Dextromethorphan/Selected Serotonergic Agents Interactions
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Medical warning:
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Both of these medicines can increase the level of serotonin in your body.
What might happen:
High serotonin levels may cause changes in body temperature, blood pressure, muscle movements and mood, leading to a medical condition called Serotonin Syndrome. Serotonin Syndrome may be life threatening.
What you should do about this interaction:
Make sure your healthcare professional (e.g.doctor or pharmacist) know that you are taking these medicines together. Do not take more than the recommended amount of dextromethorphan.If you experience muscle twitching, tremors, shivering or stiffness, fever, heavy sweating, heart palpitations, restlessness, confusion, agitation, trouble with coordination, or severe diarrhea contact your doctor right away.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
- 1.Paxil (paroxetine hydrochloride) US prescribing information. Apotex Technologies January, 2017.
- 2.Prozac (fluoxetine hydrochloride) US prescribing information. Eli Lilly and Company August, 2023.
- 3.Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005 Mar 17; 352(11):1112-20.
- 4.Gillman PK. Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity. Br J Anaesth 2005 Oct;95(4):434-41.
- 5.Schwartz AR, Pizon AF, Brooks DE. Dextromethorphan-induced serotonin syndrome. Clin Toxicol (Phila) 2008 Sep;46(8):771-3.
- 6.Hardy M, Panikkar G. A Case of Serotonin Syndrome in the Setting of Dextromethorphan-Based Cough Medicine, Tramadol, and Multiple Antidepressants. Prim Care Companion CNS Disord 2020 Mar 5;22(2):.
- 7.Dy P, Arcega V, Ghali W, Wolfe W. Serotonin syndrome caused by drug to drug interaction between escitalopram and dextromethorphan. BMJ Case Rep 2017 Aug 7;2017:.
- 8.Navarro A, Perry C, Bobo WV. A case of serotonin syndrome precipitated by abuse of the anticough remedy dextromethorphan in a bipolar patient treated with fluoxetine and lithium. Gen Hosp Psychiatry 2006 Jan-Feb; 28(1):78-80.
- 9.Achamallah NS. Visual hallucinations after combining fluoxetine and dextromethorphan. Am J Psychiatry 1992 Oct;149(10):1406.
- 10.Skop BP, Finkelstein JA, Mareth TR, Magoon MR, Brown TM. The serotonin syndrome associated with paroxetine, an over-the-counter cold remedy, and vascular disease. Am J Emerg Med 1994 Nov;12(6):642-4.
- 11.Sethi R, Kablinger AS, Kavuru B. Serotonin Syndrome in a Sertraline-Treated Man Taking NyQuil Containing Dextromethorphan for Cold. Prim Care Companion CNS Disord 2012;14(6):.
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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.