Drug interactions
Atomoxetine + Paroxetine
Severity: Major
Atomoxetine and Paroxetine: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Paroxetine strongly inhibits CYP2D6, the main enzyme clearing atomoxetine, leading to several-fold higher atomoxetine exposure. This increases the risk of adverse effects such as raised heart rate and blood pressure, insomnia and irritability.
What this interaction means in plain words
Atomoxetine and Paroxetine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Atomoxetine belongs to Central Nervous System; Paroxetine belongs to Central Nervous System.
Why it happens
Strong CYP2D6 inhibition by paroxetine reduces atomoxetine clearance.
What to do
Start atomoxetine at a reduced dose and titrate slowly according to tolerability. Monitor heart rate and blood pressure.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Paroxetine
- Isocarboxazid + Paroxetine Contraindicated
- Methylene blue + Paroxetine Contraindicated
- Paroxetine + Phenelzine Contraindicated
- Paroxetine + Pimozide Contraindicated
- Paroxetine + Procarbazine Contraindicated
- Paroxetine + Selegiline Contraindicated
Other interactions of Atomoxetine
- Atomoxetine + Isocarboxazid Contraindicated
- Atomoxetine + Linezolid Contraindicated
- Atomoxetine + Phenelzine Contraindicated
- Atomoxetine + Procarbazine Contraindicated
- Atomoxetine + Rasagiline Contraindicated
- Atomoxetine + Selegiline Contraindicated
Frequently asked questions
Can I take Atomoxetine with Paroxetine?
MediHelp rates the interaction as major. Atomoxetine and Paroxetine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Paroxetine strongly inhibits CYP2D6, the main enzyme clearing atomoxetine, leading to several-fold higher atomoxetine exposure. This increases the risk of adverse effects such as raised heart rate and blood pressure, insomnia and irritability.
How serious is the interaction between Atomoxetine and Paroxetine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Start atomoxetine at a reduced dose and titrate slowly according to tolerability. Monitor heart rate and blood pressure.
What other medicines interact with Paroxetine?
MediHelp also lists interactions of Paroxetine with, for example, Isocarboxazid, Methylene blue, Phenelzine. The full list is on the Paroxetine page.
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