Risk of serotonin syndrome w/ irreversible non-selective MAOIs, reversible, selective MAO-A inhibitor eg, moclobemide, irreversible, selective MAO-B inhibitor eg, selegiline. Reversible, non-selective MAOI eg, linezolid. May lead to serotonin syndrome w/ serotonergics eg, tramadol, sumatriptan & other triptans. May lower seizure threshold w/ antidepressants (eg, tricyclics, SSRIs), neuroleptics (eg, phenothiazines, thioxanthenes & butyrophenones), mefloquine, bupropion & tramadol. Enhanced effects w/ lithium or tryptophan. Increased adverse reactions w/ herbal remedies containing St. John's wort (Hypericum perforatum
). May alter anticoagulant effects w/ oral anticoagulants. Increased bleeding tendency w/ NSAIDs. Increased plasma conc w/ CYP2C19 inhibitors eg, omeprazole, cimetidine, esomeprazole, fluvoxamine, lansoprazole, ticlopidine. Drugs metabolised by CYP2D6 & w/ narrow therapeutic index eg, flecainide, propafenone & metoprolol or some CNS acting drugs mainly metabolized by CYP2D6 eg, desipramine, clomipramine & nortriptyline, risperidone, thioridazine & haloperidol.