From the Guidelines
Fluoxetine and domperidone should not be used together due to a potentially dangerous drug interaction, as this combination increases the risk of QT interval prolongation, which can lead to serious cardiac arrhythmias including torsades de pointes, a potentially fatal heart rhythm disorder. This is because fluoxetine, a selective serotonin reuptake inhibitor (SSRI) used for depression and anxiety, inhibits the CYP2D6 enzyme that metabolizes domperidone, a dopamine antagonist used for nausea and vomiting, as noted in the study by 1.
The study by 1 also highlights the importance of considering drug-drug interactions when prescribing SSRIs, and notes that fluoxetine may interact with drugs metabolized by CYP2D6. Although the study by 1 does not specifically mention domperidone, the principle of cautious prescribing and monitoring for potential interactions is relevant.
Key points to consider when evaluating the interaction between fluoxetine and domperidone include:
- The potential for QT interval prolongation and cardiac arrhythmias
- The inhibition of CYP2D6 by fluoxetine, which can increase domperidone blood levels
- The importance of careful cardiac monitoring if the combination is used
- The consideration of alternative medications, such as ondansetron or sertraline, which may have a lower risk of interaction.
In clinical practice, it is essential to prioritize the safety of patients and avoid potentially dangerous drug interactions, as emphasized by the study by 1. Therefore, the combination of fluoxetine and domperidone should be avoided whenever possible, and alternative medications or careful monitoring should be considered if the combination is necessary.
From the Research
Interaction between Fluoxetine and Domperidone
- The interaction between fluoxetine (Selective Serotonin Reuptake Inhibitor - SSRI) and domperidone (Dopamine Antagonist) is not directly addressed in the provided studies.
- However, it is known that domperidone can prolong the QT interval (QTc) and may cause life-threatening arrhythmias 2, 3.
- Fluoxetine, on the other hand, is involved in many drug interactions with potentially serious clinical consequences, especially with other psychotropics 4, 5, 6.
- The risk of QT-prolongation is increased when domperidone is coadministered with QT-interacting medications 2, 3.
- Fluoxetine can inhibit drug metabolism, which may lead to increased levels of other medications, including domperidone 4, 5, 6.
- Although there is no direct evidence of an interaction between fluoxetine and domperidone, the combination of these medications may increase the risk of QT-prolongation and other adverse effects due to their individual properties 2, 4, 3, 5, 6.