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Fluoxetine and amitriptyline — GPhC CRA MCQ

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HardCNS TherapeuticsFluoxetine and amitriptylineGPhC CRA

A 45-year-old woman with depression is prescribed amitriptyline 10mg at night for neuropathic pain. She also takes fluoxetine 40mg daily and reports palpitations. Her ECG shows QTc 486ms. What is the most appropriate action?

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Correct answer: E — Contact the prescriber because fluoxetine may increase amitriptyline exposure and QT risk

Fluoxetine can inhibit metabolism of tricyclic antidepressants and increase amitriptyline exposure. Both medicines can contribute to QT prolongation, and the patient already has palpitations and prolonged QTc. Prescriber review is needed before supply or continuation. Abruptly stopping fluoxetine is not pharmacist-directed management and can destabilise mental health.

Reference: BNF