Who should not take Luvox CR Capsules? This Medication Guide summarizes the most important information about Luvox CR Capsules. If you would like more information, talk with your healthcare provider. You may ask your healthcare provider or pharmacist for information about Luvox CR Capsules that is written for healthcare professionals. Fallon was a pioneer in using like and to treat hypochondriacs. Of the 539 cases of deliberate or accidental overdose involving fluvoxamine reported from this population, there were 55 deaths. Of these, 9 were in patients thought to be taking immediate-release fluvoxamine tablets alone and the remaining 46 were in patients taking fluvoxamine along with other drugs. Among non-fatal overdose cases, 404 patients recovered completely. Five patients experienced adverse sequelae of overdosage, to include persistent mydriasis, unsteady gait, hypoxic encephalopathy, kidney complications from trauma associated with overdose bowel infarction requiring a hemicolectomy, and vegetative state. In 13 patients, the outcome was provided as abating at the time of reporting. In the remaining 62 patients, the outcome was unknown.
The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia psychomotor restlessness hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. Patients should be advised that the use of Luvox CR Capsules with any of the following medications may produce clinically significant adverse reactions. Patients should inform their physician if they are taking any of these medications before starting treatment with Luvox CR Capsules. Patients should also inform their physician prior to taking any of these medications while receiving Luvox CR Capsule therapy. aciphex purchase online payment europe
Do not stop taking any medications without consulting your healthcare provider. Do not keep outdated medicine or medicine no longer needed. Carbamazepine: Elevated carbamazepine levels and symptoms of toxicity have been reported with the coadministration of immediate-release fluvoxamine maleate tablets and carbamazepine. Instead, hypochondriacs need to learn to get help and change their way of thinking. This table shows the percentage of patients in each group who had at least one occurrence of a reaction at some time during their treatment. Reported adverse reactions were classified using a COSTART-based Dictionary terminology. bactrim
Treatment with Luvox CR Capsules and any concomitant serotonergic agents should be discontinued immediately if the above events occur, and supportive symptomatic treatment should be initiated. Possible triggers that set off people's symptoms vary a lot, too. They include smoke, auto exhaust, perfume, insecticide, new carpet, chlorine, and more. Others say that the symptoms stem from an extreme sensitivity to certain smells. It's possible that conditions such as and play a role, too. Sumatriptan: - There have been rare postmarketing reports describing patients with weakness, hyperreflexia, and incoordination following the use of a selective serotonin reuptake inhibitor SSRI and sumatriptan.
Comparisons of immediate-release fluvoxamine maleate tablets or Luvox CR Capsules and placebo groups in separate pools of short-term OCD and depression trials on 1 mean change from baseline on various ECG variables and on 2 incidence of patients meeting criteria for potentially important changes from baseline on various ECG variables revealed no important differences between fluvoxamine maleate and placebo. In vitro data suggest that fluvoxamine is a relatively weak inhibitor of CYP2D6. Caution is recommended when the drug is administered to patients with a history of convulsive disorders. Fluvoxamine should be avoided in patients with unstable epilepsy, and patients with controlled epilepsy should be carefully monitored. Treatment with fluvoxamine should be discontinued if seizures occur or if seizure frequency increases. Fluvoxamine may impair your thinking or reactions. Avoid driving or operating machinery until you know how fluvoxamine will affect you. Elderly patients and those with hepatic impairment have been observed to have a decreased clearance of fluvoxamine maleate. Consequently, it may be appropriate to titrate slowly following the initial dose of 100 mg in these patient groups. Decreased appetite and weight loss have been observed in association with the use of fluvoxamine as well as other SSRIs. Consequently, regular monitoring of weight and growth should be performed in children and adolescents treated with an SSRI such as Luvox CR Capsules. Don't really notice any side effects. However it really reduced my racing thoughts my anxiety and overall calmer mood. DR. took me off it cold turkey in 2006 4 weeks later I had 3 grand maul seizures. Dr put me back on and the Luvox starting working in about 6 weeks. In 2012 Dr reduced from 100 mg twice a day to 50 mg twice a day 6 weeks later had another grand maul seizure. Dr raise the dose back to 100 mg twice a day and have not had any seizures since. Also we have no history of seizures in the previous three generations of both sides of our family's and three generations beneath me no one has ever had a recorded seizure. I never had any seizure's except when the DR took me off cold turkey and then even tried cutting half over a 4 month period. How should I take Luvox CR Capsules? Patients should be advised that Luvox CR Capsules may increase the risk of bleeding events, which have ranged from ecchymoses, hematomas, epistaxis, and petechiae to life-threatening hemorrhages. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of fluvoxamine in the elderly. However, elderly patients are more likely to have hyponatremia low sodium in the blood and liver problems, which may require an adjustment in the dose for patients receiving fluvoxamine. Fallon. "They can feel like they're not being listened to, and so they'll go shopping for another doctor and wind up repeating the process. Luvox CR Capsules may be taken with or without food. Your doctor may call it “idiopathic environmental intolerance. Incidence based on number of male patients. Fluvoxamine treatment has been associated with several cases of priapism. In those cases with a known outcome, patients recovered without sequelae and upon discontinuation of fluvoxamine.
