Question:
I have read many medical journal articles on how
taking Fluoxetine (Prozac) and Buspirone (BuSpar)
together may cause Serotonin Syndrome. How can you
ensure this not to happen since you regularly
recommend the two to be taken together for GAD,
Fractured Enjoyment and BPD patients?
Dr. Heller's Answer:
I can’t. There are rare cases of problems with every
medication. You can get serotonin syndrome from
Sudafed, bright lights, St. John’s wort, lithium,
trazodone, electric shock therapy and many foods.
This complication is extraordinarily rare. The FDA
approved package insert for Prozac (fluoxetine) does
not include a warning about combining it with BuSpar
(buspirone).
Most cases of serotonin syndrome with SSRI
medications like Prozac (fluoxetine) occur when it’s
combined with tricyclic antidepressants and MAO
inhibitors. The tricyclic antidepressant Elavil
(amitryptilline) is frequently added to SSRI
antidepressants for migraines. This has a much
greater risk of serotonin syndrome than combining
BuSpar (buspirone) and Prozac (fluoxetine).
I have a lot of patients on this combination and have
never seen the serotonin syndrome. I had one patient
attempt suicide by taking 250mg 15mg BuSpar tablets
with 350 Prozac pulvules. She did fine, although she
was very shaky for a few weeks.
There’s no guarantee on anything in life.
Approximately 10 people per year are killed by
vending machines falling down on them. You can be
killed or maimed every time you drive a car. The
computer you’re using can explode. Bad weather,
earthquakes, lightning and terrorists can kill. The
electricity in your home can cause a fatal fire in
your house. Your car can explode. You can be killed
by lightning hitting your telephone line.
Being depressed increases the risk of a heart attack
by 600%. There are more suicides per year than the
combination of homicide and automobile accidents
combined. Anxiety dramatically increases the risk of
immune system disease, cancer, heart attacks,
strokes, high blood pressure and others.
There is no absolute prevention of risk. What we do
with everything in life is make an attempt to balance
the risks versus the benefits.
I would not be
concerned if any of my loved ones took BuSpar
(buspirone) and Prozac (fluoxetine) together, in fact
some do.
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