Safety of Starting Fluvoxamine with Lexapro (Escitalopram)

Clinical Manifestations and Management

• Serotonin syndrome typically develops within 24-48 hours of combining serotonergic medications and presents with mental status changes, neuromuscular hyperactivity, autonomic instability, and advanced symptoms, according to Praxis Medical Insights 1
• The American College of Clinical Pharmacology recommends allowing a washout period based on the half-life of the medication being discontinued before starting the new SSRI, with a washout period of at least 1-2 weeks recommended for escitalopram before starting fluvoxamine 1
• The National Institute of Mental Health suggests considering alternative augmentation strategies such as adding a different class of medication rather than another SSRI, as combining two SSRIs is contraindicated, and both fluvoxamine and escitalopram are approved for social anxiety disorder in Japan as first-line options, but should be used as monotherapy 2, 3
• Patients should be warned against over-the-counter serotonergic compounds while on either medication, as recommended by Praxis Medical Insights 1
• If serotonin syndrome occurs, immediately discontinue all serotonergic agents and provide hospital-based supportive care with continuous cardiac monitoring, according to Praxis Medical Insights 1