SSRIs and anticoagulants has been associated with an increased risk of bleeding. Bleeding events reported have included epistaxis, ecchymosis, hematoma, petechiae, and life-threatening hemorrhages. Altered anticoagulant effects (including increased bleeding) have been reported with the coadministration of SSRIs with anticoagulants. When FLUoxetine and an anticoagulant are given concurrently, monitor patient for signs of increased bleeding. Patients who are taking an anticoagulant should be monitored closely for altered anticoagulant effects, including increased bleeding, when FLUoxetine therapy is initiated or discontinued .
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
When FLUoxetine and an anticoagulant are given concurrently, monitor patient for signs of increased bleeding. Patients who are taking an anticoagulant should be monitored closely for altered anticoagulant effects, including increased bleeding, when FLUoxetine therapy is initiated or discontinued.
Mechanism Of Interaction
Release of serotonin by platelets; additive effects on hemostasis
Literature Reports
A) A population-based, case-controlled study of new coumarin users (acenocoumarol and phenprocoumon) with concomitant selective serotonin reuptake inhibitors (SSRIs) resulted in an increased risk of hospitalization due to non-gastrointestinal bleeding. Using national pharmacy and hospitalization records, Netherlands researchers identified 1848 cases that were admitted for abnormal bleeding and compared them with 5818 control subjects also taking coumarins. Median duration of treatment in patients was 220 days (range, 1 to 4690 days). Patients on SSRIs showed a significant 1.7-fold increased risk for hospitalization for non-gastrointestinal bleeding; however, the rate of gastrointestinal bleeding was not significantly different .
B) Case reports and epidemiological studies (case-control and cohort studies) have demonstrated an association between the use of drugs that interfere with serotonin reuptake and the occurrence of gastrointestinal bleeding. Based on data from published observational studies, exposure to SSRIs, particularly in the month before delivery, has been associated with a less than 2-fold increase in the risk of postpartum hemorrhage. Bleeding events related to SSRIs and SNRIs have ranged from ecchymosis, hematoma, epistaxis, and petechiae to life-threatening hemorrhages .
Fluoxetine Overview
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Fluoxetine is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), some eating disorders, and panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks). Fluoxetine is also used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. It is also used along with olanzapine (Zyprexa) to treat depression that did not respond to other medications and episodes of depression in people with bipolar I disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Fluoxetine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.
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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.