Details of Drug Interaction

Details of Drug-Drug Interaction

 Drug General Information (ID: DDI0E51ALI)
  Drug Name Dexfenfluramine Drug Info Ozanimod Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Appetite Depressants Selective Immunosuppressants
  Structure

 Mechanism of Dexfenfluramine-Ozanimod Interaction (Severity Level: Moderate)
     Additive serotonergic effects Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Dexfenfluramine Ozanimod
      Mechanism Serotonergic effects
Serotonin transporter  Inhibitor 		Serotonergic effects
Monoamine oxidase-B selective  Inhibitor
      Key Mechanism Factor 1
Factor Name Serotonin transporter
×
Structure Sequence
METTPLNSQKQLSACEDGEDCQENGVLQKVVPTPGDKVESGQISNGYSAVPSPGAGDDTRHSIPATTTTLVAELHQGERETWGKKVDFLLSVIGYAVDLGNVWRFPYICYQNGGGAFLLPYTIMAIFGGIPLFYMELALGQYHRNGCISIWRKICPIFKGIGYAICIIAFYIASYYNTIMAWALYYLISSFTDQLPWTSCKNSWNTGNCTNYFSEDNITWTLHSTSPAEEFYTRHVLQIHRSKGLQDLGGISWQLALCIMLIFTVIYFSIWKGVKTSGKVVWVTATFPYIILSVLLVRGATLPGAWRGVLFYLKPNWQKLLETGVWIDAAAQIFFSLGPGFGVLLAFASYNKFNNNCYQDALVTSVVNCMTSFVSGFVIFTVLGYMAEMRNEDVSEVAKDAGPSLLFITYAEAIANMPASTFFAIIFFLMLITLGLDSTFAGLEGVITAVLDEFPHVWAKRRERFVLAVVITCFFGSLVTLTFGGAYVVKLLEEYATGPAVLTVALIEAVAVSWFYGITQFCRDVKEMLGFSPGWFWRICWVAISPLFLLFIICSFLMSPPQLRLFQYNYPYWSIILGYCIGTSSFICIPTYIAYRLIITPGTFKERIIKSITPETPTEIPCGDIRLNAV
Gene Name SLC6A4
Uniprot ID SC6A4_HUMAN
KEGG Pathway hsa:6532
Protein Family Sodium:neurotransmitter symporter (SNF) (TC 2.A.22) family
Protein Function
Serotonin transporter whose primary function in the central nervous system involves the regulation of serotonergic signaling via transport of serotonin molecules from the synaptic cleft back into the pre-synaptic terminal for re-utilization. Plays a key role in mediating regulation of the availability of serotonin to other receptors of serotonergic systems. Terminates the action of serotonin and recycles it in a sodium-dependent manner.
    Click to Show/Hide
      Key Mechanism Factor 2
Factor Name Monoamine oxidase type B
×
Structure Sequence
MSNKCDVVVVGGGISGMAAAKLLHDSGLNVVVLEARDRVGGRTYTLRNQKVKYVDLGGSYVGPTQNRILRLAKELGLETYKVNEVERLIHHVKGKSYPFRGPFPPVWNPITYLDHNNFWRTMDDMGREIPSDAPWKAPLAEEWDNMTMKELLDKLCWTESAKQLATLFVNLCVTAETHEVSALWFLWYVKQCGGTTRIISTTNGGQERKFVGGSGQVSERIMDLLGDRVKLERPVIYIDQTRENVLVETLNHEMYEAKYVISAIPPTLGMKIHFNPPLPMMRNQMITRVPLGSVIKCIVYYKEPFWRKKDYCGTMIIDGEEAPVAYTLDDTKPEGNYAAIMGFILAHKARKLARLTKEERLKKLCELYAKVLGSLEALEPVHYEEKNWCEEQYSGGCYTTYFPPGILTQYGRVLRQPVDRIYFAGTETATHWSGYMEGAVEAGERAAREILHAMGKIPEDEIWQSEPESVDVPAQPITTTFLERHLPSVPGLLRLIGLTTIFSATALGFLAHKRGLLVRV
Gene Name MAOB
Uniprot ID AOFB_HUMAN
KEGG Pathway hsa:4129
Protein Family Flavin monoamine oxidase family
Protein Function
Catalyzes the oxidative deamination of primary and some secondary amines such as neurotransmitters, and exogenous amines including the tertiary amine, neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), with concomitant reduction of oxygen to hydrogen peroxide and participates in the metabolism of neuroactive and vasoactive amines in the central nervous system and peripheral tissues (PubMed:11134050, PubMed:8665924, PubMed:8316221, PubMed:11049757, PubMed:20493079). Preferentially degrades benzylamine and phenylethylamine (PubMed:11134050, PubMed:8665924, PubMed:8316221, PubMed:11049757, PubMed:20493079).
