Paroxetine

MAOI that increases risk of serotonin syndrome when combined with paroxetine. Paroxetine is contraindicated.

Concomitant use increases risk of serotonin syndrome. Paroxetine is contraindicated in patients taking linezolid.

Intravenous methylene blue with paroxetine increases risk of serotonin syndrome. Paroxetine is contraindicated in patients taking methylene blue.

Contraindicated due to risk of serotonin syndrome.

MAOI that increases risk of serotonin syndrome when combined with paroxetine. Paroxetine is contraindicated.

Serious, sometimes fatal reactions reported when used concomitantly with MAO inhibitors.

Increased plasma concentrations may increase risk of QTc prolongation and ventricular arrhythmias. Paroxetine is contraindicated in patients taking pimozide.

MAOI that increases risk of serotonin syndrome when combined with paroxetine. Paroxetine is contraindicated.

Increased plasma concentrations may increase risk of QTc prolongation and ventricular arrhythmias. Paroxetine is contraindicated in patients taking thioridazine.

Inhibits CYP450 2D6, elevating thioridazine levels and augmenting QTc prolongation, risking serious cardiac arrhythmias including Torsades de pointes.

MAOI that increases risk of serotonin syndrome when combined with paroxetine. Paroxetine is contraindicated.

CYP2D6 inhibitor that increases codeine plasma concentration but decreases morphine concentration, potentially causing reduced analgesic efficacy or opioid withdrawal symptoms. Discontinuation may cause increased morphine levels and potentially fatal respiratory depression.

SSRI inhibits P450 2D6; caution advised in coadministration and when switching between classes.

Concomitant use of serotonergic drugs with paroxetine increases risk of serotonin syndrome.

Concomitant use increases risk of serotonin syndrome and increases amphetamine exposure via CYP2D6 inhibition.

Strong CYP2D6 inhibitor increases aripiprazole exposure. Reduce aripiprazole dosage.

Strong CYP2D6 inhibitor that increases aripiprazole exposure. Avoid concomitant use because dosage cannot be modified.

Concurrent use of aspirin with paroxetine may potentiate the risk of bleeding.

CYP2D6 inhibitor that increases atomoxetine steady-state plasma concentrations 6- to 8-fold AUC and 3- to 4-fold Cmax in extensive metabolizers.

CYP2D6 inhibitor that increases atomoxetine steady-state plasma concentrations 6- to 8-fold in extensive metabolizers, with C max increased 3- to 4-fold.

Concomitant use increases risk of serotonin syndrome.

SSRI that inhibits P450 2D6 and may increase clomipramine plasma levels, potentially causing toxicity.

Concurrent use of clopidogrel with paroxetine may potentiate the risk of bleeding.

SSRI that inhibits cytochrome P450 2D6, potentially increasing desipramine plasma concentrations.

Strong CYP2D6 inhibitor that increases systemic exposure to active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Maximum recommended dose should not exceed 36 mg per day.

CYP2D6 inhibitor and serotonergic drug; increases dextroamphetamine exposure and serotonin syndrome risk. Use lower doses and monitor.

CYP2D6 inhibitor and serotonergic drug that increases amphetamine exposure and risk of serotonin syndrome. Initiate with lower doses and monitor for serotonin syndrome.

CYP2D6 inhibitor and serotonergic drug that increases dextroamphetamine exposure and risk of serotonin syndrome. Initiate with lower doses and monitor for serotonin syndrome.

Exposure increases 2-fold. Reduce paroxetine dose and adjust based on clinical response.

Potent CYP2D6 inhibitor; increases duloxetine AUC by approximately 60%, with greater inhibition expected at higher doses.

Potent CYP2D6 inhibitor that increases duloxetine AUC by about 60%, with greater inhibition expected at higher doses.

Concomitant use increases risk of serotonin syndrome.

CYP2D6 inhibitor that increases haloperidol concentrations; significant QTc prolongation observed when combined with ketoconazole.

