Types of drugs that interact with metoprolol include antidepressants including bupropion wellbutrin , fluoxetine prozac, sarafem , and paroxetine paxil antimalaria drugs such as hydroxychloroquine medications used to treat heartburn or other stomach conditions, such as cimetidine tagamet and ranitidine zantac some heart medications, including clonidine catapres , propafenone rythmol , and quinidine quinaglute, quinidex antihistamines like diphenhydramine benadryl certain hiv drugs, including ritonavir norvir some antifungal medications, including terbinafine lamisil certain drugs used to treat mental illness, including thioridazine mellaril .
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Patients should be cautioned about the risk of bleeding associated with the concomitant use of fluoxetine and NSAIDsaspirinwarfarinor other drugs that affect coagulationsee DRUG INTERACTIONS
It is unknown whether the suicidality risk extends to longer-term usethat isbeyond several monthsHoweverthere is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression.
DUse in LIFE-THREATENING emergencies when no safer drug availablePositive evidence of human fetal risk.
SNRIs and SSRIsincluding fluoxetinemay increase the risk of bleeding reactionsConcomitant use of aspirinnonsteroidal anti-inflammatory drugswarfarinand other anti-coagulants may add to this riskCase reports and epidemiological studiescase-control and cohort designhave demonstrated an association between use of drugs that interfere with serotonin reuptake and the occurrence of gastrointestinal bleedingBleeding reactions related to SNRIs and SSRIs use have ranged from ecchymoseshematomasepistaxisand petechiae to life-threatening hemorrhages.
The following symptomsanxietyagitationpanic attacksinsomniairritabilityhostilityaggressivenessimpulsivityakathisiapsychomotor restlessnesshypomaniaand maniahave been reported in adult and pediatric patients being treated with antidepressants for Major Depressive Disorder as well as for other indicationsboth psychiatric and nonpsychiatricAlthough a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been establishedthere is concern that such symptoms may represent precursors to emerging suicidality.
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