Psychopharmacology: fluvoxamine interaction: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Psychopharmacology: fluvoxamine interaction

Sample item

A patient stable on clozapine is started on fluvoxamine for OCD and develops sedation, seizures and hypotension. The reason is:

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. CYP1A2 inhibition raising clozapine levels

Fluvoxamine strongly inhibits CYP1A2, which metabolises clozapine, olanzapine, caffeine and theophylline, so levels rise and toxicity follows. The dose of clozapine must be reduced, or another SSRI used.

Option by option

  • A. CYP1A2 inhibition raising clozapine levels (correct)

    Correct. CYP1A2 inhibition raises clozapine levels.

  • B. Increased renal excretion of clozapine

    Renal excretion is not increased.

  • C. Reduced absorption of clozapine

    Absorption is not reduced.

  • D. CYP2D6 induction

    CYP2D6 induction is not involved.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is A, CYP1A2 inhibition raising clozapine levels. Fluvoxamine strongly inhibits CYP1A2, which metabolises clozapine, olanzapine, caffeine and theophylline, so levels rise and toxicity follows.

Why is "Increased renal excretion of clozapine" not the answer?

Renal excretion is not increased.

Why is "Reduced absorption of clozapine" not the answer?

Absorption is not reduced.

Why is "CYP2D6 induction" not the answer?

CYP2D6 induction is not involved.

What concept does this question test?

It tests Psychopharmacology: fluvoxamine interaction in Psychiatry. The dose of clozapine must be reduced, or another SSRI used.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Psychopharmacology: fluvoxamine interaction?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.