Concurrent use of heparin with paroxetine may potentiate the risk of bleeding.

Concomitant use increases risk of serotonin syndrome.

Strong CYP2D6 inhibitor that increases metoclopramide plasma concentrations and risk of extrapyramidal symptoms exacerbation. Dosage reduction recommended.

Strong CYP2D6 inhibitor increasing metoclopramide plasma concentrations with risk of exacerbation of extrapyramidal symptoms; dosage reduction recommended.

Strong CYP2D6 inhibitor that doubles metoprolol concentrations, decreasing cardioselectivity. Close monitoring required.

Strong CYP2D6 inhibitor that doubles metoprolol concentrations, decreasing cardioselectivity and requiring close monitoring.

Strong CYP2D6 inhibitor that doubles metoprolol plasma concentrations, decreasing cardioselectivity. Close monitoring required.

Strong CYP2D6 inhibitor that doubles metoprolol concentrations, decreasing cardioselectivity. Close monitoring required.

Strong CYP2D6 inhibitor that doubles metoprolol concentrations, decreasing cardioselectivity.

SSRI that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiation and dose increases.

SSRI that inhibits P450 2D6. Caution indicated in co-administration with nortriptyline; may require dose adjustment.

CYP2D6 inhibitor that increases propafenone plasma levels, potentially causing cardiac arrhythmias and proarrhythmia risk.

CYP2D6 inhibitor that increases propafenone plasma levels, potentially leading to cardiac arrhythmias and proarrhythmia risk.

SSRI co-administration with triptans has been reported to cause serotonin syndrome. Cases have been reported during co-administration.

Concomitant use increases risk of serotonin syndrome.

Paroxetine's CYP2D6 inhibition may reduce tamoxifen efficacy. Consider alternative antidepressant with little or no CYP2D6 inhibition.

Strong CYP2D6 inhibitor increases tamsulosin Cmax by 1.3-fold and AUC by 1.6-fold, with potential for significant exposure increase in poor metabolizers.

Strong CYP2D6 inhibitor that markedly increases exposure to tetrabenazine metabolites. Dose reduction necessary; maximum daily dose 50 mg, maximum single dose 25 mg.

Concomitant use increases risk of serotonin syndrome.

CYP2D6 inhibitor that increases tramadol plasma concentration and decreases M1 concentration, resulting in increased risk of seizures, serotonin syndrome, and opioid withdrawal symptoms.

CYP2D6 inhibitor may increase tramadol plasma concentration and decrease M1 concentration, resulting in increased risk of seizures, serotonin syndrome, and opioid withdrawal or toxicity.

CYP2D6 inhibitor that increases tramadol plasma concentration and decreases M1 concentration, risking seizures, serotonin syndrome, opioid withdrawal, and respiratory depression.

CYP2D6 inhibitor may increase tramadol plasma concentration and decrease M1 concentration, resulting in increased risk of seizures, serotonin syndrome, and opioid withdrawal or toxicity.

Concomitant use of serotonergic drugs triptans with paroxetine increases risk of serotonin syndrome.

Concomitant use increases risk of serotonin syndrome.

Concurrent use of warfarin with paroxetine may potentiate the risk of bleeding and increase warfarin plasma concentration. Monitor INR carefully.

In vitro studies suggest possible drug interaction with alprazolam based on CYP3A inhibition. Caution recommended during coadministration.

Paroxetine is a strong CYP2D6 inhibitor that may increase amitriptyline concentrations. Use caution and monitor.

Paroxetine inhibits P450 2D6; caution is indicated in co-administration with tricyclic antidepressants and in switching between classes.

Strong CYP2D6 inhibitor that increases aripiprazole exposure. Reduce aripiprazole dosage when used concomitantly.

Asenapine may enhance paroxetine's inhibitory effects on its own metabolism, increasing paroxetine exposure 2-fold. Paroxetine dose should be reduced by half.

CYP2D6 substrate and inhibitor that increases paroxetine exposure 2-fold when combined with SAPHRIS. Paroxetine dose should be reduced by half.

