Duloxetine with Paroxetine Interaction Details
Brand Names Associated with Duloxetine
- Cymbalta®
- Drizalma Sprinkle®
- Duloxetine
Brand Names Associated with Paroxetine
- Brisdelle®
- Paroxetine
- Paxil®
- Paxil® CR
- Pexeva®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 13, 2023
Interaction Effect
Increased DULoxetine and PARoxetine exposure and an increased risk of serotonin syndrome
Interaction Summary
DULoxetine is a selective serotonin and norepinephrine reuptake inhibitor (SNRI). The concomitant use of DULoxetine with PARoxetine, an SSRI, is not recommended due to the potential for serotonin syndrome. In addition, coadministration of PARoxetine, a potent CYP2D6 inhibitor, at a dose of 20 mg once daily with DULoxetine 40 mg once daily resulted in a 60% increase in DULoxetine serum concentration. DULoxetine and PARoxetine are both substrates for, and moderately potent inhibitors of CYP2D6. Concomitant use increases the plasma concentrations of both the drugs and may increase the risk of toxicity. Monitor plasma concentrations of DULoxetine and PARoxetine and reduce dosage if necessary. Also, monitor all patients on DULoxetine therapy for serotonin syndrome, especially during initiation. If concomitant use is required, notify patients of the increased risk of serotonin syndrome and monitor for symptoms. Immediately discontinue treatment with DULoxetine and any concomitant serotonergic agent if symptoms occur and initiate supportive treatment. Exercise caution when coadministering DULoxetine delayed-release capsules and potent CYP2D6 inhibitors .
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
The concomitant use of DULoxetine with other serotonergic drugs like PARoxetine may result in serotonin syndrome, which can be life-threatening. Also, DULoxetine and PARoxetine are both substrates for, and moderately potent inhibitors of CYP2D6. Concomitant use increases the plasma concentrations of both the drugs and may increase the risk of toxicity. Monitor plasma concentrations of DULoxetine and PARoxetine and reduce dosage if necessary. Also, monitor all patients on DULoxetine therapy for serotonin syndrome, especially during initiation. If concomitant use is required, notify patients of the increased risk of serotonin syndrome and monitor for symptoms. Immediately discontinue treatment with DULoxetine and any concomitant serotonergic agent if symptoms occur and initiate supportive treatment. Exercise caution when coadministering duloxetine delayed-release capsules and potent CYP2D6 inhibitors .
Mechanism Of Interaction
Inhibition of CYP2D6-mediated DULoxetine metabolism; inhibition of CYP2D6-mediated PARoxetine metabolism; additive serotonergic effects
Literature Reports
A) Coadministration of DULoxetine 40 mg once daily with another potent CYP2D6 inhibitor (PARoxetine 20 mg once daily) resulted in a 60% increase in the serum concentration of duloxetine .
Duloxetine Overview
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Duloxetine is used to treat depression in adults and generalized anxiety disorder (GAD; excessive worry and tension that disrupts daily life and lasts for 6 months or longer) in adults and children 7 years of age and older. Duloxetine is also used to treat pain and tingling caused by diabetic neuropathy (damage to nerves that can develop in people who have diabetes) in adults and fibromyalgia (a long-lasting condition that may cause pain, muscle stiffness and tenderness, tiredness, and difficulty falling asleep or staying asleep) in adults and children 13 years of age and older. It is also used to treat ongoing bone or muscle pain such as lower back pain or osteoarthritis (joint pain or stiffness that may worsen over time) in adults. Duloxetine is in a class of medications called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). It works by increasing the amounts of serotonin and norepinephrine, natural substances in the brain that help maintain mental balance and stop the movement of pain signals in the brain.
Paroxetine Overview
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Paroxetine tablets, suspension (liquid), and extended-release (long-acting) tablets are used to treat depression, panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks), and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). Paroxetine tablets and suspension are also used to treat obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), generalized anxiety disorder (GAD; excessive worrying that is difficult to control), and posttraumatic stress disorder (disturbing psychological symptoms that develop after a frightening experience). Paroxetine extended-release tablets are also used to treat premenstrual dysphoric disorder (PMDD, physical and psychological symptoms that occur before the onset of the menstrual period each month). Paroxetine capsules (Brisdelle) are used to treat hot flashes (sudden feelings of warmth, especially in the face, neck, and chest) in women who are experiencing menopause (stage of life when menstrual periods become less frequent and stop and women may experience other symptoms and body changes). Paroxetine is in a class of medications called selective serotonin-reuptake inhibitors (SSRIs). It treats depression and other mental illnesses by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance. There is not enough information available at this time to know how paroxetine works to treat hot flashes.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.