Does Prozac interact with Vyvanse? (+1 interactions)
By
Dr Milena Locci de Oliveira (PhD)
Author bio
Dr Milena Locci de Oliveira is a Pharmacist and Doctor of Philosophy in Sciences from the University of São Paulo (USP). She has experience in microbiology, analytical toxicology, and clinical pharmacokinetics. She writes and reviews content on these topics.
Dr Milena’s Highlights:
-PhD in Sciences, University of São Paulo, Brazil, 2019.
-University College London (UCL) – Semester of remote collaboration in the areas of Pharmacometrics and Population Pharmacokinetics, 2018.
-Bachelor in Biochemical Pharmacy, University of São Paulo, Brazil, 2013.
“Science can be translated, and it is essential that everyone has access to quality information to make informed decisions” – Dr Milena Oliveira, PhD.
Professional Experience:
With a decade-long career as a researcher, Dr Milena has amassed extensive experience in conducting research projects in microbiology, analytical toxicology, and clinical pharmacokinetics.
Her expertise also extends to the preparation of technical and scientific reports, literature reviews, data analysis, and scientific communication, both oral and written.
Dr Milena has served as a Clinical Pharmacist, providing expert supervision and guidance to teams during the challenging times of the COVID-19 pandemic, particularly in the ICUs of two reference hospitals for patient hospitalization.
In her most recent role, Dr Milena worked on the implementation of the deliberatives of the São Paulo State Government Pharmaceutical Assistance Coordination. These decisions were aimed at ensuring medication access within the Unified Health System.
A widely multidisciplinary background enabled Dr Milena to become a professional capable of integrating scientific knowledge into private initiatives, education, and healthcare, delivering consistent services in patient safety and population health.
Professional Memberships & Affiliations:
Dr Milena Oliveira is a member of the Regional Council of Pharmacy of the State of São Paulo, Brazil.
Education:
-PhD in Sciences, University of São Paulo, Brazil, 2019.
-University College London (UCL) – Semester of remote collaboration, 2018.
-Bachelor in Biochemical Pharmacy, University of São Paulo, Brazil, 2013.
Relevant Published Work & Citations:
Oliveira ML de, Rocha A, Nardotto GHB, Pippa LF, Simões BP, Lanchote VL. Analysis of daunorubicin and its metabolite daunorubicinol in plasma and urine with application in the evaluation of total, renal and metabolic formation clearances in patients with acute myeloid leukemia. Journal of Pharmaceutical and Biomedical Analysis. Nov 2020. 191:113-124.
Abstracts. CPT: Pharmacometrics & Systems Pharmacology. 2020 Nov; 9 (S1).
Pippa LF, Oliveira ML de, Rocha A, de Andrade JM, Lanchote VL. Total, renal and hepatic clearances of doxorubicin and formation clearance of doxorubicinol in patients with breast cancer: Estimation of doxorubicin hepatic extraction ratio. Journal of Pharmaceutical and Biomedical Analysis. 2020 Jun 5; 185:113-231.
Godoy ALPC, De Jesus C, De Oliveira ML, Rocha A, Pereira MPM, Larangeira DF, Lanchote VL, Barrouin-Melo SM. Determination of Allopurinol and Oxypurinol in Dogs Plasma by High-Performance Liquid Chromatography with an Ultraviolet Detector: Application for Pharmacokinetic Studies. J Chromatogr Sep Tech. 2017; 8 (4).
Clímaco EC, Oliveira ML de, Pitondo-Silva A, Oliveira MG, Medeiros M, Lincopan N, et al. Clonal complexes 104, 109 and 113 playing a major role in the dissemination of OXA-carbapenemase-producing Acinetobacter baumannii in Southeast Brazil. Infection, Genetics and Evolution. 2013 Oct;19:127–33.