There was considerable variation in risk of suicidality among drugs, but a tendency toward an increase in the younger patients for almost all drugs studied. There were differences in absolute risk of suicidality across the different indications, with the highest incidence in MDD. The risk differences drug vs placebo however, were relatively stable within age strata and across indications. Opioid withdrawal symptoms were reported following fluvoxamine maleate discontinuation in another patient. The obsessions or compulsions cause marked distress, are time-consuming, or significantly interfere with social or occupational functioning. Appropriate studies have not been performed on the relationship of age to the effects of fluvoxamine extended-release capsules in the pediatric population. Safety and efficacy have not been established. Physicians should also note the results of a prospective longitudinal study of 201 pregnant women with a history of major depression, who were either on antidepressants or had received antidepressants less than 12 weeks prior to their last menstrual period, and were in remission. Women who discontinued antidepressant medication during pregnancy showed a significant increase in relapse of their major depression compared to those women who remained on antidepressant medication throughout pregnancy. Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using fluvoxamine. Your family or other caregivers should also be alert to changes in your mood or symptoms. Nervous System: Infrequent: confusion, incoordination, sleep disorder, suicidal tendency. Drinking alcohol can increase certain side effects of fluvoxamine. divalproex
There are no clinical studies establishing the benefits or risks of combined use of ECT and fluvoxamine maleate. Ask your doctor before taking a nonsteroidal anti-inflammatory drug NSAID for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen Advil, Motrin naproxen Aleve celecoxib Celebrex diclofenac, indomethacin, meloxicam, and others. Using an NSAID with fluvoxamine may cause you to bruise or bleed easily. Some Luvox CR may pass into your breast milk. Talk to your healthcare provider about the best way to feed your baby while taking Luvox CR Capsules. Diltiazem: Bradycardia has been reported with the coadministration of immediate-release fluvoxamine maleate tablets and diltiazem. Luvox CR is unclear. This can lead to serious trouble for hypochondriacs using the vast and unregulated web. Signs and symptoms of hyponatremia include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which may lead to falls. Clozapine: Elevated serum levels of clozapine have been reported in patients taking immediate-release fluvoxamine maleate tablets and clozapine. Since clozapine-related seizures and orthostatic hypotension appear to be dose related, the risk of these adverse reactions may be higher when fluvoxamine and clozapine are coadministered. Patients should be closely monitored when Luvox CR Capsules and clozapine are used concurrently. Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco. If you take too much Luvox CR, call your healthcare provider or poison control center right away, or get emergency treatment. Body as a Whole: Infrequent: chills, malaise, photosensitivity reaction, suicide attempt. Other people find that medicines for and help. AUC, respectively, compared to the administration of tacrine alone. Five subjects experienced nausea, vomiting, sweating, and diarrhea following coadministration, consistent with the cholinergic effects of tacrine. vasodilan mail order store usa vasodilan
Your healthcare provider or pharmacist can tell you if it is safe to take Luvox CR Capsules with your other medicines. Do not start or stop any medicine while taking Luvox CR Capsules without talking to your healthcare provider first. Alcohol: Studies involving single 40 g doses of ethanol oral administration in one study and intravenous in the other and multiple dosing with immediate-release fluvoxamine maleate tablets 50 mg given twice daily revealed no effect of either drug on the pharmacokinetics or pharmacodynamics of the other. As with other psychotropic medications, patients should be advised to avoid alcohol while taking Luvox CR Capsules. Additionally, there was an approximate 25% decrease in nausea. Fluvoxamine is usually taken at night. