Paroxetine

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Paroxetine

Dos & Don'ts

Paroxetine

Paroxetine is a member of the selective serotonin reuptake inhibitor (SSRI) family of drugs used to treat people with depression.

Do…
  • Try ginkgo, as it may prevent sexual side effects SSRI drugs closely related to paroxetine have been known to cause sexual dysfunction that may be relieved by taking 240 mg per day of herbal Ginkgo biloba extract.
  • Ask your doctor to check your sodium status when using this medicine SSRI drugs, including paroxetine, have been reported to cause sodium depletion, especially in women, seniors, and patients using diuretics, so routine monitoring may be necessary.
Don't…
  • Take supplements that interact with paroxetine

    Taking St John’s wort, 5-HTP, and L-tryptophan with SSRIs may result in potentially dangerous drug interactions; therefore, they should be taken only under the supervision of a healthcare provider.

  • Drink alcohol This drug may cause dizziness or drowsiness, which may be intensified by alcohol, so avoid drinking alcohol during paroxetine therapy.

Interaction

Summary of Interactions with Vitamins, Herbs, & Foods

dnicon_Beneficial May Be Beneficial: Depletion or interference—This medication may deplete these substances from the body or interfere with how they work; extra intake may help replenish them.

Sodium
dnicon_Beneficial May Be Beneficial: Side effect reduction and/or prevention—These substances may help reduce the likelihood and/or severity of a potential side effect caused by the medication.

Ginkgo*
dnicon_Beneficial May Be Beneficial: Supportive interaction—These substances may help this medication work better.

none

dnicon_Avoid Avoid: Reduces drug effectiveness—When taking this medication, avoid these substances as they may decrease the medication's absorption and/or activity in the body.

none

dnicon_Avoid Avoid: Adverse interaction—When taking this medication, avoid these substances, as the combination may cause undesirable or dangerous interactions.

5-HTP*

L-Tryptophan*

St. John’s Wort*
dnicon_Check Check: Explanation needed—When taking this medication, read the article details and discuss them with your doctor or pharmacist before taking these substances.

none


An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions Details

Interactions with Vitamins

5-Hydroxytryptophan (5-HTP) and L-trytophan

Paroxetine increases serotonin activity in the brain. 5-HTP and L-tryptophan are converted to serotonin in the brain, and taking either of these compounds with paroxetine may increase paroxetine-induced side effects. Dietary supplements of L-tryptophan (available only by prescriptions from special compounding pharmacists) taken with paroxetine caused headache, sweating, dizziness, agitation, restlessness, nausea, vomiting, and other symptoms.1 Some doctors have used small amounts of L-tryptophan in combination with SSRIs, to increase the effectiveness of the latter. However, because of the potential for side effects, 5-HTP and L-tryptophan should never be taken in combination with paroxetine or other SSRIs, unless the combination is being closely monitored by a doctor. Foods rich in L-tryptophan do not appear to interact with paroxtine or other SSRIs.

On the other hand, the combination of 45 mg DL-tryptophan (a synthetic variation of L-tryptophan) per pound of body weight (a relatively high dose) with zimelidine, a drug with a similar action to paroxetine, did not cause these side effects in another trial.2

Sodium

SSRI drugs, including paroxetine, have been reported to cause sodium depletion.3 , 4 , 5 The risk for SSRI-induced sodium depletion appears to be increased during the first few weeks of treatment in women, the elderly, and patients also using diuretics. Doctors prescribing SSRI drugs, including paroxetine, should monitor their patients for signs of sodium depletion.

Interactions with Herbs

Ginkgo biloba

In three men and two women treated with fluoxetine or sertraline (SSRI drugs closely related to paroxetine) for depression who experienced sexual dysfunction, addition of Ginkgo biloba extract (GBE) in the amount of 240 mg per day effectively reversed the sexual dysfunction.6 This makes sense because ginkgo has been reported to help men with some forms of erectile dysfunction.7

St. John’s wort  (Hypericum perforatum)

One report described a case of serotonin syndrome in a patient who took St. John’s wort and trazodone, a weak SSRI drug.8 The patient reportedly experienced mental confusion, muscle twitching, sweating, flushing, and ataxia. In another case, a patient experienced grogginess, lethargy, nausea, weakness, and fatigue after taking one dose of paroxetine after ten days of St. John’s wort use.9

Interactions with Foods & Other Compounds

Food

Paroxetine may be taken with or without food.10

Alcohol

SSRI drugs, including paroxetine, may cause dizziness or drowsiness.11 Alcohol may intensify these effects and increase the risk of accidental injury. Alcohol should be avoided during paroxetine therapy.

Brands

Common brand names:

Paxil, Paxil CR

References

1. Threlkeld DS, ed. Central Nervous System Drugs, Antidepressants, Selective Serotonin Reuptake Inhibitors. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1997, 264q–4r.

2. Walinder J, Carlsson A, Persson R. 5-HT reuptake inhibitors plus tryptophan in endogenous depression. Acta Psych Scand Suppl 1981;290:179–90.

3. Spigset O, Hedenmalm K, Mortimer O. Hyponatremia as a side effect of serotonin uptake inhibitors. Lakartidningen 1998;95:3537–9 [Swedish].

4. Strachan J, Shepherd J. Hyponatraemia associated with the use of selective serotonin re-uptake inhibitors. Aust N Z J Psychiatry 1998;32:295–8.

5. Bouman WP, Pinner G, Johnson H. Incidence of selective serotonin reuptake inhibitor (SSRI) induced hyponatraemia due to the syndrome of antidiuretic hormone (SIADH) secretion in the elderly. Int J Geriatr Psychiatry 1998;13:12–5.

6. Cohen AJ. Long term safety and efficacy of Ginkgo biloba extract in the treatment of anti-depressant-induced sexual dysfunction. Psychiatry On-Line http://www.priory.com/ginkgo.html.

7. Sohn M, Sikora R. Ginkgo biloba extract in the therapy of erectile dysfunction. J Sex Educ Ther 1991;17:53–61.

8. Demott K. St. John’s wort tied to serotonin syndrome. Clinical Psychiatry News 1998;26:28.

9. Gordon JB. SSRIs and St. John’s Wort: possible toxicity? Am Fam Physician 1998;57:950.

10. Nemeroff CB. Paroxetine: an overview of the efficacy and safety of a new selective serotonin reuptake inhibitor in the treatment of depression. J Clin Psychopharmacol 1993;13(6 suppl 2):10S–7S [review].

11. Threlkeld DS, ed. Central Nervous System Drugs, Antidepressants, Selective Serotonin Reuptake Inhibitors. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1997, 264q–4r.

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