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Question. I am taking 20mg of Paxil and am seeing a behavior therapist for obsessive-compulsive disorder. My obsessions have been greatly subdued and I feel I have a life again. The other day my doctor told me he wanted to switch to Luvox. I was wondering if you could tell me more about the switch and what this will most likely mean for my OCD? I would also like to know about Luvox and possible interactions with other drugs, particularly antihistamines and melatonin? Also, I find it hard to sleep on Paxil. Would melatonin help?

Answer. Frankly, I would think twice before switching from Paxil if you have done very well on it, except for some insomnia. Of course, Luvox is a perfectly fine medication for obsessive-compulsive disorder (OCD), and is even FDA-labeled for that specific use (as is Paxil). Both are probably roughly equal in effectiveness for OCD. Luvox is actually a bit more likely to produce insomnia than is Paxil (11% vs. 7%, placebo-adjusted rates). There are some drug-drug interactions to avoid with Luvox, including use of two antihistamines: terfenadine and astemizole (Seldane and Hismanal). This is less likely to be a problem with Paxil. Luvox should never be used together with an MAOI-type antidepressant.

In theory, Luvox might elevate blood levels of other drugs, including tricyclic antidepressants, Xanax, Halcion, Tegretol, Clozapine, Inderal, theophylline, erythromycin, and warfarin (a blood thinner), and this list is not exhaustive. However, not all these interactions are necessarily clinically significant; the ones to stay away from with Luvox are MAOI, terfenadine, and astemizole. As far as something to help with sleep while taking Paxil: a very small dose of a sedating tricyclic, such as doxepin 10 mg to 25 mg, could help (elevations of doxepin blood levels would probably not be a major concern at that dose, but levels should be monitored).

Trazodone (Desyrel) 25 mg to 50 mg at bed could also help, though there is a very small chance that this might worsen OCD symptoms. A small amount of lorazepam (Ativan) 0.5 mg to 1.0 mg could also be of help. I am not aware of adverse interactions between melatonin and either Paxil or Luvox; however, two caveats: 1) There is very little published research in this area, since melatonin is available over-the counter; and 2) there have been reports of melatonin aggravating depressive symptoms. Whether it would aggravate OCD is not clear, but I’m not sure I’d take the chance. I would encourage you to discuss all these issues carefully with your doctor.