From the Guidelines
Fluoxetine and amphetamine and dextroamphetamine (Adderall) are not absolutely contraindicated together, but their combination requires careful monitoring due to the potential risk of serotonin syndrome and increased side effects of Adderall. When considering the combination of these medications, it is essential to weigh the potential benefits against the risks for each individual patient's situation, as noted in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. The guideline emphasizes the importance of caution when prescribing serotonergic drugs, such as fluoxetine, with other medications that may interact with them, including amphetamines. Key considerations include:
- Starting with lower doses of Adderall and monitoring closely for side effects
- Being aware of the potential for fluoxetine to inhibit the metabolism of amphetamines, potentially increasing Adderall's effects and side effects
- Monitoring for symptoms of serotonin syndrome, such as agitation, hallucinations, rapid heart rate, fever, excessive sweating, shivering, tremors, muscle stiffness, and seizures
- Immediately reporting unusual symptoms to the healthcare provider The decision to use these medications together should be made by a healthcare provider who can carefully assess the individual patient's situation and provide close monitoring, as medical education, training, and experience are necessary to safely and effectively prescribe antidepressant medications 1.
From the Research
Interaction between Fluoxetine and Amphetamine/Dextroamphetamine
- The combination of fluoxetine (Prozac) and amphetamine/dextroamphetamine (Adderall) is not directly addressed in the provided studies as a contraindication 2, 3, 4, 5, 6.
- However, it is known that fluoxetine is a selective serotonin reuptake inhibitor (SSRI) and amphetamine/dextroamphetamine is a stimulant medication, which can increase the risk of serotonin syndrome, a potentially life-threatening condition 3, 5.
- A study on the combination of methylphenidate (another stimulant) and SSRIs found no significant increase in adverse event risk, but this may not be directly applicable to amphetamine/dextroamphetamine 4.
- Another study found that the combination of atomoxetine (a non-stimulant ADHD medication) and fluoxetine was well-tolerated in pediatric patients with ADHD and comorbid symptoms of depression or anxiety, but this does not provide direct evidence for the combination of fluoxetine and amphetamine/dextroamphetamine 6.
- The study on fluoxetine's adverse effects and drug-drug interactions mentions that fluoxetine can interact with various medications, including stimulants, but does not specifically address the combination with amphetamine/dextroamphetamine 5.
Safety Considerations
- When considering the use of fluoxetine and amphetamine/dextroamphetamine together, it is essential to monitor patients closely for signs of serotonin syndrome, such as altered mental status, neuromuscular abnormalities, and autonomic hyperactivity 3.
- The risk of serious cardiovascular adverse events, including statistically or clinically significant increases in QTc, and sudden cardiac death associated with stimulants, is extremely low, but caution is advised when considering stimulant medications for patients with a personal or family history of cardiovascular disease 2.