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended. Metabolism: Fluvoxamine maleate is extensively metabolized by the liver; the main metabolic routes are oxidative demethylation and deamination. Nine metabolites were identified following a 5 mg radiolabelled dose of fluvoxamine maleate, constituting approximately 85% of the urinary excretion products of fluvoxamine. The main human metabolite was fluvoxamine acid which, together with its N-acetylated analog, accounted for about 60% of the urinary excretion products. A third metabolite, fluvoxethanol, formed by oxidative deamination, accounted for about 10%. Fluvoxamine acid and fluvoxethanol were tested in an in vitro assay of serotonin and norepinephrine reuptake inhibition in rats; they were inactive except for a weak effect of the former metabolite on inhibition of serotonin uptake 1-2 orders of magnitude less potent than the parent compound. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. What should I discuss with my healthcare provider before taking Luvox fluvoxamine? Use and dose must be determined by your doctor. Arthur Barsky, MD, of Harvard Medical School and the author of Worried Sick: Our Troubled Quest for Wellness 1988. As a result, a hypochondriac's work and suffer. And those with the condition aren't the only ones who pay the price: According to Fallon, hypochondria costs billions of dollars a year in unnecessary medical tests and treatments. While these reactions are generally self-limiting, there have been reports of serious discontinuation symptoms. Anyone considering the use of Luvox CR Capsules in a child or adolescent must balance the potential risks with the clinical need. Antidepressants increased the risk compared to placebo of suicidal thinking and behavior suicidality in children, adolescents, and young adults in short-term studies of major depressive disorder MDD and other psychiatric disorders. Anyone considering the use of Luvox CR fluvoxamine maleate Extended-Release Capsules or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Patients should be maintained on the lowest effective dose. Blue No. 2, Opacode Grey, red iron oxide, titanium dioxide gelatin porcine- or bovine-derived sugar spheres, and talc. Luvox CR Capsules are gluten-free.
However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression. Thioridazine administration produces a dose-related prolongation of the QTc interval, which is associated with serious ventricular arrhythmias, such as torsades de pointes-type arrhythmias, and sudden death. It is likely that this experience underestimates the degree of risk that might occur with higher doses of thioridazine. Moreover, the effect of fluvoxamine may be even more pronounced when it is administered at higher doses. Patients should be monitored for these symptoms when discontinuing treatment with Luvox CR Capsules. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. If you take Luvox CR Capsules, you should not take any other medicines that contain fluvoxamine maleate including: Fluvoxamine Maleate Immediate-Release Tablets. LCR 150 on the other side of the cap. Patients receiving Luvox CR Capsules should be advised to notify their physicians if they are breast-feeding an infant. Tell your healthcare provider about all the medicines that you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Luvox CR Capsules and some medicines may interact with each other, may not work as well, or may cause serious side effects. While it is difficult to know the precise risk of sexual dysfunction associated with the use of SSRIs, health care providers should routinely inquire about such possible side effects. Lower doses may be effective in female compared to male patients. Talk to your healthcare provider if you do not think that your condition is getting better with Luvox CR treatment. Carcinogenesis: There was no evidence of carcinogenicity in rats treated orally with fluvoxamine maleate for 30 months or hamsters treated orally with fluvoxamine maleate for 20 months females or 26 months males. Luvox CR Capsules in placebo-controlled trials. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Do not suddenly stop taking this medicine without checking with your doctor first. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. This is to decrease the chance of having withdrawal symptoms such as agitation, confusion, headache, irritability, numbness or tingling, restlessness, trouble sleeping, or unusual drowsiness or weakness. Wort and with drugs that impair metabolism of serotonin in particular, MAOIs, both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue. Relapse during the double-blind phase was defined as an increase in the Y-BOCS score of at least 30% over the baseline for that phase or patient refusal to continue treatment due to a substantial increase in OCD symptoms. In the double-blind phase, patients receiving continued immediate-release fluvoxamine maleate tablets treatment experienced, on average, a significantly lower relapse rate than those receiving placebo. acol.info vibramycin
