A client diagnosed with depression is prescribed fluoxetine. On a return visit to the clinic, the client tells the nurse about also taking St. John's wort to feel better. The nurse assesses the client for which potential side effect?

Question

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Fluoxetine is a selective serotonin reuptake inhibitor that when combined with St. John's wort can lead to serotonin syndrome. Water intoxication is possible with mood stabilizers such as lithium. The combination of fluoxetine and St. John's wort leads to an increase in intrasynaptic serotonin. Therefore, a potential for toxicity is present. Hypertensive crisis occurs when MAOIs are taken with tyramine-rich foods.

A Client Diagnosed with Depression Is Prescribed Fluoxetine