At a 2-week follow-up appointment, he had 50% subjective improvement in his mood swings and irritability but still had insomnia despite implementing behavioral techniques. He was also provided behavioral strategies to improve his initiation and maintenance insomnia. Mr A was started on fluoxetine 10 mg for unspecified depressive disorder ( DSM-5 criteria) and increased to 20 mg after a week.
Symptoms had recently worsened in the context of increased work demands. Mr A is a 24-year-old male military service member in deployed settings who presented to a military deployed field behavioral health outpatient clinic in September 2015 with symptoms of insomnia, mood swings, anxiety, and irritability for 2 months. 4 The following case report describes a probable drug-drug interaction between trazodone and fluoxetine resulting in exacerbation of symptoms, which rapidly resolved after discontinuation of trazodone.Ĭase report. 3 Some data, however, suggest worse outcomes when trazodone is combined with strong cytochrome P450 (CYP) 2D6 inhibitors such as fluoxetine. 2, 3 The popularity of trazodone as a hypnotic is most likely due to lack of known abuse potential unlike the majority of other hypnotics. 1 Although its efficacy data as a hypnotic are mixed, trazodone is second only to nonbenzodiazepine drugs and is used by up to 1% of Americans each month. To the Editor: Trazodone is commonly used as an off-label hypnotic. Fluoxetine and Trazodone Combination Pharmacotherapy Resulting in Severe Irritability, Anger, Anxiety, and Anorexia: Probable Adverse Drug Interaction
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