Drug Secrets

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👉Fluvoxamine and ramelteon should not be prescribed concomitantly because ramelteon levels will be increased up to more than 100-fold as ramelteon is metabolized by CYP1A2 and fluvoxamine is strong CYP1A2 inhibitor.
👉Ramelteon is a melatonin receptor agonist with high affinity for MT1 and MT2 receptors used for insomnia.

👉It is primarily metabolized by CYP1A2 (and to a lesser extent by CYP3A4).

👉Fluvoxamine: an SSRI FDA approved for OCD (Obsessive compulsive disorder) and is a potent CYP1A2 inhibitor.
👉When taken together, fluvoxamine dramatically increases ramelteon plasma levels.

👉Studies showed up to a 190-fold increase in ramelteon exposure.
وبالتالي العيان لو أخد الاتنين مع بعض هيحصل excessive sedation, next day drowsiness, dizziness, impaired concentration, potential hypotension but in rare cases and respiratory issues may be occurred but rare in studies.
وعشان كده
🚫This combination is contraindicated.

🚫If the patient is on fluvoxamine, ramelteon must not be prescribed.
طب ايه هي البدائل المتاحة الآمنة كمنوم لمريض الوسواس القهري اللي بياخد fluvoxamine
كالآتي:-
👉Z-drugs (zaleplon, zolpidem, eszopiclone).
👉Melatonin supplements.
👉Orexin receptors antagonists (Suvorexant , lemborexant) as they are metabolized mainly by CYP3A4 .