The following drugs may precipitate serotonin syndrome in people on<unk> s: * Linezolid * Monoamine oxidase<unk> s (MAOIs) including moclobemide, phenelzine, tranylcypromine, selegiline and methylene blue * Lithium * Sibutramine * MDMA (ecstasy) * Dextromethorphan * Tramadol * 5-HTP * Pethidine/meperidine * St. John's wort * Yohimbe * Tricyclic antidepressants (TCAs) * Serotonin-norepinephrine reuptake<unk> s (SNRIs) * Buspirone * Triptan * Mirtazapine Painkillers of the NSAIDs drug family may interfere and reduce efficiency of<unk> s and may compound the increased risk of gastrointestinal bleeds caused by<unk>  use. NSAIDs include: * Aspirin * Ibuprofen (Advil, Nurofen) * Naproxen (Aleve) There are a number of potential pharmacokinetic interactions between the various individual<unk> s and other medications. Most of these arise from the fact that every<unk>  has the ability to inhibit certain P450 cytochromes. Drug name CYP1A2 CYP2C9 CYP2C19 CYP2D6 CYP3A4 CYP2B6 Citalopram + 0 0 + 0 0 Escitalopram 0 0 0 + 0 0 Fluoxetine + ++ +/++ +++ + + Fluvoxamine +++ ++ +++ + + + Paroxetine + + + +++ + +++ Sertraline + + +/++ + + + Legend: 0 — no inhibition + — mild inhibition ++ — moderate inhibition +++ — strong inhibition The CYP2D6 enzyme is entirely responsible for the metabolism of hydrocodone, codeine and dihydrocodeine to their active metabolites (hydromorphone, morphine, and dihydromorphine, respectively), which in turn undergo phase 2 glucuronidation. These opioids (and to a lesser extent oxycodone, tramadol, and methadone) have interaction potential with<unk> s. The concomitant use of some<unk> s (paroxetine and fluoxetine) with codeine may decrease the plasma concentration of active metabolite morphine, which may result in reduced analgesic efficacy. Another important interaction of certain<unk> s involves paroxetine, a potent<unk>  of CYP2D6, and tamoxifen, an agent used commonly in the treatment and prevention of breast cancer. Tamoxifen is a prodrug that is metabolised by the hepatic cytochrome P450 enzyme system, especially CYP2D6, to its active metabolites. Concomitant use of paroxetine and tamoxifen in women with breast cancer is associated with a higher risk of death, as much as a 91 percent in women who used it the longest.
Selective serotonin reuptake inhibitor
Atypical antidepressant
Tricyclic antidepressant
Tetracyclic antidepressant
Heterocyclic antidepressant
Glycine reuptake inhibitor
Serotonin–dopamine reuptake inhibitor
Dopamine reuptake inhibitor