Pimozide is metabolized by the CYP3A4 isozyme and it has been demonstrated that ketoconazole, a potent inhibitor of CYP3A4, blocks the metabolism of this drug, resulting in increased plasma concentrations of parent drug. An increased plasma concentration of pimozide causes QT prolongation and has been associated with torsades de pointes-type ventricular tachycardia, sometimes fatal. As noted below, a substantial pharmacokinetic interaction has been observed for fluvoxamine in combination with alprazolam, a drug that is known to be metabolized by the CYP3A4 isozyme. Although it has not been definitively demonstrated that fluvoxamine is a potent CYP3A4 inhibitor, it is likely to be, given the substantial interaction of fluvoxamine with alprazolam. In addition, patients should be advised to notify their physicians if they are taking, or plan to take, any prescription or over-the-counter drugs, since there is a potential for clinically important interactions with Luvox CR Capsules. Tell your doctor right away if you become pregnant while taking this medicine. Fluvoxamine may cause serious lung problems or other complications in a newborn if you take the medication during late pregnancy. However, you may have a relapse of OCD symptoms if you stop taking fluvoxamine. Do not start or stop taking the medication during pregnancy without your doctor's advice. Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products. Warfarin - When immediate-release fluvoxamine maleate tablets 50 mg given three times daily were administered concomitantly with warfarin for two weeks, warfarin plasma concentrations increased by 98% and prothrombin times were prolonged. Thus patients receiving oral anticoagulants and Luvox CR Capsules should have their prothrombin time monitored and their anticoagulant dose adjusted accordingly. No dosage adjustment is required for Luvox CR Capsules. Nervous System: Frequent: amnesia, apathy, hyperkinesia, hypokinesia, manic reaction, myoclonus, psychotic reaction; Infrequent: agoraphobia, akathisia, ataxia, CNS depression, convulsion, delirium, delusion, depersonalization, dyskinesia, dystonia, emotional lability, euphoria, extrapyramidal syndrome, gait unsteady, hallucinations, hemiplegia, hostility, hypersomnia, hypochondriasis, hypotonia, hysteria, increased libido, paralysis, paranoid reaction, phobia, psychosis, stupor, twitching, vertigo; Rare: akinesia, coma, fibrillations, mutism, obsessions, reflexes decreased, slurred speech, tardive dyskinesia, torticollis, trismus, withdrawal syndrome. When immediate-release fluvoxamine maleate tablets 100 mg twice daily were administered for 3 days prior to single-dose coadministration of ramelteon 16 mg and immediate-release fluvoxamine maleate tablets, the AUC for ramelteon increased approximately 190-fold and the C max increased approximately 70-fold compared to ramelteon administered alone. Luvox CR Capsules because this can cause serious heart rhythm problems or sudden death. Luvox CR Capsules or immediate-release fluvoxamine maleate tablets have not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease. Patients with these diagnoses were systematically excluded from many clinical studies during premarketing testing of these products. Evaluation of the electrocardiograms for patients with depression or OCD who participated in premarketing studies revealed no differences between fluvoxamine and placebo in the emergence of clinically important ECG changes. Gender: In a study with 15 male and 13 female healthy volunteers who were administered Luvox CR Capsules 100 mg, AUC and C max of fluvoxamine were increased by approximately 60% in females compared to males. There were no differences in the elimination half-life between males and females. Fluvoxamine maleate is a white to off-white, odorless, crystalline powder that is sparingly soluble in water, freely soluble in ethanol and chloroform, and practically insoluble in diethyl ether. Low salt sodium levels in the blood. Elderly people may be at greater risk for this. Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment. At first, 100 milligrams mg once a day at bedtime. Your doctor may adjust your dose as needed. However, the dose is usually not more than 300 mg per day. Many drugs can interact with fluvoxamine. Not all possible interactions are listed here. buy cozaar reddit
Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat. The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables. Reliable estimates of the incidence and severity of untoward experiences involving sexual desire, performance, and satisfaction are difficult to obtain, however, in part because patients and health care providers may be reluctant to discuss them. Accordingly, estimates of the incidence of untoward sexual experience and performance cited in product labeling are likely to underestimate their actual incidence. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. Triptans: There have been rare postmarketing reports of serotonin syndrome with use of an SSRI and a triptan. The following adverse reactions have been identified during post-approval use of immediate-release fluvoxamine maleate tablets or Luvox CR Capsules. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Reactions that are discussed in other sections of this prescribing information are not repeated here. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Respiratory System: Frequent: cough increased, sinusitis; Infrequent: asthma, bronchitis, hoarseness, hyperventilation; Rare: apnea, congestion of upper airway, hemoptysis, hiccups, laryngismus, obstructive pulmonary disease, pneumonia. All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia psychomotor restlessness hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should be advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient's prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Side Effects List Fluvoxamine MALEATE side effects by likelihood and severity. Barsky, "since that feeling of relief doesn't last anyway. Contrary to what some skeptics think, hypochondriacs are not pretending or just trying to get attention. Luvox CR is an extended-release capsule for oral administration that contains fluvoxamine maleate, a selective serotonin 5-HT reuptake inhibitor SSRI belonging to the chemical series, the 2-aminoethyl oxime ethers of aralkylketones. Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Dictionary terminology has been used to classify reported adverse reactions.
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Infants exposed to SSRIs in pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn PPHN. PPHN occurs in 1-2 per 1000 live births in the general population and is associated with substantial neonatal morbidity and mortality. Several recent epidemiologic studies suggest a positive statistical association between SSRI use LUVOX and Luvox CR are SSRIs in pregnancy and PPHN. Other studies do not show a significant statistical association. What is Luvox CR Capsules? As with other psychotropic medications, patients should be advised to avoid alcohol while taking Luvox CR Capsules. doxylamine
Warfarin and Other Drugs That Interfere With Hemostasis NSAIDs, Aspirin, etc. Approximately 7% of the normal population has a genetic code that leads to reduced levels of activity of CYP2D6 enzyme. Such individuals have been referred to as "poor metabolizers" PM of drugs such as debrisoquin, dextromethorphan, and tricyclic antidepressants. While none of the drugs studied for drug interactions significantly affected the pharmacokinetics of fluvoxamine, an in vivo study of fluvoxamine single-dose pharmacokinetics in 13 PM subjects demonstrated altered pharmacokinetic properties compared to 16 "extensive metabolizers" EM: mean C max, AUC, and half-life were increased by 52%, 200%, and 62%, respectively, in the PM compared to the EM group. This suggests that fluvoxamine is metabolized, at least in part, by CYP2D6.
It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs including any herbal medicines or supplements or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you. Special Senses: Infrequent: accommodation abnormal, conjunctivitis, diplopia, eye pain, mydriasis, otitis media, parosmia, visual field defect; Rare: corneal ulcer. pantozol purchase store uk
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Luvox CR Capsules for a condition for which it was not prescribed. Do not give Luvox CR Capsules to other people, even if they have the same condition. It may harm them. Neurologic: Patients should be monitored for symptoms of serotonin syndrome. Do not start Luvox CR Capsules in a patient who is being treated with linezolid or intravenous methylene blue because there is an increased risk of serotonin syndrome. Fluvoxamine may cause a serious condition called serotonin syndrome if taken together with some medicines. propranolol