Drug interactions
Flecainide + Paroxetine
Severity: Major
Flecainide 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 is a potent CYP2D6 inhibitor and can substantially raise flecainide concentrations. Higher levels may cause conduction slowing, QRS widening and ventricular arrhythmias.
What this interaction means in plain words
Flecainide 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.
Flecainide belongs to Cardiovascular; Paroxetine belongs to Central Nervous System.
Why it happens
Inhibition of CYP2D6-mediated flecainide metabolism, increasing flecainide exposure.
What to do
Monitor ECG (PR and QRS) and flecainide plasma levels, and reduce the flecainide dose accordingly. Prefer an antidepressant with weak CYP2D6 inhibition, such as mirtazapine or citalopram-class alternatives, as appropriate.
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 Flecainide
- Flecainide + Nirmatrelvir Contraindicated
- Flecainide + Nirmatrelvir / ritonavir Contraindicated
- Flecainide + Pimozide Contraindicated
- Flecainide + Ritonavir Contraindicated
- Flecainide + Thioridazine Contraindicated
- Flecainide + Tipranavir Contraindicated
Other interactions of Paroxetine
- Isocarboxazid + Paroxetine Contraindicated
- Methylene blue + Paroxetine Contraindicated
- Paroxetine + Phenelzine Contraindicated
- Paroxetine + Pimozide Contraindicated
- Paroxetine + Procarbazine Contraindicated
- Paroxetine + Selegiline Contraindicated
Frequently asked questions
Can I take Flecainide with Paroxetine?
MediHelp rates the interaction as major. Flecainide 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 is a potent CYP2D6 inhibitor and can substantially raise flecainide concentrations. Higher levels may cause conduction slowing, QRS widening and ventricular arrhythmias.
How serious is the interaction between Flecainide 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: Monitor ECG (PR and QRS) and flecainide plasma levels, and reduce the flecainide dose accordingly. Prefer an antidepressant with weak CYP2D6 inhibition, such as mirtazapine or citalopram-class alternatives, as appropriate.
What other medicines interact with Flecainide?
MediHelp also lists interactions of Flecainide with, for example, Nirmatrelvir, Nirmatrelvir / ritonavir, Pimozide. The full list is on the Flecainide page.
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