Conference Papers:
Oliveira, M. L.; NARDOTTO, G. H. B.; PIPPA, L. F.; ROCHA, A.; SIMOES, B. P.; LANCHOTE, V. L. . Daunorubicin metabolism and urinary excretion in patients with acute myeloid leukemia. In: 84th Annual Meeting of the German Society for Experimental and Clinical Pharmacology and Toxicology (DGPT) and the 20th Annual Meeting of the Association of the Clinical Pharmacology Germany (VKliPha), 2018, Göttingen. Naunyn-Schmiedeberg’s Arch Pharmacol, 2018. v. 391. p. S76-S76.
Oliveira, M. L.; NARDOTTO, G. H. B. ; ROCHA, A. ; SIMOES, B. P. ; LANCHOTE, V. L. . The low contribution of urinary excretion in the elimination of daunorubicin and its metabolite daunorubicinol in patients with acute myeloid leukemia. In: 49th Brazilian Congress of Pharmacology and Experimental Therapeutics., 2017, Ribeirão Preto. Livro de Resumos, 2017. p. 64-64.
Oliveira, M. L.; PIPPA, L. F. ; ROCHA, A. ; SIMOES, B. P. ; LANCHOTE, V. L. . Quantification of daunorubicin and its metabolite daunorubicinol in human plasma by LC-MS/MS. In: I International Meeting of Environmental Health and Toxicology (IMEHTOX), 2016, Ribeirão Preto. Livro de Resumos, 2016.
Oliveira, M. L.; Clímaco, E.C. ; OLIVEIRA, M. G. ; Lincopan, N. ; Darini A.L.C. . PFGE typing of Carbapenem-Resistant Acinetobacter baumannii isolated from different University Hospitals. In: V International Postgraduate and Research Symposium, 2012.
Clímaco, E.C. ; SILVA, A. P. ; Oliveira, M. L. ; OLIVEIRA, M. G. ; Lincopan, N. ; Darini A.L.C. Relação clonal entre linhagens de Acinetobacter baumannii produtoras de carbapenemases da família OXA em quatro hospitais no Brasil. In: XXI Latin American Congress of Microbiology, 2012, Santos. XXI Latin American Congress of Microbiology, 2012.
Oliveira, M. L.; Clímaco, E.C. ; OLIVEIRA, M. G. ; Darini A.L.C. . Dissemintion of OXA carbapenemases genes in carbapenem-resistant Acinetobacter baumannii in University Hospital of Juiz de Fora, MG. In: 8th CIFARP – International Congress of Pharmaceutical Sciences, 2011, Ribeirão Preto.
Clímaco, E.C. ; Oliveira, M. L. ; OLIVEIRA, M. G. ; Darini A.L.C. . Avaliação do sequenciamento parcial do gene rpoB e de seus flanqueadores para identificação de espécies de Acinetobacter na rotina laroratorial. In: 2° International Symposium on Clinical Microbiology, 2010, Florianópolis.
You can view some of Dr Milena’s work below and links to her professional profile.
Linkedin: https://www.linkedin.com/in/dra-milena-locci-de-oliveira-28986042/?locale=en_US
ResearchGate: https://www.researchgate.net/profile/Milena-Oliveira-6
Escavador: https://www.escavador.com/sobre/5394254/milena-locci-de-oliveira
Lattes: https://buscatextual.cnpq.br/buscatextual/busca.do
Scopus: https://www.scopus.com/authid/detail.uri?authorId=57199779361
Scholar: https://scholar.google.com/citations?view_op=list_works&hl=pt-BR&user=1YUBDIQAAAAJ
In this article, we will discuss if Prozac can react or interact with Vyvanse, what causes these interactions, how the interactions occur and what factors affect them. In addition to this, the treatment strategies will also be discussed.
Does Prozac interact with Vyvanse?
Yes, Prozac can interact with Vyvanse. Prozac (Fluoxetine) and Vyvanse (lisdexamfetamine) are two different drugs with two different mechanisms. These may interact with one another when taken together especially when doses are not adjusted properly.
