Drug interactions
Imipramine + Paroxetine
Severity: Major
Imipramine and Paroxetine: major interaction.
Last updated
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 markedly raises imipramine and desipramine concentrations, risking tricyclic toxicity including arrhythmias and seizures. Additive serotonergic effects also raise the risk of serotonin syndrome.
What this interaction means in plain words
Imipramine 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.
Imipramine belongs to Central Nervous System; Paroxetine belongs to Central Nervous System.
Why it happens
Potent CYP2D6 inhibition by paroxetine plus additive serotonin reuptake inhibition.
What to do
Avoid if possible; if combined, use a much lower imipramine dose guided by plasma levels and monitor ECG and for serotonin toxicity.
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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Other interactions of Imipramine
- Dronedarone + Imipramine Contraindicated
- Imipramine + Isocarboxazid Contraindicated
- Imipramine + Phenelzine Contraindicated
- Imipramine + Pimozide Contraindicated
- Imipramine + Rasagiline Contraindicated
- Imipramine + Safinamide 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 Imipramine with Paroxetine?
MediHelp rates the interaction as major. Imipramine 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 markedly raises imipramine and desipramine concentrations, risking tricyclic toxicity including arrhythmias and seizures. Additive serotonergic effects also raise the risk of serotonin syndrome.
How serious is the interaction between Imipramine 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: Avoid if possible; if combined, use a much lower imipramine dose guided by plasma levels and monitor ECG and for serotonin toxicity.
What other medicines interact with Imipramine?
MediHelp also lists interactions of Imipramine with, for example, Dronedarone, Isocarboxazid, Phenelzine. The full list is on the Imipramine page.
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