    Click to Show/Hide
      Mechanism Description
  • Additive serotonergic effects by the combination of Dexfenfluramine and Ozanimod 

Recommended Action
      Management Until more information is available, concomitant use of ozanimod with serotonergic agents should be avoided when possible. Blood pressure and other vitals should be monitored if coadministration is required.

References
1 Alvine G, Black DW, Tsuang D "Case of delirium secondary to phenelzine/L-tryptophan combination." J Clin Psychiatry 51 (1990): 311. [PMID: 2365671]
2 Beasley CM Jr, Masica DN, Heiligenstein JH, Wheadon DE, Zerbe RL "Possible monoamine oxidase inhibitor-serotonin uptake inhibitor interaction: fluoxetine clinical data and preclinical findings." J Clin Psychopharmacol 13 (1993): 312-20. [PMID: 8227489]
3 Bem JL, Peck R "Dextromethorphan. An overview of safety issues." Drug Saf 7 (1992): 190-9. [PMID: 1503667]
4 Bhatara VS, Bandettini FC "Possible interaction between sertraline and tranylcypromine." Clin Pharm 12 (1993): 222-5. [PMID: 8491079]
5 Bodner RA, Lynch T, Lewis L, Kahn D "Serotonin syndrome." Neurology 45 (1995): 219-23. [PMID: 7854515]
6 Brannan SK, Talley BJ, Bowden CL "Sertraline and isocarboxazid cause a serotonin syndrome." J Clin Psychopharmacol 14 (1994): 144-5. [PMID: 8195456]
7 Brubacher JR, Hoffman RS, Lurin MJ "Serotonin syndrome from venlafaxine-tranylcypromine interaction." Vet Hum Toxicol 38 (1996): 358-61. [PMID: 8888541]
8 Cetaruk EW, Aaron CK "Hazards of nonprescription medications." Emerg Med Clin North Am 12 (1994): 483-510. [PMID: 8187693]
9 Chan BSH, Graudins A, Whyte IM, Dawson AH, Braitberg G, Duggin GG "Serotonin syndrome resulting from drug interactions." Med J Aust 169 (1998): 523-5. [PMID: 9861909]
10 Ciraulo DA, Shader RI "Fluoxetine drug-drug interactions. II." J Clin Psychopharmacol 10 (1990): 213-7. [PMID: 2198298]
11 Ciraulo DA, Shader RI "Fluoxetine drug-drug interactions: I. Antidepressants and antipsychotics." J Clin Psychopharmacol 10 (1990): 48-50. [PMID: 1968472]
12 Corkeron MA "Serotonin syndrome - a potentially fatal complication of antidepressant therapy." Med J Aust 163 (1995): 481-2. [PMID: 7476638]
13 Darcy PF, Griffin JP "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev 14 (1995): 211-31. [PMID: 8845455]
14 De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5. [PMID: 4379192]
15 Diamond S "The use of sumatriptan in patients on monoamine oxidase inhibitors." Neurology 45 (1995): 1039-40. [PMID: 7783861]
16 Diamond S, Pepper BJ, Diamond ML, Freitag FG, Urban GJ, Erdemoglu AK "Serotonin syndrome induced by transitioning from phenelzine to venlafaxine: four patient reports." Neurology 51 (1998): 274-6. [PMID: 9674820]
17 Feighner JP, Boyer WF, Tyler DL, Neborsky RJ "Adverse consequences of fluoxetine-MAOI combination therapy." J Clin Psychiatry 51 (1990): 222-5. [PMID: 2347858]
18 Fischer P "Serotonin syndrome in the elderly after antidepressive monotherapy." J Clin Psychopharmacol 15 (1995): 440-2. [PMID: 8748434]
