Taking Prozac With Ativan And Trazodone

abby asked

I suffer from anxiety and depression. I take Prozac and trazodone. I still get jumpy and anxious every few day and then I take Ativan 0.5 mg. Is this OK?

Answer

There are a few potential interactions between Prozac (fluoxetine), trazodone and Ativan (lorazepam), which are discussed below.

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Prozac With Trazodone

Taking Prozac (fluoxetine) with trazodone increases the risk of a rare, but serious medical condition known as serotonin syndrome. Serotonin syndrome is characterized by the following symptoms:

• Hyperthermia (increased body temperature)
• Hypertension (high blood pressure)
• Myoclonus (muscle spasticity)
• Muscle rigidity
• Increased heart rate
• Nausea/vomiting
• Mental status changes (e.g., delirium or coma)

The risk of serotonin syndrome increases when multiple serotonergic drugs are used together. Both Prozac and trazodone increase concentrations of serotonin in the brain. While serotonin syndrome is relatively rare, both Prozac and trazodone have documented case studies in which it occurred.

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It is important to be aware of the symptoms of serotonin syndrome, and if it is suspected, you should seek immediate medical attention.

In addition to the risk of serotonin syndrome, both Prozac and trazodone can cause QT prolongation, which increases the risk of arrhythmia.

In general, Prozac and trazodone should be avoided in patients with risk factors for QT prolongation or in those with cardiac disease or other conditions that may increase the risk of QT prolongation.

It should be noted that the risk of adverse effects with trazodone and Prozac are dose-related, meaning higher doses increases the risk of them occurring.

Trazodone, when used at low dosages (as is common in those using for anxiety or insomnia), has less of a risk of side effects. Nevertheless, it is important to be aware of all the potential issues.

Ativan With Trazodone

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Both Ativan (lorazepam) and trazodone are CNS (central nervous system) depressants and can increase sedation and grogginess.

It is important that CNS depressants be used cautiously together and you should avoid activities that require mental alertness, including as driving, until you know how the medications affect you.

Final Words

Be sure to discuss your medication regimen with your doctor to address any concerns you may have.

Although there are potential interactions between the drugs in question (Ativan, Prozac, and Trazodone), they have been, and can be, used together safely. It is, however, important to be aware of potential side effects and take action as appropriate.

References

1. QTc Prolongation With Antidepressants and Antipsychotics. US Pharmacist
2. A comparison of the risk of QT prolongation among SSRIs. PubMed
3. Serotonin syndrome associated with sertraline, trazodone and tramadol abuse. PubMed
4. Serotonin Syndrome With Fluoxetine: Two Case Reports. PubMed
5. Desyrel Prescribing Information. AccessFDA
6. Prozac Prescribing Information. Lilly

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