Can Fluvoxamine and Trazodone be taken together? (3+ risks)

In this article, we will answer the question “Can Fluvoxamine and Trazodone be taken together?”. We will discuss the research conducted on this combination, potential benefits and adverse effects, and what kind of population can benefit from such a combination.

Can Fluvoxamine and Trazodone be taken together?

Yes, Fluvoxamine and Trazodone can be taken together under continuous monitoring of the patient. This combination if prescribed has to be monitored for adverse events, especially the occurrence of serotonin syndrome. Your doctor will only give you this combination if the benefits outweigh the risks.

Fluvoxamine (also known as Luvox) is a drug belonging to the selective serotonin reuptake inhibitors (SSRIs). It is an antidepressant approved by the FDA for the treatment of obsessive-compulsive disorder (OCD). It has also been prescribed ‘off-label’ for major depressive disorder (MDD), panic disorder (PD), posttraumatic stress disorder (PTSD), social anxiety disorder (SAD) and eating disorders (1).

Trazodone (also known as Desyrel) is an antidepressant belonging to a class called serotonin antagonists and reuptake inhibitors (SARIs). Trazodone also shares many properties with the SSRIs. It is approved by the FDA for the treatment of major depressive disorder (MDD). It has been used to help with generalised anxiety disorder (GAD), PD, PTSD, OCD, schizophrenia and diabetic neuropathy (2).

What does research suggest?

Only a few research studies assessing the safety and efficacy of the combination of SSRIs (including Fluvoxamine) and Trazodone have been published. These studies have different views on the usage of both medications in combination.

A study evaluating the pharmacokinetic characteristics of fluvoxamine in the treatment of anxiety and related disorders, states that a combination of Trazodone with Fluvoxamine should not be used due to the higher risk of sedation and serotonin syndrome (3).

A case study assessing suicide due to an overdose of Trazodone reported that the patient had a history of combination therapy of Fluvoxamine and Trazodone before he tragically committed suicide. He was given this combination to treat severe depression (4).

Another study reported that the combination of Trazodone and Fluvoxamine may be used to treat the side effects associated with Fluvoxamine therapy. Trazodone is added to such a regimen to combat insomnia caused by SSRIs. However, because both medications have the potential to cause serotonin syndrome, dosage reduction to a safe level and continuous monitoring are necessary (5).

A clinical study assessed the combination of Fluvoxamine and Trazodone for the treatment of pica in late-stage Alzheimer’s disease. This study reported that both medications when used in combination alleviated the pica behaviours in the patient and did not cause sedation, extrapyramidal symptoms or other side effects (6).

What are the benefits of the combination of Fluvoxamine and Trazodone?

The combination therapy of Fluvoxamine and Trazodone is beneficial for patients who have severe depression that cannot be treated with monotherapy with either medication.

Effect on sleep

It is also given to patients who report insomnia as a side effect when on Fluvoxamine therapy. The combination of medications affects the patient’s sleep quality and structure. Trazodone can reduce the number of awakenings and may improve sleep quality in the night hence counteracting the Fluvoxamine-induced insomnia.

Effect on cognitive function

Trazodone has a risk of causing memory issues. It can cause short-term memory dysfunctions. Fluvoxamine is found to improve cognitive functioning, and increase concentration and recall abilities of individuals receiving therapy. Fluvoxamine also helps in preventing stress-induced cognitive impairment by its memory-protective characteristics on the hippocampus.

Effect on stress or mood-regulating hormones

Both medications are known to improve serotonin levels in the brain. Serotonin is considered a neurotransmitter as well as a hormone. Serotonin is needed for the regulation of mood, emotions and motor skills.

What are the potential side effects of Fluvoxamine and Trazodone?

Both medications are found to have an array of side effects. Some of the side effects are as follows (1,2):

Fluvoxamine is known to cause: 

• Nausea
• Insomnia
• Nervousness
• Anorexia
• Tremors
• Vomiting
• Agitation
• Decreased libido
• Sweating

Trazodone is known to cause:

• Edema
• Blurred vision
• Syncope
• Diarrhoea
• Drowsiness
• Fatigue
• Nasal congestion
• Acid reflux
• Weight loss
• Joint pain

What are some risks of the Fluvoxamine and Trazodone combination?

Fluvoxamine and Trazodone both have the risk of causing serotonin syndrome, suicidal ideation, activation of mania, and discontinuation syndrome. The risk of these side effects is increased during combination therapy. If your doctor prescribes both medications at once, you will need continuous monitoring to assess for any signs and symptoms which will lead to these side effects.

Serotonin syndrome – Serotonin syndrome is a life-threatening condition characterised by agitation, delirium, hallucinations, tachycardia, dizziness, lack of coordination and seizures in individuals on therapy. If severe and left untreated serotonin syndrome can result in coma and even death.

Suicidal ideation – Almost all antidepressant drugs are found to increase suicidal thoughts and behaviours. Hence, if Fluvoxamine and Trazodone are used together, additional monitoring of patients for suicidal behaviours is needed.

Activation of mania – Patients should be screened for a family history of bipolar disorder or mania before initiating therapy with any antidepressant. Both medications have reported the precipitation of manic episodes in patients who were receiving treatment for bipolar disorder-related depression. Both medications should be used with caution in patients with a history of mania.

Discontinuation syndrome – Both Fluvoxamine and Trazodone are known to cause discontinuation syndrome if rapid dose reduction or abrupt cessation of therapy occurs. The risk for discontinuation and withdrawal symptoms to occur increases when these medications are used in combination. Some signs and symptoms of discontinuation syndrome are sensory disturbances, anxiety, confusion, irritability, tinnitus, agitation, headache and dizziness. Gradual dose reduction of both medications is required to alleviate these symptoms.

If you experience any of these side effects while taking your medications, do not stop taking them instead consult your doctor for proper guidance.

When is the combination of Fluvoxamine and Trazodone prescribed?

The combination of SSRIs, including Fluvoxamine, with Trazodone, is not yet well explored. Some clinicians may prescribe these medications together if the patient does not respond to any other medications. However, both medications have the potential to cause common side effects which can increase in magnitude and become life-threatening.

Due to this reason, healthcare providers start with the lowest possible dose of both drugs and keep a close check on patients given this therapy. Your doctor may even advise you to cut your tablets to reduce the dosage ingested.

If you are prescribed this combination, your doctor might check on you more regularly than usual to assess any potential side effects. You should also tell your doctor if you feel that these medications are not improving your condition and causing any unwanted effects.

Conclusion

In this article, we discussed the combination of Fluvoxamine and Trazodone and the potential risks and benefits associated with this combination. We also discussed what research studies have reported in this regard.

In my opinion, Fluvoxamine and Trazodone can be taken together but only after the evaluation of the risks and benefits of therapy by a healthcare professional. As both these medications have a risk of causing potential life-threatening side effects they should be used with immense caution, under continuous monitoring and only on the prescription of a healthcare provider.

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