Drug interactions
Metoprolol + Paroxetine
Severity: Major
Metoprolol 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 metoprolol, and raises metoprolol exposure several-fold. This can cause pronounced bradycardia, hypotension and loss of beta-1 selectivity.
What this interaction means in plain words
Metoprolol 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.
Metoprolol belongs to Cardiovascular; Paroxetine belongs to Central Nervous System.
Why it happens
Paroxetine inhibits CYP2D6, reducing the metabolism of metoprolol and increasing its plasma concentrations.
What to do
Monitor heart rate and blood pressure and reduce the metoprolol dose when starting or increasing paroxetine. Consider an antidepressant with less CYP2D6 inhibition, such as sertraline in low doses or escitalopram, or a beta-blocker not dependent on CYP2D6.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Metoprolol and Paroxetine, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Metoprolol
- Metoprolol + Thioridazine Contraindicated
- Amifostine + Metoprolol Major
- Amiodarone + Metoprolol Major
- Atenolol-chlorthalidone + Metoprolol Major
- Atenolol + Metoprolol Major
- Betaxolol + Metoprolol Major
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 Metoprolol with Paroxetine?
MediHelp rates the interaction as major. Metoprolol 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 metoprolol, and raises metoprolol exposure several-fold. This can cause pronounced bradycardia, hypotension and loss of beta-1 selectivity.
How serious is the interaction between Metoprolol 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 heart rate and blood pressure and reduce the metoprolol dose when starting or increasing paroxetine. Consider an antidepressant with less CYP2D6 inhibition, such as sertraline in low doses or escitalopram, or a beta-blocker not dependent on CYP2D6.
What other medicines interact with Metoprolol?
MediHelp also lists interactions of Metoprolol with, for example, Thioridazine, Amifostine, Amiodarone. The full list is on the Metoprolol page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
