Tizanidine + fluvoxamine/viloxazine/ciprofloxacin — CYP1A2
- Tizanidine = sensitive CYP1A2 victim
- Fluvoxamine: AUC ↑ ~33×
- Ciprofloxacin: AUC ↑ ~10×
- Hypotension/sedation can be profound
- Both combinations are contraindicated
- Viloxazine also inhibits CYP1A2 → avoid
Interaction at a glance
- Fluvoxamine: AUC ↑ ~33×
- Both combinations are contraindicated
Management
- Tizanidine = sensitive CYP1A2 victim
- Both combinations are contraindicated
- Viloxazine also inhibits CYP1A2 → avoid
Magnitude / time course
- Fluvoxamine: AUC ↑ ~33×
- Ciprofloxacin: AUC ↑ ~10×
Clinical consequence
- Hypotension/sedation can be profound
Self-check
- How should tizanidine be handled with fluvoxamine/ciprofloxacin vs viloxazine?
Fluvoxamine/ciprofloxacin: contraindicated; viloxazine: avoid.
- About how much can fluvoxamine raise tizanidine AUC?
About 33×.
Drugs in this interaction (4)
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