And i kind of breezed through the earlier sections of a little bit more quickly because drug interactions with fluvoxamine are so critical I've had numerous situations where fluvoxamine mean has caused various toxicities and or issues so Let's think about many of the cyp enzyme. So sip one eighty two Fluvoxamine actually inhibits cyp. One a two So a drug like claws ping definitely a drug that's very sensitive potentially to concentration changes Those concentrations can go up due to Adding fluvoxamine on board The effects of caffeine and other one through cyp one a two. If we inhibit cyp one a two caffeine effects can go up Orlando pain and other antipsychotic affected by cyp one. A two so numerous drug interactions. They're potentially In addition Patients who smoke can actually have lower levels of fluvoxamine member smoking Induces cyp one. A two who've oxygene is partly at least partly broken down by cyp twenty two and so flu vaccine concentrations can go down as patients Or smokers can have lower levels of loxton. If somebody stop smoking those fluvoxamine levels can go up so definitely can be a very complicated Type of situation there Fluvoxamine also inhibits cyp two c nineteen. So if you remember a few drugs here Benetton at least in parts broken down by cyp two c nineteen I have absolutely seen a case of benetton toxicity. Because fluvoxamine was added to a patient's medication regimen Other medications increased concentrations of mapra sol And also potentially Reduced effectiveness of drug light clopidogrel. Remember that one is a pro drug and is impacted by cyp. Two c nineteen activity sip to see nine so Fluvoxamine is technically classified as a weak inhibitor of cyp two c nine and if you remember war friend is broken down significantly by the enzyme To see nine so we can end up with elevations in irr in increased orphaned concentrations. If vaccine is out another enzyme that fluvoxamine impacts is cyp..