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Antidepressants SSRIs (fluoxetine, sertraline, paroxetine): Minor interaction Possible increased sedation or vivid dreams Generally safe at low melatonin doses SNRIs (venlafaxine, duloxetine): Similar to SSRIs Monitor for increased side effects MAOIs (phenelzine, tranylcypromine): More concerning interaction Can increase blood pressure Requires medical supervision Fluvoxamine specifically: MAJOR interactionincreases melatonin levels 12-fold Avoid combination or use extremely low melatonin dose (0.1-0.3mg) under supervision Management: Discuss with psychiatrist before starting Start with low melatonin dose (0.3-0.5mg) Monitor mood and side effects closely Particularly watch for increased vivid dreams or daytime sedation Sedatives and Sleep Medications Medications affected: Benzodiazepines (lorazepam, clonazepam, diazepam) Z-drugs (zolpidem/Ambien, eszopiclone/Lunesta) Antihistamines (diphenhydramine/Benadryl) Interaction: Additive sedationincreased drowsiness, cognitive impairment, fall risk

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Update on lupus nephritis: core curriculum 2020