Drug interactions
Paroxetine + Trimipramine
Severity: Major
Paroxetine and Trimipramine: 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 can markedly raise tricyclic concentrations and toxicity. The combination also adds serotonergic effects, increasing serotonin syndrome risk.
What this interaction means in plain words
Paroxetine and Trimipramine 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 belongs to Central Nervous System; Trimipramine belongs to Central Nervous System.
Why it happens
Potent CYP2D6 inhibition by paroxetine reduces trimipramine clearance, with additive serotonergic effects.
What to do
Avoid the combination where possible. If it is used, give a much lower tricyclic dose, monitor plasma levels and the ECG, and watch for anticholinergic and serotonergic 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 Trimipramine
- Disopyramide + Trimipramine Contraindicated
- Dofetilide + Trimipramine Contraindicated
- Ibutilide + Trimipramine Contraindicated
- Isocarboxazid + Trimipramine Contraindicated
- Pentamidine + Trimipramine Contraindicated
- Phenelzine + Trimipramine 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 Paroxetine with Trimipramine?
MediHelp rates the interaction as major. Paroxetine and Trimipramine 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 can markedly raise tricyclic concentrations and toxicity. The combination also adds serotonergic effects, increasing serotonin syndrome risk.
How serious is the interaction between Paroxetine and Trimipramine?
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 it is used, give a much lower tricyclic dose, monitor plasma levels and the ECG, and watch for anticholinergic and serotonergic toxicity.
What other medicines interact with Trimipramine?
MediHelp also lists interactions of Trimipramine with, for example, Disopyramide, Dofetilide, Ibutilide. The full list is on the Trimipramine page.
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