Paxil Drug Interactions
There are many medications that can potentially interact when taken with Paxil. Usually, drug interactions with Paxil result in moderate to severe reactions. Therefore, it is important to discuss with your healthcare provider for appropriate instructions.
Significant Drug Interactions
Some of the drugs that are known to cause significant drug interactions when taken with Paxil include the following:
Drugs that interfere with hemostasis (blood thinners) – Taking Paxil with medications that affect blood clotting ability of the body may increase the risk of stomach bleeding. Caution is advised when taking these drugs together with Paxil.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
- Warafarin (Coumadin, Jantoven)
Certains drug for ADHD – Combining Paxil with Strattera, a medication for ADHD, may increase the blood levels of Strattera, possibly increase the risk of side effects. Dose adjustments may be necessary.
- Atomoxetine (Strattera)
Certain heart medications – Taking Paxil together with certain heart medications particularly antiarrhythmia drugs can increase the level of both drugs, possibly increasing the risk of side effects. Your healthcare provider may recommend close monitoring and, if necessary, dose adjustment. Caution is advised when taking these drugs together with Paxil.
- Digoxin (Lanoxin)
- Quinidine (Quin-G)
- Procainamide (Pronestyl)
- Disopyramide (Norpace)
- Flecainide (Tambocor)
- Mexiletine (Mexitil)
- Propafenone (Rythmol)
Certain antiseizure drugs – Combining these medications with Paxil may decrease the level of Paxil in the blood, possibly making it less effective. This drug combination may also cause increase drowsiness. Your healthcare provider may recommend close monitoring and, if necessary, dose adjustment.
- Phenytoin (Dilantin)
Certain antiulcer drug – Combining Paxil with cimetidine can increase the blood levels of Paxil; possibly increase the risk of side effects. Dose adjustments may be necessary or switching cimetidine with another medication.
- Cimetidine (Tagamet)
Monoamine oxidase inhibitors (MAOIs) – Taking Paxil with MAOI drug can lead to life-threatening side effects. Paxil should never be taken with MAOI drugs. If you have taken a MAOI drug, wait for at least two weeks before you start Paxil.
If an individual taking Paxil needs to start methylene blue or linezolid and there are no other options, then Paxil treatment should be discontinued immediately. However, the patient should be monitored carefully for possible withdrawal symptoms. Treatment with Paxil may be continued again after at least 24 hours of the last dose of methylene blue or linezolid.
- Isocarboxazid (Marplan)
- Linezolid (Zyvox)
- Methylene blue
- Phenelzine (Nardil)
- Rasagiline (Azilect)
- Selegiline (Eldepryl)
- Tranylcypromine (Parnate)
Certain psychotropic drugs – Concomitant use of Paxil and some medications used for treatment of psychiatric conditions can cause an increase in the levels of antipsychotic drugs in the blood, possibly increasing the risk of side effects. Paxil can also increase the chances of experiencing drowsiness. Inform your healthcare provider if you are taking any of such medications.
Paxil may be contraindicated in certain psychotropic medications such as thioridaine (Mellaril) and Pimozide (Orap) because of potentially dangerous drug interactions.
- Chlorpromazine (Thorazine)
- Fluphenazine (Permitil, Prolixin)
- Haloperidol (Haldol)
- Lithium (Lithobid, Eskalith)
- Perphenazine (Trilafon)
- Risperidone (Risperdal)
- Pimozide (Orap)
Certain medication for dystonia – Taking Paxil with procyclidine may increase the blood levels of procyclidine, possibly increasing the risk of side effects. Dose adjustments may be necessary when using these drugs together.
- Procyclidine (Kemadrin)
Certain medication for breast cancer – Tamoxifen needs to be processed by the liver to be activated. However, Paxil can interfere with the mechanism of action of tamoxifen possibly making it less effective.
- Tamoxifen (Nolvadex, Soltamox)
Certain bronchodilator – Concomitant use of Paxil and theophylline can increase the level of theophylline in the body, possibly increasing the risk of side effects. Your healthcare provider may recommend close monitoring of your theophylline levels in the body and, if necessary, theophylline dose may be adjusted.
- Theophylline (Elixophyllin, Theo-24, Theochron, Uniphyl)
Tricylcic antidepressants (TCAs) – Concomitant use of Paxil and TCAs can cause an increase the blood levels of the antidepressant. Depending on the patient’s response, the dose of TCA may be adjusted.
- Amitriptyline (Elavil)
- Clomipramine (Anafranil)
- Desipramine (Norpramin)
- Doxepin (Sinequan, Silenor)
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
- Protriptyline (Vivactil)
- Trimipramine (Surmontil)
Certain antiviral drugs – Taking Paxil with certain antiviral medications can significantly reduce the blood levels of Paxil, potentially making it less effective. Consult your healthcare provider if taking these medications together for possible dose adjustment.
- Fosamprenavir (Lexiva)
- Ritonavir (Norvir, Kaletra)
Medications that affect serotonin levels of the body – There are a number of medications that can cause a group of symptoms known as serotonin syndrome when taken together with Paxil. Symptoms of serotonin syndrome may include confusion, diarrhea, feeling faint, rapid heartbeat, sweating, fever, muscle spasm, and difficulty walking.
Be sure to consult your healthcare provider if you are taking any of these medications. Take note that other natural supplements or herbal products such as St. John’s Wort may also actually affect blood serotonin levels. In case you develop any sign of serotonin syndrome, contact your healthcare provider immediately as this drug reaction can be life threatening.
- Fentanyl (Abstral, Actiq, Duragesic, Fentora, Onsolis);
- Tramadol (Rybix ODT, Ryzolt, Ultram, Ultram ER)
- Tramadol and acetaminophen (Ultracet)
- Lithium (Lithobid, Eskalith)
- Other SSRI antidepressants including Citalopram, Zoloft, Lexapro, Prozac.
- SNRI antidepressants including Cymbalta, Pristiq, Effexor, Savella
- Any other antidepressants
This medication guide may not discuss all the drugs that can potentially react with Paxil. Be sure to inform your healthcare provider of all the drugs you take, prescription and nonprescription drugs including vitamins, herbal supplements and other natural products.