Drug interactions
Maprotiline + Paroxetine
Severity: Major
Maprotiline 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 strongly inhibits CYP2D6, which is the main route of maprotiline metabolism, so maprotiline concentrations can rise considerably. This raises the risk of seizures, QT prolongation, anticholinergic effects and serotonin toxicity.
What this interaction means in plain words
Maprotiline 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.
Maprotiline belongs to Central Nervous System; Paroxetine belongs to Central Nervous System.
Why it happens
CYP2D6 inhibition by paroxetine reduces maprotiline clearance, combined with additive serotonergic and seizure-threshold-lowering effects.
What to do
Avoid the combination where possible. If used, start maprotiline at a low dose, titrate cautiously, and monitor for serotonin syndrome, seizures and ECG changes.
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 Maprotiline
- Arsenic trioxide + Maprotiline Contraindicated
- Disopyramide + Maprotiline Contraindicated
- Dofetilide + Maprotiline Contraindicated
- Ibutilide + Maprotiline Contraindicated
- Isocarboxazid + Maprotiline Contraindicated
- Maprotiline + Methylene blue 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 Maprotiline with Paroxetine?
MediHelp rates the interaction as major. Maprotiline 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, which is the main route of maprotiline metabolism, so maprotiline concentrations can rise considerably. This raises the risk of seizures, QT prolongation, anticholinergic effects and serotonin toxicity.
How serious is the interaction between Maprotiline 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 the combination where possible. If used, start maprotiline at a low dose, titrate cautiously, and monitor for serotonin syndrome, seizures and ECG changes.
What other medicines interact with Maprotiline?
MediHelp also lists interactions of Maprotiline with, for example, Arsenic trioxide, Disopyramide, Dofetilide. The full list is on the Maprotiline page.
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