19 Fleishaker JC, Ryan KK, Jansat JM, et al. "Effect of MAO-A inhibition on the pharmacokinetics of almotriptan, an antimigraine agent in humans." Br J Clin Pharmacol 51 (2001): 437-41. [PMID: 11422001]
20 Gardner DM, Lynd LD "Sumatriptan contraindications and the serotonin syndrome." Ann Pharmacother 32 (1998): 33-8. [PMID: 9475817]
21 Gillman PK "Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity." Br J Anaesth (2005):. [PMID: 16051647]
22 Graber MA, Hoehns TB, Perry PJ "Sertraline-phenelzine drug interaction: a serotonin syndrome reaction." Ann Pharmacother 28 (1994): 732-5. [PMID: 7919561]
23 Graham PM, Ilett KF "Danger of MAOI therapy after fluoxetine withdrawal." Lancet 2 (1988): 1255-6. [PMID: 2903989]
24 Graham PM, Potter JM, Paterson J "Combination monoamine oxidase inhibitor/tricyclic antidepressants interaction." Lancet 2 (1982): 440. [PMID: 6124828]
25 Heisler MA, Guidry JR, Arnecke B "Serotonin syndrome induced by administration of venlafaxine and phenelzine." Ann Pharmacother 30 (1996): 84. [PMID: 8773172]
26 Jacob JE, Wagner ML, Sage JI "Safety of selegiline with cold medications." Ann Pharmacother 37 (2003): 438-41. [PMID: 12639177]
27 Jimenez-Genchi A "Immediate switching from moclobemide to duloxetine may induce serotonin syndrome." J Clin Psychiatry 67 (2006): 1821-1822. [PMID: 17196070]
28 Kline SS, Mauro LS, Scala-Bennett DM, Zick D "Serotonin syndrome versus neuroleptic malignant death syndrome as a cause of death." Clin Pharm 8 (1989): 510-4. [PMID: 2568897]
29 Klysner R, Larsen JK, Sorensen P, Hyllested M, Pedersen BD "Toxic interaction of venlafaxine and isocarboxazide." Lancet 346 (1995): 1298-9. [PMID: 7475741]
30 Levy AB, Bucher P, Votolato N "Myoclonus, hyperreflexia and diaphoresis in patients on phenelzine- tryptophan combination treatment." Can J Psychiatry 30 (1985): 434-6. [PMID: 4063940]
31 Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6. [PMID: 8909274]
32 Mathew NT, Tietjen GE, Lucker C "Serotonin syndrome complicating migraine pharmacotherapy." Cephalalgia 16 (1996): 323-7. [PMID: 8869767]
33 Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11. [PMID: 9818800]
34 Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763. [PMID: 9330840]
35 Nierenberg DW, Semprebon M "The central nervous system serotonin syndrome." Clin Pharmacol Ther 53 (1993): 84-8. [PMID: 8257462]
36 Paruchuri P, Godkar D, Anandacoomarswamy D, Sheth K, Niranjan S "Rare case of serotonin syndrome with therapeutic doses of paroxetine." Am J Ther 13 (2006): 550-552. [PMID: 17122538]
37 Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7. [PMID: 5655478]
38 Phillips SD, Ringo P "Phenelzine and venlafaxine interaction." Am J Psychiatry 152 (1995): 1400-1. [PMID: 7653704]
39 Pope HG Jr, Jonas JM, Hudson JI, Kafka MP "Toxic reactions to the combination of monoamine oxidase inhibitors and tryptophan." Am J Psychiatry 142 (1985): 491-2. [PMID: 3976924]
