Paroxetine Interactions With Drugs, Alcohol, And Foods

Last Updated: June 3, 2020

Authored by Roger Weiss, MD

Paroxetine (sold under the brand names Paxil and Seroxat) is an antidepressant medication in the class of the selective serotonin reuptake inhibitors. Drug interactions with Paroxetine may range from mild symptoms to severe, life-threatening conditions such as arrhythmias, convulsions, and even coma. Therefore, patients are strongly advised to adhere to prescription instructions by their doctors and have knowledge of these adverse interactions.

Severe Interactions with Paxil

The following combinations with Paroxetine (Paxil) cause critical, life-threatening interactions and, therefore, should not be used:

  • Seroxat and Monoamine Oxidase Inhibitors such as selegiline and rasagiline: This combination dramatically increases the amount of serotonin in the body, causing a life-threatening condition called serotonin syndrome. This presents with elevated body temperature, high blood pressure, intense tremors, and muscle rigidity, severe diarrhea and dehydration, altered mentation, and life-threatening arrhythmias.
  • Paxil and Linezolid: This combination also causes serotonin syndrome, with its attendant complications such as irregular heartbeat and coma.
  • Paroxetine and Pimozide: Taking both drugs together slows down how the body metabolizes Pimozide, causing it to accumulate in the body to potentially dangerous levels. This results in life-threatening irregular heart rhythms, which may cause death.
  • Seroxat and Thioridazine: A combination of these drugs slow down the metabolism and elimination of Thioridazine from the body, causing it to accumulate. High levels of Thioridazine causes life-threatening irregular heartbeat.
  • Paxil and Fenfluramine/Dexfenfluramine: Using both drugs together also causes serotonin syndrome.
  • Seroxat and Fentanyl: Fentanyl is an extremely dangerous drug itself, but in combination with Pexeva has a small risk of causing serotonin syndrome.

Serious Paroxetine Interactions

Taking Seroxat in any of the following combinations has a potential for causing serious interactions. Therefore, one may either use it under strict supervision and monitoring by doctors or use an alternative medicine altogether.

  • Paxil and Metoclopramide: Using these drugs together can cause serious muscle and movement disorders such as muscle spasms, tremors, and tardive dyskinesia, in which muscles in certain parts of the body – especially the face – become stiff and jerk uncontrollably.
  • Paxil and Tamoxifen: Using Paroxetine with this breast cancer treatment drug reduces its anticancer effect by impairing how the body activates it.
  • Seroxat and Aripiprazole: Using both drugs together reduces the metabolism and elimination of Aripiprazole from the body, amplifying its side effects; such as restlessness, involuntary muscle jerking, and excessive sweating.
  • Paroxetine and Quinidine: Taking Seroxat and Quinidine slows down how the liver metabolizes Quinidine, causing it to accumulate in the body. This may amplify Quinidine’s side effects and also trigger serotonin syndrome.
  • Paroxetine and Trazodone: Using this Trazodone and Paxil together can cause serotonin syndrome. Besides, such combination also impairs the metabolism of both medicines, aggravating adverse effects of both of them. This may even worsen the usual Paxil weight gain effect in patients that use it.
  • Seroxat and Meperidine: A combination with Meperidine can cause a significant rise in serotonin levels in the body, potentially causing serotonin syndrome.
  • Seroxat and Warfarin: Combining both medicines may increase the risk of bleeding. This occurs because Seroxat slows down how the liver metabolizes and processes Warfarin, causing it to stay longer in the system. This leads to a more prolonged and more profound blood-thinning effect of Warfarin.
  • Paroxetine and Wellbutrin: Wellbutrin vs. Paxil are drugs that are commonly compared. Some people believe that it is safe to use them together to enhance the effect. However, such a combination increases the risk of causing a serious interaction. This is because Bupropion inhibits the breakdown of Seroxat in the liver, prolonging its stay in the system. This produces more than usual side effects, from even a small dose of Paxil 10mg.

two different medications interacting

Moderate Interactions With Paxil

These interactions cause minimally to moderately clinically effects. However, a combination of these drugs may be used if the risk can be minimized or if benefits outweigh potential risks. A small dose may not elicit these effects, but if the drug is taken in large doses, such as to achieve a Paxil high feeling, these interactions may be worse.

