Paroxetine with Anileridine Interaction Details
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
An increased risk of serotonin syndrome
Interaction Summary
Coadministration of PARoxetine and other serotonergic drugs increases the risk of serotonin syndrome, which may be life-threatening. If used concomitantly, monitor patients for signs and symptoms of serotonin syndrome (eg, mental status changes [agitation, hallucinations, delirium, coma], autonomic instability [tachycardia, labile blood pressure, dizziness, diaphoreses, flushing, hyperthermia], neuromuscular symptoms [tremor, rigidity, myoclonus, hyperreflexia, incoordination], seizures, and gastrointestinal symptoms [nausea, vomiting, diarrhea]), particularly during treatment initiation and dosage increases. If serotonin syndrome occurs, consider discontinuation of PARoxetine and/or concomitant serotonergic drugs and initiate symptomatic treatment.
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Coadministration of PARoxetine and other serotonergic drugs increases the risk of serotonin syndrome, which may be life-threatening. If used concomitantly, monitor patients for signs and symptoms of serotonin syndrome (eg, mental status changes [agitation, hallucinations, delirium, coma], autonomic instability [tachycardia, labile blood pressure, dizziness, diaphoreses, flushing, hyperthermia], neuromuscular symptoms [tremor, rigidity, myoclonus, hyperreflexia, incoordination], seizures, and gastrointestinal symptoms [nausea, vomiting, diarrhea]), particularly during treatment initiation and dosage increases. If serotonin syndrome occurs, consider discontinuation of PARoxetine and/or concomitant serotonergic drugs and initiate symptomatic treatment.
Mechanism Of Interaction
Additive serotonergic effects
Literature Reports
A) In a study of patients receiving co-prescribed 5-hydroxytryptamine receptor agonists (triptans) and SSRI or serotonin norepinephrine reuptake inhibitor (SNRI) antidepressants over 14 years (n=19,017; total exposure=30,928 person-years), the risk of serotonin syndrome with concomitant use was determined to be 0 to 4 cases per 10,000 person-years of exposure. Using confirmed cases only (n=2) and confirmed cases plus possible cases (n=7), the risk of serotonin syndrome with concomitant use was 0.6 (95% CI, 0 to 1.5) and 2.3 (95% CI, 0.6 to 3.9) cases per 10,000 person-years of exposure, respectively. Throughout the study, a mean of 26% (range, 21% to 29%) of patients received triptan prescriptions, including SUMAtriptan, ZOLMitriptan, naratriptan, rizatriptan, eletriptan, almotriptan, or frovatriptan, with a co-prescribed SSRI or SNRI antidepressant, including citalopram, fluvoxaMINE, escitalopram, PARoxetine, FLUoxetine, sertraline, DULoxetine, or venlafaxine .
B) A 40-year old female with a 9-year history of a bipolar disorder was started on PARoxetine therapy, with the dose being increased to 30 mg daily within one week. After seven days of PARoxetine 30 mg, she received an injection of sumatriptan for a migraine headache. Within 24 hours, she developed sustained dystonic contractions of her neck muscles, dystonic arching of her back, choreaform rocking of her hips, choreaform up and down movements of her shoulders, and wavelike, athetoid movements of her abdominal muscles. These dyskinesias occurred about five times daily and lasted for 20 to 30 minutes. Following the discontinuation of PARoxetine, these abnormal movements decreased in severity but worsened when PARoxetine was again initiated. All medications were stopped, and clozapine at a dose of 100 mg daily caused a remission of her paroxysmal dyskinesias. The authors speculated that the combination of PARoxetine and sumatriptan may have sensitized the 5-HT autoreceptors and induced postsynaptic receptor supersensitivity .
C) The effect of PARoxetine on desipramine metabolism was studied in 9 extensive metabolizers (EM) and 8 poor metabolizers (PM) of desipramine. Subjects took a single oral dose of desipramine before starting PARoxetine and a second dose after 11 days of PARoxetine use. After the addition of PARoxetine, EMs experienced a 5-fold decrease in clearance of desipramine, indicating that PARoxetine inhibits oxidation reactions catalyzed by CYP2D6. PMs had a slight increase in clearance of desipramine with PARoxetine. With concurrent administration of desipramine and PARoxetine, interaction of the two drugs may result in a need for dosage adjustments, especially in extensive metabolizers of desipramine .
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.