Prozac is prescribed for depression and mood disorders. However, Vyvanse is usually prescribed for the treatment of ADHD or in some cases binge eating disorder (BED), since it is a CNS stimulant (1). The potential interactions of these drugs may include:
- Increased risk of serotonin syndrome
- Increased risk of CVS side effects
- Increased risk of anxiety and insomnia
- Decreased effectiveness of either medication
It is crucial to consult your healthcare professional before using the combination of Prozac and Vyvanse. Never start or stop any medication without proper professional guidance.
How does Prozac interact with Vyvanse?
Prozac and Vyvanse can interact in a few different ways.
Prozac is a selective serotonin reuptake inhibitor (SSRI) which increases the levels of serotonin in the brain cells (2). Vyvanse is a stimulant but also has effects on serotonin levels causing an increase. If two drugs are taken together this may increase the serotonin levels to an extent where serotonin syndrome may occur.
Prozac and Vyvanse are also found to have potentiating effects on norepinephrine, another neurotransmitter involved in attention, focus and energy. When Prozac is combined with Vyvanse, The two drugs can have an additive effect on the norepinephrine levels causing increased alertness and focus (3).
Prozac and Vyvanse are both metabolized by the enzyme CYPD26. When these two drugs are present in the body at the same time, they compete for the enzyme which can lead to increased levels of either of these drugs in blood (4) (5).
What are the potential interactions between Prozac and Vyvanse?
Prozac and Vyvanse can lead to the following interactions.
Serotonin Syndrome
Serotonin syndrome is a rare but serious condition that may result due to the interaction of Prozac and Vyvanse. This is the condition when there is too much serotonin in the body (6). This may cause the following symptoms to appear:
- Confusion
- Agitation
- Fever
- Sweating
- Diarrhea
- Seizures
Prozac and Vyvnase can lead to serotonin syndrome, especially at higher doses.
Increased risk of CVS side effects
Vyvanse is found to increase heart rate and blood pressure due to its stimulating effect on the body (7). Prozac, however, is an SSRI yet is found to have similar effects on heart and blood pressure (2).
These two drugs, when taken together can cause an unnecessary increase in heart rates, blood pressure, heart palpitations and arrhythmia which may lead to various complications and can be life-threatening.
Increased risk of anxiety and insomnia
Prozac and Vyvanse can both cause anxiety and insomnia due to their increased serotonin levels and stimulating effects respectively (8) (4). If the doses of these two drugs are combined, they may cause increased side effects of anxiety and insomnia in the patients taking them.
Decreased effectiveness of either medication
Prozac and Vyvanse, both are metabolized by the same enzyme called CYP2D6. In the case of taking these medications together in higher doses, the two will have to compete for the same enzyme and this may lead to increased levels of these drugs in the blood (4) (5). This can lead to decreased effectiveness as the body cannot metabolize them.
What factors influence the interaction between Prozac and Vyvanse?
The interaction can be influenced by several factors including:
Individual variation: Each person’s body reacts to the medication differently. Some individuals may be more susceptible to the effects of these drugs whereas, others may not experience any side effects. Genetic factors play an important role in this factor.
Dosages: The specific doses are important. Higher doses may increase the risk of interaction as they can result in a risk of greater impact on levels of neurotransmitters in the brain.
Medical History: Your medical history including preexisting medical health conditions or any other medications you are taking can influence the risk of interaction. For example, if you have a history of seizures, bipolar disorder, or a sensitivity to medication your doctor may need to be cautious before prescribing these two drugs together.
Duration of use: The longer you use these medications together, the higher the risk for interaction and side effects. Over time, neurotransmitters may continue to accumulate, increasing the risk of side effects.
What to do if Prozac and Vyvanse show interaction?
If you are taking Prozac together with Vyvanse and you are noticing the potential interactions, it is crucial to take immediate action to ensure your safety and well-being.
- Consulting your doctor is the immediate step to be taken. Your doctor, after careful analysis, may suggest and prescribe appropriate treatment strategies.
- Fluids and electrolytes may help to prevent dehydration and electrolyte imbalances, which can be caused by serotonin syndrome and other side effects of Prozac and Vyvanse.