  • Paxil and Aspirin: Using Paroxetine with aspirin may increase the risk of bleeding.
  • Paroxetine and Pravastatin: Using Paroxetine with Pravastatin may cause impaired glucose control, which may interfere with the treatment of diabetes or increase one’s risk of diabetes.
  • Paroxetine and Adderall: Paroxetine may exacerbate the side effects of amphetamines, including anxiety, restlessness, jitteriness, and tremors. Besides, this combination also has a risk of causing serotonin syndrome.
  • Paroxetine and Oxycodone: When combined with Oxycodone, Seroxat blocks its metabolism, potentially reducing the analgesic effects of Oxycodone.
  • Seroxat and Tramadol: Tramadol and Paxil, when used together, may result in high serotonin levels in the body, causing serotonin syndrome.

Paxil Interactions With Alcohol

Mixing Paxil and alcohol has several adverse effects, and that’s because of the link between both substances: Seroxat is used in the treatment of alcohol dependence and withdrawal. However, alcohol increases the side effects of Paxil, causing severe dizziness and drowsiness, depressed mood, impaired judgment, and increased suicidal tendencies. These may lead to alcohol relapse and an increased risk of overdosing on alcohol.

Rarely, combining both substances can lead to new-onset alcohol dependence, in which case, an individual who was never an alcoholic becomes one. But this is often transient and stops when the individual discontinues Paroxetine. Also, using paroxetine and alcohol reduces compliance with the drug, which may lead to Paxil discontinuation syndrome when users stop its use abruptly.

Generally, patients are strongly advised to avoid alcohol drinking on Paxil.

Interactions With Food

Seroxat may interact with certain foods and drinks, such as citrus fruits (such as grapefruits), St. John’s wort, and tyramine-rich foods.

  • Citrus fruits: Paroxetine is metabolized by the CYP 2D6 system of enzymes in the liver, and these enzymes also break down grapefruit. Therefore, grapefruit may decrease how fast the liver metabolizes it, increasing Paxil half-life. This may cause potentially life-threatening toxic features.
  • St. John’s wort: This is a common Paroxetine herbal interaction. Using Seroxat with St. John’s wort often causes mild-to-moderate symptoms such as nausea, dizziness, fatigue, and lethargy.
  • Tyramine-rich foods such as cheese, chocolate, milk, chicken liver, soybeans, avocadoes, and bananas should not be eating while on paroxetine because of the potential for a synergistic effect in increasing serotonin levels in the body. This may lead to serotonin syndrome.

grapefruit and pills interaction

Paxil Interactions With Weed

Although an adverse interaction is relatively rare with a combination of Paxil and weed, however, case reports have created speculations that taking Paroxetine with weed may cause hypomania, a condition characterized by less severe symptoms of mania.

In addition, using Paxil and marijuana concurrently may make it difficult for a doctor to evaluate the efficacy of the drug in the presence of another mood-altering substance such as weed.

Preventing Adverse Drug Interactions

It is important that one follows prescription instructions regarding the use and administration of Seroxat. Also, read the prescription label to get more information about potential interactions with the drug. In the event that a patient has another prescription drug or would like to use an over-the-counter medication to treat another condition while using Seroxat, it is imperative to consult a doctor first.

Note that combining drugs to increase their recreational potential is the alarming sign of developing an addiction. Contact the drug rehab center professionals to find out if the situation is still under control. In some cases, drug abuse treatment may be required.

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Published on: May 23rd, 2019

Updated on: June 3rd, 2020

About Author

Roger Weiss, MD

Dr. Roger Weiss is a practicing mental health specialist at the hospital. Dr. Weiss combines his clinical practice and medical writing career since 2009. Apart from these activities, Dr. Weiss also delivers lectures for youth, former addicts, and everyone interested in topics such as substance abuse and treatment.


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