PREPARATIONS: Oral capsules: 7.5 mg
- Brisdelle should not be used with or within 14 days of taking a monoamine oxidase inhibitor (MAOI) due to the risk of serotonin syndrome, a rare, but potentially life-threatening condition caused by abnormally high levels of the chemical serotonin in the body. Similarly, due to a high risk of serotonin syndrome, Brisdelle should not be combined with linezolid (Zyvox) or intravenous methylene blue (Urolene Blue).
- Other medications that also increase the risk of serotonin syndrome and should be used cautiously with Brisdelle include triptans (a type of antimigraine medication), lithium (Lithobid, Eskalith), tramadol (Ultram), St. John's Wort, dextromethorphan (an over-the-counter common cold/cough medicine), and various classes of commonly used antidepressants including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs).
- Brisdelle should not be used with thioridazine (Mellaril) or pimozide (Orap). Thioridazine and pimozide are known to prolong the QT interval (a heart rhythm disorder). Because Brisdelle increases the concentration of these drugs in the blood, coadministration increases the risk of death.
- Serotonin plays an important role in forming blood clots. SSRI's, including Brisdelle may increase the risk of bleeding, especially if taken with the blood thinner warfarin (Coumadin, Jantoven), aspirin, or non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin), naproxen (Naprosyn), and indomethacin (Indocin).
- Paroxetine, the medicine in Brisdelle, is a strong inhibitor of the CYP2D6 enzymes. Taking Brisdelle with other drugs that are metabolized by this pathway may increase the risk for side effects. Therefore, Brisdelle should be used cautiously with nortriptyline (Pamelor), amitriptyline (Elavil), imipramine (Tofranil), desipramine (Norpramin), fluoxetine (Prozac), risperidone (Risperdal), flecainide (Tambocor), and others.
- In addition to being a strong CYP2D6 inhibitor, paroxetine is also a CYP2D6 substrate and is itself metabolized via this pathway. Consequently, administration with drugs that alter the activity of these enzymes may affect the concentration of Brisdelle in the body. Strong CYP2D6 inducers may decrease the blood levels of paroxetine, resulting in poor treatment outcomes. Examples of strong CYP2D6 inducers include rifampin (Rimactane), carbamazepine (Tegretol), and phenytoin (Dilantin).
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