Central and peripheral
toxicity developed in a number of patients taking fluoxetine with
tryptophan. On theoretical grounds an
adverse reaction (such as serotonin
syndrome) seems possible between any SSRI and
tryptophan.
The combination is probably best avoided, as advised by the manufacturers of
tryptophan. If
tryptophan is given with an SSRI, the SSRI should be started at a low dose and
tryptophan gradually introduced starting with a low dose. Patients should be closely monitored for adverse effects.