- Fever is a common symptom so your doctor may prescribe antipyretics and fever-controlling measures including acetaminophen or cooling blankets.
- Muscle relaxants can help to relieve muscle rigidity and spasms, which may also be common side effects.
- Sedatives can help calm the agitation and anxiety occurring as an effect of the potential interaction.
- Cyproheptadine, an anti-serotonin medication may also be given in case of serious serotonin syndrome. It can help counter the effects of serotonin in the patient (9).
What other drugs can replace Vyvanse if interactions occur?
If Prozac and Vyvanse are causing interactions then your healthcare provider may suggest altering Vyvanse with any of the following medications with lesser potential to interact with Prozac.
- Amphetamines (Adderall or Dexedrine)
- Methylphenidate (Ritalin or Concerta)
In addition to these, there are some non-stimulant medications that can be a good option to treat ADHD instead of Vyvanse.
- Atomoxetine (Strattera)
- Guanfacine (Intuniv)
- Clonidine (Kapvay)
These medications work similar to Vyvanse but have a different side effect profile. Your doctor can help choose the best option suited to you.
Conclusion
In my opinion, Prozac and Vyvanse can interact with each other if the doses are not adjusted properly. The interactions can be observed in some patients susceptible to it and others may tolerate the combination well.
Starting or stopping drugs has to be carefully monitored and done under the supervision of a healthcare provider.
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References
1.-
Goodman D. W. (2010). Lisdexamfetamine dimesylate (vyvanse), a prodrug stimulant for attention-deficit/hyperactivity disorder. P & T : a peer-reviewed journal for formulary management, 35(5), 273–287.
2.-
Sohel, A. J. (2022, July 4). Fluoxetine. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK459223/
3.-
Vo, K., Neafsey, P. J., & Lin, C. A. (2015). Concurrent use of amphetamine stimulants and antidepressants by undergraduate students. Patient preference and adherence, 9, 161–172. https://doi.org/10.2147/PPA.S74602
4.-
Ermer, J., Corcoran, M., & Martin, P. (2015). Lisdexamfetamine Dimesylate Effects on the Pharmacokinetics of Cytochrome P450 Substrates in Healthy Adults in an Open-Label, Randomized, Crossover Study. Drugs in R&D, 15(2), 175–185. https://doi.org/10.1007/s40268-015-0090-z
5.-
Deodhar, M., Rihani, S. B. A., Darakjian, L., Turgeon, J., & Michaud, V. (2021). Assessing the Mechanism of Fluoxetine-Mediated CYP2D6 Inhibition. Pharmaceutics, 13(2), 148. https://doi.org/10.3390/pharmaceutics13020148
6.-
Simon, L. V. (2023, July 17). Serotonin Syndrome. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK482377/
7.-
Sinha, A., Lewis, O., Kumar, R., Yeruva, S. L., & Curry, B. H. (2016). Adult ADHD Medications and Their Cardiovascular Implications. Case reports in cardiology, 2016, 2343691. https://doi.org/10.1155/2016/2343691
8.-
Catherine A. Marcinkiewcz, Christopher M. Mazzone, Giuseppe D’Agostino, Lindsay R. Halladay, J. Andrew Hardaway, Jeffrey F. DiBerto, Montserrat Navarro, Nathan Burnham, Claudia Cristiano, Cayce E. Dorrier, Gregory J. Tipton, Charu Ramakrishnan, Tamas Kozicz, Karl Deisseroth, Todd E. Thiele, Zoe A. McElligott, Andrew Holmes, Lora K. Heisler, Thomas L. Kash. Serotonin engages an anxiety and fear-promoting circuit in the extended amygdala. Nature, 2016; DOI: 10.1038/nature19318
9.-
Shihai, Li., Zili, Xu., Mingkun, Guo., Menglong, Li., Zhining, Wen. (2021). Drug-induced QT Prolongation Atlas (DIQTA) for enhancing cardiotoxicity management.. Drug Discovery Today, doi: 10.1016/J.DRUDIS.2021.10.009
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