Strong CYP2D6 inhibitor that increases brexpiprazole exposure. Dosage adjustment may be needed depending on clinical context.

CYP2D6 substrate; bupropion inhibits CYP2D6 and increases paroxetine concentrations; consider dose reduction.

Bupropion inhibits CYP2D6 and can increase paroxetine concentrations; consider dose reduction of paroxetine.

CYP2D6 substrate antidepressant. Bupropion inhibits CYP2D6, increasing paroxetine exposure. Dose reduction may be necessary.

CYP2D6 substrate. Bupropion inhibits CYP2D6 and can increase paroxetine concentrations. Consider dose reduction of paroxetine when used with bupropion.

CYP2D6-metabolized antidepressant. Bupropion inhibits CYP2D6 and can increase paroxetine concentrations. Consider dose reduction.

CYP2D6 inhibitor expected to increase blood levels of carvedilol R(+) enantiomer, potentially increasing vasodilating effects and dizziness.

Potent CYP2D6 inhibitor expected to increase carvedilol R(+) enantiomer blood levels, potentially causing dizziness and vasodilation.

Increases paroxetine steady-state plasma concentrations by approximately 50%.

Other SSRIs increase risk of serotonin syndrome when used concomitantly with citalopram. Monitor for serotonin syndrome symptoms.

Other SSRIs increase risk of serotonin syndrome when used concomitantly with citalopram. Monitor for signs and symptoms of serotonin syndrome.

CYP2D6 or CYP3A4 inhibitor that can increase clozapine levels and lead to adverse reactions. Close monitoring and dose reduction may be necessary.

CYP2D6 inhibitor; no dosing adjustments recommended for darifenacin when co-administered with paroxetine.

Paroxetine inhibits CYP2D6, increasing desipramine exposure. Decrease desipramine dosage if needed with concomitant paroxetine use.

Paroxetine inhibits CYP2D6, increasing dextromethorphan exposure. Decrease dextromethorphan dosage if needed with concomitant paroxetine use.

Paroxetine decreases plasma concentrations of digoxin. Digoxin dosage may need increase with concentration monitoring.

Weakness, hyperreflexia, and incoordination may occur rarely with coadministration of selective serotonin reuptake inhibitors.

SSRI that inhibits P450 2D6. Caution is indicated in coadministration with doxepin; may require dose adjustment and plasma level monitoring.

Potent CYP2D6 inhibitor increases duloxetine AUC by about 60% at 20 mg daily; greater increases expected at higher doses.

Strong CYP2D6 inhibitor resulted in 1.3-fold increase in tamsulosin Cmax and 1.6-fold increase in AUC. Monitor when coadministered with tamsulosin.

Paroxetine is a strong CYP2D6 inhibitor that may increase encainide concentrations. Use caution and monitor.

Paroxetine inhibits CYP2D6, increasing flecainide exposure. Decrease flecainide dosage if needed with concomitant paroxetine use.

Paroxetine is a strong CYP2D6 inhibitor that may increase fluoxetine concentrations. Use caution and monitor.

Phenytoin Decreased paroxetine exposure Fosamprenavir/Ritonavir Decreased plasma concentration of paroxetine Cimetidine Increased plasma concentration of paroxetine Use caution if co-administering paroxetine capsules with other drugs that inhibit CYP2D6 (e.g., quinidine).

CYP2D6 inhibitor that increases haloperidol plasma concentrations; QTc prolongation observed when combined with ketoconazole.

Strong CYP2D6 inhibitor that increased iloperidone and P88 metabolite peak concentrations ~1.6 fold, decreased P95 by half. Dose reduction required.

Paroxetine is a strong CYP2D6 inhibitor that may increase imipramine concentrations. Use caution and monitor.

SSRI that inhibits cytochrome P450 2D6 to variable extent. Caution indicated in coadministration with imipramine; monitoring of TCA plasma levels recommended.

