Paroxetine with Oxycodone Interaction Details

Brand Names Associated with Paroxetine

Brand Names Associated with Oxycodone

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 13, 2023

Interaction Effect

Increased oxycodone exposure and increased risk of serotonin syndrome and paralytic ileus

Interaction Summary

Coadministration of oxycodone and paroxetine, a CYP2D6 inhibitor, may result in prolonged or increased opioid effects. These effects may be more pronounced when paroxetine is added after stable dose of oxycodone is achieved. Because both oxycodone and paroxetine both affect the serotonergic neurotransmitter system, coadministration may also result in serotonin syndrome. If concomitant use of oxycodone and paroxetine is clinically required, monitor patients frequently for signs of sedation, respiratory depression, and serotonin syndrome, especially during treatment initiation and dosage adjustment. Consider dosage reduction of oxycodone until stable plasma concentrations are achieved. Discontinue oxycodone if serotonin syndrome is suspected. If paroxetine is discontinued, monitor for signs of opioid withdrawal and consider increasing the oxycodone dosage until stable drug effects are achieved. Consider prescribing naloxone for the emergency treatment of opioid overdose. Also, monitor patients for signs of urinary retention or reduced gastric motility when oxycodone is used concomitantly with anticholinergic drugs like paroxetine .

Severity

Major

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Coadministration of oxycodone and paroxetine, a CYP2D6 inhibitor, may result in prolonged or increased opioid effects. These effects may be more pronounced when paroxetine is added after stable dose of oxycodone is achieved. Because both oxycodone and paroxetine both affect the serotonergic neurotransmitter system, coadministration may also result in serotonin syndrome. If concomitant use of oxycodone and paroxetine is clinically required, monitor patients frequently for signs of sedation, respiratory depression, and serotonin syndrome, especially during treatment initiation and dosage adjustment. Consider dosage reduction of oxycodone until stable plasma concentrations are achieved. Discontinue oxycodone if serotonin syndrome is suspected. If paroxetine is discontinued, monitor for signs of opioid withdrawal and consider increasing the oxycodone dosage until stable drug effects are achieved. Consider prescribing naloxone for the emergency treatment of opioid overdose. Also, monitor patients for signs of urinary retention or reduced gastric motility when oxycodone is used concomitantly with anticholinergic drugs like paroxetine .

Mechanism Of Interaction

Inhibition of CYP2D6-mediated oxycodone metabolism; additive serotonergic effect; additive effects on gastric motility

Paroxetine Overview

• 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.

Oxycodone Overview

• Oxycodone is used to relieve moderate to severe pain. Oxycodone extended-release tablets and extended-release capsules are used to relieve severe pain in people who are expected to need pain medication around the clock for a long time and who cannot be treated with other medications. Oxycodone extended-release tablets and extended-release capsules should not be used to treat pain that can be controlled by medication that is taken as needed. Oxycodone extended-release tablets, extended-release capsules, and concentrated solution should only be used to treat people who are tolerant (used to the effects of the medication) to opioid medications because they have taken this type of medication for at least one week. Oxycodone is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.

• Oxycodone is also available in combination with acetaminophen (Oxycet, Percocet, Roxicet, Xartemis XR, others); aspirin (Percodan); and ibuprofen. This monograph only includes information about the use of oxycodone alone. If you are taking an oxycodone combination product, be sure to read information about all the ingredients in the product you are taking and ask your doctor or pharmacist for more information.

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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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.