Drug interactions
Paroxetine + Perhexiline
Severity: Major
Paroxetine and Perhexiline: 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
Perhexiline is cleared mainly by CYP2D6 and has a narrow therapeutic range. Paroxetine strongly inhibits CYP2D6 and can markedly raise perhexiline concentrations, risking hepatotoxicity, neuropathy, hypoglycemia and ataxia.
What this interaction means in plain words
Paroxetine and Perhexiline 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.
Why it happens
Paroxetine inhibits CYP2D6, reducing perhexiline metabolism.
What to do
Avoid if possible; otherwise reduce the perhexiline dose and monitor plasma perhexiline concentrations and liver function closely.
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 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 Paroxetine with Perhexiline?
MediHelp rates the interaction as major. Paroxetine and Perhexiline 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. Perhexiline is cleared mainly by CYP2D6 and has a narrow therapeutic range. Paroxetine strongly inhibits CYP2D6 and can markedly raise perhexiline concentrations, risking hepatotoxicity, neuropathy, hypoglycemia and ataxia.
How serious is the interaction between Paroxetine and Perhexiline?
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; otherwise reduce the perhexiline dose and monitor plasma perhexiline concentrations and liver function closely.
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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