SSRI that inhibits P450 2D6, increasing imipramine plasma concentrations. Caution and dose adjustment may be necessary during co-administration or switching.

May increase or decrease ioflupane binding to dopamine transporter and may interfere with imaging results.

CYP2D6 inhibitor that increases lofexidine plasma levels by 28%. Monitor for orthostatic hypotension and bradycardia.

CYP2D6 inhibitor paroxetine increases lofexidine plasma levels by 28%. Monitor for orthostatic hypotension and bradycardia.

Strong CYP2D6 inhibitor that doubles metoprolol concentrations and decreases cardioselectivity; close monitoring required.

CYP2D6 inhibitor that may increase nebivolol levels; use caution when co-administered.

CYP2D6 inhibitor may increase nebivolol levels. Use caution when co-administered.

Paroxetine is a strong CYP2D6 inhibitor that may increase nortriptyline concentrations. Use caution and monitor.

CYP2D6 inhibitor that increases oliceridine plasma concentration, resulting in increased or prolonged opioid effects. May require less frequent dosing and close monitoring for respiratory depression.

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms.

Paroxetine inhibits P450 2D6, increasing perphenazine plasma concentrations. Close monitoring is essential and dose reduction may be necessary to avoid toxicity.

Paroxetine inhibits cytochrome P450 2D6; caution is indicated in coadministration with amitriptyline and dose adjustments may be necessary.

CYP2D6 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

CYP2D6 enzyme inhibitor increases plasma concentrations of risperidone. Reduce initial dose and do not exceed 8 mg per day of risperidone.

Phenytoin Decreased paroxetine exposure Fosamprenavir/Ritonavir Decreased plasma concentration of paroxetine Cimetidine Increased plasma concentration of paroxetine Use caution if co-administering paroxetine capsules with other drugs that inhibit CYP2D6 (e.g., quinidine).

Other SSRIs increase risk of serotonin syndrome; monitor for signs and symptoms.

Impact on tamoxifen efficacy not well established. Strong CYP2D6 inhibitors may reduce tamoxifen efficacy by reducing potent active metabolites, though some studies show no effect.

Paroxetine increases plasma concentrations of theophylline. Dosage may need decrease with concentration and tolerability monitoring.

Increased tolterodine exposure may occur; dosage adjustment may be needed.

In vitro data suggest possible drug interaction with triazolam. Caution recommended during coadministration.

Paroxetine inhibits P450 2D6, potentially increasing trimipramine concentrations. Caution is indicated in co-administration or switching between these drugs.

Paroxetine inhibits P450 2D6, potentially increasing trimipramine maleate concentrations. Caution is indicated in co-administration.

Increased venlafaxine exposure may occur; dosage adjustment may be needed.

Strong CYP2D6 inhibitor increases plasma concentrations of vortioxetine. Reduce TRINTELLIX dose by half when coadministered.

CYP2D6 inhibitor; no dosing adjustments recommended.

No pharmacokinetic or pharmacodynamic interaction detected with single-dose coadministration.

Co-administration did not produce any interaction on psychomotor performance. Paroxetine did not alter zaleplon pharmacokinetics, confirming no role of CYP2D6 in zaleplon metabolism.

Diazepam Under steady-state conditions, diazepam does not appear to affect paroxetine kinetics. The effects of paroxetine on diazepam were not evaluated.

In addition, in vitro studies have shown ketoconazole, a potent inhibitor of CYP3A4 activity, to be at least 100 times more potent than paroxetine as an inhibitor of the metabolism of several substrates for this enzyme, including terfenadine, astemizole, cisapride, triazolam, and cyclosporine.

Beta-Blockers In a study where propranolol (80 mg twice daily) was dosed orally for 18 days, the established steady-state plasma concentrations of propranolol were unaltered during coadministration with paroxetine (30 mg once daily) for the final 10 days. The effects of propranolol on paroxetine have not been evaluated (see ADVERSE REACTIONS: Postmarketing Reports ).