Alice,

I'm very worried about one of my friends who suffers from anorexia. She has recently turned to Dexatrim as a way to stop herself from eating. My concern is that she is also on Prozac for depression. I read the back of the Dexatrim package, and it says do not take if you are taking MAOI inhibitors, including Prozac. Is she in danger???

Worried friend

Dear Worried friend,

Your question brings up a couple of different, complicated issues. First, in regards to your inquiry about the dangers of mixing Dexatrim (an over-the-counter weight loss supplement) and Prozac (generic name: fluoxetine), it may help to know that fluoxetine isn't in the antidepressant class of monoamine oxidase inhibitors (MAOIs). Rather, it's a selective serotonin reuptake inhibitor (SSRI). Nevertheless, due to overlapping negative side effects, it’s best to err on the side of caution and avoid taking both Dexatrim and fluoxetine at the same time. You don't mention whether your friend has been diagnosed with anorexia or whether you've noticed behaviors that are indicative of disordered eating. Either way, in this instance, talking with your friend about your concerns may help provide some clarity for you, as well as give you an opportunity to share your concerns (more on this in a bit). As for your friend’s safety, only their health care provider can accurately assess their physical and emotional well-being, as well as the safety of drug interactions.

If your friend is indeed taking Dexatrim while also taking fluoxetine, the best bet would be for them to discuss this with her health care provider. Although using these two drugs together is not specifically contraindicated from a medical standpoint, it's possible that there could be adverse reactions, such as an increased or decreased effect of one or both of the drugs, or intensified side effects. For example, both fluoxetine and Dexatrim share side effects of decreased appetite, headaches, and joint pain, just to name a few. Additionally, those with eating disorders have a higher risk of cardiovascular issues and liver damage, both of which are also associated with Dexatrim.

Dexatrim previously contained phenylpropanolamine (PPA) and ephedrine as its main active ingredients. PPA curbs appetite and is associated with an increased risk of stroke, while ephedrine stimulates the central nervous system, but there are a number of unpleasant side effects associated with both. Therefore, the U.S. Food and Drug Administration (FDA) asked that manufacturers of products containing PPA replace it with alternative active ingredients. Dexatrim has since been reformulated with green tea extract (GTE), caffeine, and ginseng.

Despite this reformulation, each of the three main active ingredients in Dexatrim has potential negative side effects:

  • GTE in weight loss supplements has been associated with liver injury.
  • Caffeine has negative effects on cardiovascular function and sleep, and a number of studies suggest that it may increase the risk of substance abuse among those with mental health disorders.
  • Ginseng has been associated with adverse interactions with blood thinners, anti-inflammatory drugs, and MAOIs.

One of the side effects of fluoxetine is that it may actually cause a loss of weight and disinterest in food. It's possible that your friend has been prescribed fluoxetine because they're depressed (common in eating disorders), yet hasn't revealed the fact that she's struggling with issues around food. It’s crucial that your friend be honest with her health care providers about the patterns of eating and the feelings that prompt her behavior. This may help her be appropriately diagnosed and treated.

Have you shared your concerns with your friend? Talking about your concerns with her may be an opportunity to share this information with her, as well as help her get connected to resources that provide support (if she's interested). If you're nervous about the conversation, planning it out with a trusted friend, family member, or mental health professional may help. You may also want to learn more by reading the Disordered Eating & Eating Disorders category in the Go Ask Alice! Nutrition & Physical Activity archives, as well as reading questions such as Online eating disorder support resources.

Hope this helps,

Alice!

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