40 Product Information. Brintellix (vortioxetine). Takeda Pharmaceuticals America, Lincolnshire, IL.
41 Product Information. Celexa (citalopram). Forest Pharmaceuticals, St. Louis, MO.
42 Product Information. Cymbalta (duloxetine). Lilly, Eli and Company, Indianapolis, IN.
43 Product Information. D.H.E. 45 (dihydroergotamine). Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
44 Product Information. Effexor (venlafaxine). Wyeth-Ayerst Laboratories, Philadelphia, PA.
45 Product Information. Fetzima (levomilnacipran). Forest Pharmaceuticals, St. Louis, MO.
46 Product Information. Imitrex (sumatriptan). Glaxo Wellcome, Research Triangle Park, NC.
47 Product Information. Lexapro (escitalopram). Forest Pharmaceuticals, St. Louis, MO.
48 Product Information. Luvox (fluvoxamine). Solvay Pharmaceuticals Inc, Marietta, GA.
49 Product Information. Manerix (moclobemide). Hoffmann-La Roche Limited, Mississauga, IA.
50 Product Information. Maxalt (rizatriptan). Merck & Co, Inc, West Point, PA.
51 Product Information. Paxil (paroxetine). GlaxoSmithKline, Research Triangle Park, NC.
52 Product Information. Pristiq (desvenlafaxine). Wyeth Laboratories, Philadelphia, PA.
53 Product Information. Prozac (fluoxetine). Dista Products Company, Indianapolis, IN.
54 Product Information. Savella (milnacipran). Forest Pharmaceuticals, St. Louis, MO.
55 Product Information. Viibryd (vilazodone). Trovis Pharmaceuticals LLC, New Haven, CT.
56 Product Information. Zeposia (ozanimod). Celgene Corporation, Summit, NJ.
57 Product Information. Zoloft (sertraline). Roerig Division, New York, NY.
58 Product Information. Zomig (zolmitriptan). Zeneca Pharmaceuticals, Wilmington, DE.
59 Rivers N, Horner B "Possible lethal reaction between nardil and dextromethorphan." Can Med Assoc J 103 (1970): 85. [PMID: 20311659]
60 Ruiz F "Fluoxetine and the serotonin syndrome." Ann Emerg Med 24 (1994): 983-5. [PMID: 7978579]
61 Schulz R, Antonin KH, Hoffmann E, et al "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther 46 (1989): 528-36. [PMID: 2510962]
62 Sovner R, Wolfe J "Interaction between dextromethorphan and monoamine oxidase inhibitor therapy with isocarboxazid ." N Engl J Med 319 (1988): 1671. [PMID: 3200285]
63 Spiker DG, Pugh DD "Combining tricyclic and monoamine oxidase inhibitor antidepressants." Arch Gen Psychiatry 33 (1976): 828-30. [PMID: 942286]
64 Staufenberg EF, Tantam D "Malignant hyperpyrexia syndrome in combined treatment." Br J Psychiatry 154 (1989): 577-8. [PMID: 2590798]
65 Sternbach H "Danger of MAOI therapy after fluoxetine withdrawal." Lancet 2 (1988): 850-1. [PMID: 2902292]
66 Sternbach H "The serotonin syndrome." Am J Psychiatry 148 (1991): 705-13. [PMID: 2035713]
67 Suchowersky O, deVries J "Possible interactions between deprenyl and prozac." Can J Neurol Sci 17 (1990): 352-3. [PMID: 2119870]
68 Suchowersky O, deVries JD "Interaction of fluoxetine and selegiline." Can J Psychiatry 35 (1990): 571-2. [PMID: 2119876]
69 Thomas JM, Rubin EH "Case report of a toxic reaction from a combination of tryptophan and phenelzine." Am J Psychiatry 141 (1984): 281-3. [PMID: 6691495]
70 Weiner LA, Smythe M, Cisek J "Serotonin syndrome secondary to phenelzine-venlafaxine interaction." Pharmacotherapy 18 (1998): 399-403. [PMID: 9545162]
71 White K, Pistole T, Boyd JL "Combined monoamine oxidase inhibitor-tricyclic antidepressant treatment: a pilot study." Am J Psychiatry 137 (1980): 1422-5. [PMID: 7435677]
72 White K, Simpson G "Combined MAOI-tricyclic antidepressant treatment: a reevaluation." J Clin Psychopharmacol 1 (1981): 264-82. [PMID: 7037873]